Routine immunization for children in the Philippines: challenges and interventions

Dear editor,

Vaccines are critical in preventing and controlling various infectious diseases in all ages. At present, nearly 20 million infants do not receive an entire course of even basic vaccines, and still more miss out on newer vaccines. Of these, over 14 million children receive no vaccines despite the presence of immunization programs. Outbreaks of diseases like measles, diphtheria, and polio are clear reminders that effective immunization programs and efficient disease surveillance are essential for implementing routine immunization at high levels to eradicate diseases. It is in this situation that the World Health Organization, in its IA2030 global strategy program, targets to achieve the following: 90% coverage for essential vaccines given in childhood and adolescence, halving the number of children completely missing out on vaccines; and completing 500 national or subnational introductions of new or underutilized vaccines – such as those for COVID-19, rotavirus, or human papillomavirus (HPV). ¹

For routine vaccines to be effective, children must complete the required doses according to schedule from the time they are born until they are 1 year old. They also need to complete additional doses during supplementary or outbreak vaccination campaigns. Children who missed some of their routine vaccines should complete them during catch-up vaccinations. ² In the Philippines, routine immunization remains a big challenge. Even the country’s Department of Health (DOH) has an existent program since 1976 called the Philippine Expanded Program on Immunization, the coverage of basic vaccines has hovered at 70–80% in the past 30 years, which means that the program has never achieved its national target to immunize at least 95% of children fully. The most significant decline in immunization coverage occurred during the last decade (2008 to present). In 2014, immunization coverage declined to almost 65%, the lowest level since the early 1990s. ³ This low coverage resulted in measles and polio outbreaks in 2019, placing children at risk of these life-threatening diseases. Currently, the country’s immunization coverage is lower than most neighboring Asian countries.

Several challenges hinder the high success rate of routine immunization for children. First, while it is true that a massive campaign was launched, which includes a house-to-house strategy done by health workers for the vaccination, there is no follow-up when the vaccines are not available since they are in school. They usually visit homes during weekdays when children are not at home. Another type of vaccine will be offered for their next visit without having administered the missed doses of the previous vaccines. Second, since some public health centers are too remote, especially in provinces, some families find it difficult to visit one. Private hospitals and clinics offer the same vaccines, but these are too costly for some families who prefer buying food instead of the vaccines. Third, there is still a significant prevalence of vaccine hesitancy caused by the controversy surrounding Dengvaxia (Sanofi’s dengue vaccine) in 2017. This issue is one of the main reasons why COVID-19 vaccine rollout was low during the onset of the pandemic. Last, it results from supply-side systems issues related to leadership, planning, and the supply chain, leading to recurring vaccine stockouts in the past decade. ² This problem points out the lack/mismanaged vaccine supply rooted in incompetent leadership.

With these challenges, effective interventions are needed to address each issue. First, local health centers must design a strategic plan for following up regularly with those who miss the vaccination schedule. As much as possible, vaccinations must be done during weekends when children are mostly at home. This is where parents’ contact details must be obtained to monitor the availability of the vaccines. In this way, there is an assurance that the scheduled vaccination will materialize. Second, since accessibility is an issue in remote areas, more health centers and human resources are needed to reach more vaccines. There can be free transportation to vaccination sites. This plan requires an additional budget/funding to make it happen. The local government can also coordinate with administrators of private hospitals/clinics and offer agreements, such as tax exemptions and lesser amounts for services, to lessen the price of vaccines or give discounts. Third, vaccine hesitancy is a long-time issue in the country, and the possible way of addressing it is a regular massive information campaign regarding the safety and efficacy of vaccines. Since Filipinos are fond of social media, the DOH should optimize its use for this campaign. Last, the problems of vaccine supply, delivery, and importing can be addressed if there is an anticipatory prepared strategic plan that can provided by competent leaders. This is where a process of strict consultation is necessary to appoint DOH officials to perform their mandate accordingly. The virtues of excellence, credibility, and foresight must be the basic criteria for these appointees.

There may be more years to wait to achieve the target goal for a successful routine immunization for children in the country. However, with the interventions mentioned and the will to implement unconditionally these policies, it is always possible to succeed. After all, everyone cares for our children, especially regarding their safety and well-being.