Anuradha Gupta, Deputy CEO of Gavi, the Vaccine Alliance
It was a rewarding experience to witness Indonesia’s President, Joko Widodo, decisively lead the country towards a historic milestone in their immunisation journey. On 1 August, with the First Lady and his ministerial colleagues by his side, he launched the country’s highly ambitious vaccination campaign, the world’s second largest supported by Gavi. Over the course of two years, the campaign aims to immunise 70 million children aged 9 months to 15 years with a new measles-rubella vaccine to intensify the country’s ongoing fight against highly contagious measles, that globally kills 15 children every one hour. Additionally, the new vaccine will protect against the debilitating Congenital Rubella Syndrome (CRS) which maims children with horrific life-long disabilities of brain, heart, vision and hearing.
It was fantastic to see President Widodo promising to the people of his country that measles will be eliminated in Indonesia by 2020 and his spontaneous rapport with the audience as he called a few children on to the stage and chatted with them to stress that vaccines are essential, safe and life-protecting. We all know high level political commitment is the most critical prerequisite of success for such a mammoth undertaking. But what more will it take for Indonesia to complete this gigantic task?
Indonesia faces a myriad of challenges posed by geography, urban migration and a large population spread over more than 17,000 islands, many of which are hard to reach. Nearly five million children are born every year and, notwithstanding ongoing government efforts to improve the programme, over one million children residing in remote islands and growing urban slums miss out on basic vaccines every year. As a result children in Indonesia still die of vaccine preventable diseases and measles outbreaks continue to occur, causing unnecessary suffering and death, as well as social and economic costs for families, communities and the country.
This measles-rubella campaign provides a rare opportunity to identify missed children and disease hotspots, and even to develop strategies to reach these populations more regularly in future with the full range of vaccines. But fulfilling this potential will require serious commitment and efforts to prioritise unreached children as a key measure of campaign success. In provinces such as Papua, where immunisation coverage has been historically low, achieving a campaign coverage rate of 95% is a daunting task and yet an imperative.
Why do I say this? First, look at the sheer numbers – 35 million children are expected to receive the measles-rubella vaccine during the campaign’s first phase held in the Java region from August to September 2017, spanning 3,569 public health centres in 119 districts and six provinces. The second phase, which will be conducted in August-September 2018, will cover another 35 million children and all other regions outside Java. Due to Indonesia’s geographical complexity, these areas will be much more difficult to reach and the campaign coverage climb will become much steeper. Success will demand massive mobilisation of not just financial, human resources and logistics, but also social mobilisation and seamless coordination among several government ministries, in particular health, education and religious affairs.
The target group consists of young children not yet in school as well as boys and girls aged 5-15, most of whom attend private or public schools. Active interest and participation of Indonesia’s Ministry of Education and Culture will be key. At the same time, the Ministry of Religious Affairs will play a fundamental role in addressing some of the vaccine-hesitancy issues and engaging with communities to promote the fact that vaccines are ‘halal’ – acceptable to religious tenets and essential for protection of children’s lives and health. It was very informative to witness first-hand the high level of enthusiasm among both teachers and students in some of the schools that we visited in the historical city of Yogyakarta, Indonesia’s cultural capital.
And why is reaching at least 95% of children consistently across districts so important? Because across countries, we have seen that children consistently missed by routine immunisation continue to be excluded from the reach of vaccination campaigns as well. Despite the fact that these children are at the highest risk of suffering and dying from disease, living as they do in impoverished and unsanitary conditions. Most often they do not have access to safe drinking water, basic sanitation, balanced nutrition, hygiene, education and the financial ability to access healthcare when diseases hit them. It is these children therefore who need the protection of vaccines most and must get them ahead of others. Further, vaccine coverage rates lower than 95% do not provide full herd immunity, and are an invitation to the deadly measles disease to strike and spread fast.
This campaign will help the children and people of Indonesia secure a healthy future, free from the scourge of measles, rubella and other vaccine preventable diseases. Gavi, my organisation, is proud to stand along with partners WHO, UNICEF, Lions International, International Federation of Red Cross and a galaxy of civil society and faith based organisations in the service of Indonesia, as it works to achieve these worthy goals. Congratulations to the President and people of Indonesia for being bold and ambitious!