The collapse of national health systems in the wake of the Ebola outbreak in west Africa has resulted in a significant reduction in routine vaccination activities. In Montserrado County, Liberia, Doctors Without Borders/Médecins Sans Frontières (MSF) recently conducted a measles vaccination campaign with adapted safety protocols. Here, Philippe Le Vaillant, MSF representative in Liberia, discusses the need for an increase in vaccination coverage while rebuilding confidence in medical services.
How did the Ebola epidemic affect the routine vaccination of children in Liberia?
Like every other medical service in the country, the Ebola outbreak has significantly reduced vaccination activities, too. The Liberian authorities reported that the number of children vaccinated monthly had dropped by 60 percent at the end of 2014. Measles vaccination coverage also fell, to 58 percent, while the minimum acceptable level should be at least 80 percent to protect against the virus. As of January, an estimated 92,000 children below one year old in Liberia had not been vaccinated at all and are therefore today vulnerable to various preventable childhood diseases.
Have immunization activities resumed since the drop in new Ebola cases in Liberia?
In Monrovia, the majority of health facilities have reopened and most of them are able to provide routine immunization. But health workers first need reassurance before performing injections, as contact with blood is one of the main risks of contamination. People are also still afraid to seek care in medical facilities. One of our priorities is to overcome the loss of confidence in the health system, of both health care workers and patients, through training and community awareness.
A recent publication suggests that a massive regional measles outbreak might occur due to lower coverage rates. How likely is this to happen?
A measles outbreak had actually been declared in January 2014 in Conakry, Guinea, just before the Ebola epidemic began. At the start of March this year, MSF teams recorded approximately 180 measles cases in the Liberian capital city. Beyond figures and forecasts, it is essential to reinforce surveillance and investigation of suspected cases, while restoring higher vaccination coverage is urgently needed.
What exactly is MSF doing to provide vaccinations and care for those suffering from measles in Liberia?
In Montserrado County, MSF has supported health centers with donations and training, such as [on] how to isolate and care for infected children. We are also working with the Liberian health authorities and their partners to reinforce surveillance and mapping.
On March 18 and 19, our teams performed a two-day measles vaccination campaign in Peace Island. This Monrovian neighborhood had reported the highest number of measles cases. Five hundred children aged six months to five years have since been vaccinated. Reinforced infection prevention protocols were implemented during this campaign, including systematic fever screening and a medical questionnaire, disinfecting gloves between every injection, [and] shorter waiting lines, amongst others. Our objective was also to show that it is possible to safely vaccinate in an Ebola context.
We expect that the lessons learned from this limited pilot campaign will now help [with] organizing the mass vaccination the Liberian authorities have planned for this May. Ideally we would also immunize the children against other pathologies (polio, tetanus, diphtheria, pertussis, et cetera) and distribute vitamin A as well as preventive treatment against malaria, especially with the rainy season about to start. So far in this outbreak, the risk of contamination with Ebola excluded the possibility to vaccinate. Hopefully that is changing.