Immunizing Nomadic People in Ethiopia

Due to the recent discussion about immunizations in class, I found this article from the World Health Organization very applicable. We have discussed the campaigns and case studies devoted to vaccinating children across the globe. The Expanded Programme on Immunization focuses on remote areas and populations with high mortality rates among children under 5. I recall one of the barriers to reaching herd immunity is the population of nomadic people. Since they are moving from one place to another, it becomes difficult to vaccinate their children.

Enter Ethiopia. Only 17% of its 91 million people live in urban areas. This data is evidence of the special effort needed to reach the remote populations, specifically nomadic populations in Afar. The region is also known as the Afar Depression, for its low sea-point level. The people of Afar must move around to find other sources of food and water for their livestock. Afar is also well-known for its low childhood immunization rates. DTP immunization rates for 1 year olds is far below the WHO Regional Average, at about 45% in 2010, compared with the 65% average. If DTP immunization rates are low, you can speculate that immunization rates for MMR and other diseases is also low. 

After a deadly outbreak of measles took place, officials decided to take action. The Enhanced Routine Immunization Activity previously accomplished success in immunizing nomadic families in Somali. Officials decided to replicate the same program to raise immunization rates in Afar. The program consisted of (1) partnering with local leaders, government and non-governmental organizations and international organizations like UNICEF (2) win local support (3) train health workers to administer vaccines (4) register children for immunization (5) home visits (6) coordinate adequate supplies.

The program took a total of 3 months, with immunizations traveling to the child instead of the child traveling to the immunization. Unfortunately, WHO did not provide any data or numbers showing the increased rates of immunization. Data may come at a later point in time. However, healthcare workers from the Afar health posts were interviewed and felt the campaign was an improvement from past efforts. Mobilizing local capacity was one of the most critical aspects of the campaign.

ERIA first began in Somalia. Officials believe the campaign was so successful in Somalia because of the support from community elders. Once the elder(s) in the tribe gives the approval and support for the vaccine, mothers and fathers are encouraged to vaccinate all of their children. However, it is not easy work for the healthcare workers that are delivering the immunizations. Most often, it takes hours of traveling to reach a village and there can be miles between houses. House-to-house immunization was the only way to ensure immunizations were received in this area.

It has been interesting to learn about the different methods to immunize large populations. As a public health program planner, you must take into consideration the way people live in each area. Somalia and Afar’s success may not translate to urban areas of China. National Immunization Days may not translate to areas like Afar, where families are moving from place to place. Proper planning and consideration is needed in this critical health issue.  

Reference: http://www.who.int/features/2012/immunization_ethiopia/en/index.html