Wednesday, January 26, 2022

Uganda Polio mass vaccination roll out: vaccine carriers, cults and health workers

About 270 health workers were trained to roll out the vaccination against Polio for six days in Arua City.

The Wild Polio 2 virus was detected from two samples last year at two sewage treatment sites. This type of polio can lead to permanent paralysis or even death in some cases.

Uganda was named free of Wild Polio 2 virus in 2015 and it was removed from the routine immunization schedule in 2016. As such the country doesn't store vaccines for it anymore. 

As a result the government through the Ministry of Health decided to roll out mass vaccination for children below five years targeting to vaccinate at least 8.7 million children, countrywide scheduled three days.

7.2 million children were targeted to be vaccinated by Monday 17, leaving a deficit of 1.5 million children yet to receive the vaccine. But due to limited vaccine carriers the Ministry of Health extended the date for the mass polio vaccination to Wednesday, 19th.

Vaccine carriers are insulated containers where vaccines are kept cold during transportation.

In Arua, City Health officials extended days for Polio vaccination over a shortage of vaccine carriers forcing health officials to conduct the campaign in two phases from Monday up to Wednesday.

According to Peter Aziku the Deputy Health Officer Arua City, they needed 890 cold boxes but they received 469. 

Aziku said they have decided to divide the health staff into two with the first one starting vaccination in the areas of Pajulu, Adumi, and Ayivuni all in Ayivu West while the second group of health workers will resume on Monday in the areas of Arua Hill, Oli Division, Oluko Dadamu, Manibe, and Aroi.

Pader district had a target of 50,777 children under five to be vaccinated but only 45,780 received the vaccine.

Justine Ocen the LCV Vice-Chairperson, said that the district received fewer vaccines because the Ministry of Health relied on the district report about the target population, yet the figure is now different. 

Ocen said the district is liaising with other neighboring districts to get vaccines and vaccinate the remaining children.

In Mukono district, the lack of medical workers stalled the polio vaccination campaign. The district dispatched 108 medical workers to carry out the exercise in the entire district with each parish receiving one medical worker. Mukono district target was to vaccinate 147, 000 children. 

Sarah Nassaka, a health worker said that during the previous mass vaccination exercises, four medical workers were allocated to Bagala zone but this time round only one was assigned for the polio vaccination.

Stephen Mulindwa, the District Health Officer-DHO advised parents with busy schedules to take their children to the district general hospital and health center IVs where were designated immunization centers and enough staff.

The issue of lack of vaccine carriers:

As the government rolled out the national mass polio vaccination, vaccine carriers stalled the process. The exercise which was slated to commence on Thursday January 13th, 2022, and end on Sunday, 16th January was extended for three more days. 

According to a Ministry of health survey carried out prior to commencement of the exercise only 24,000 cold chain carriers were available in the country. Hence, about 56,000 out of the 80,000 teams deployed to conduct the polio vaccination exercise nationwide didn’t get carriers to safely carry the vaccines. 

The ministry then used a staggered approach, where vaccination teams shared the carriers. Dr. Immaculate Ampaire, the deputy program manager of the Uganda National Expanded Programme on Immunization (UNEPI) said the campaign exposed the need of investing in door-to-door cold storage equipment. 

"When it comes to other cold storage equipment we are okay but we do not have enough vaccine carriers. In this ongoing campaign, we had a shortfall of over 50,000 and that is why districts were asked to do passed implementation," Ampaire said.

Extension of the campaign was a necessity and the Ministry of Health also halted COVID-19 vaccination from taking place to free up cold chain boxes that would otherwise have been used to store COVID-19 vaccines. 

The Health Ministry Spokesperson, Emmanuel Ainebyoona, said that the ministry is in the long term working towards increasing the capacity of cold chain storage equipment in the country. Recently the health ministry received equipment worth US$ 8.3million. 

Using the sub-country approach: 

As a means to reach all the children the government changed to a sub-county approach from the district approach. The door to door also consists of teams visiting each household and school which will achieve the target of reaching every child. 

On Friday, Luwero district embarked on the door-to-door immunization campaign against polio among children aged five years and below.  The district targeted to immunize 106,000 children within six days and 65 centers were gazetted to coordinate the campaign.

The health workers kicked off by immunizing children in daycare and nursery schools before they move door to do together with LCI Chairpersons.

According to preliminary data released by the immunization program, Busoga has emerged as the best performing region in this campaign with 484,809 children vaccinated followed by South Central with 450,260 children. 

Ampaire attributes Busoga's excellent performance to a change in the models used. Figures from the health ministry show that the region normally scores less than 50 percent vaccine coverage on average when it comes to routine immunization. 

“This time around we had a plan that catered for all parishes. We used village teams to move from one village to another and parish to parish. This helped us plan for all hard-to-reach areas like mountains, islands, and even some cities," she said.

"We are urging parents and school administrators to go and get children under five vaccinated. This vaccine was removed from the routine immunization schedule. We got resources from the Global Polio Eradication Initiative to carry out this campaign and parents must take up this opportunity," Ampaire said.

The health officials have also involved the cultural, religious, and local council leaders in addition to the VHTs to popularize the vaccination campaign. 

Hellen Alimo a Village Health Team-VHT Officer in Luwero said parents responded positively to the exercise although there was a challenge of inadequate health workers.

Ismail Tuku the Prime Minister of Lugbara Cultural Institution said the government should consider sharing polio vaccines with the Neighboring DRC and South Sudan because of the eminent polio risk in these countries.

Cult culture inhibit uptake of polio vaccines;

Luwero district health officials are facing a challenge to reach children of cult members that are against any form of immunization. Over 50 children could be affected.

When Luwero district embarked on the door-to-door immunization campaign, parents of children who belong to the Abajiri Christian cult in Luwero rejected it.  The families are spread at villages of Kakoola, Makokonyigo, Kikandwa, and Nakasejjere village in Kamira sub-county.

Local Leaders say the cult believes that the immunization campaign is satanic and a plan to enforce the new world order.

Abdullatif Serugo the LCI Chairman of Makokonyigo village said that during the registration of families whose children are eligible for immunization, 10 families that follow the cult in his area indicated that they won’t participate in the campaign and hence refused to volunteer any information.

He said that in the past parents have been arrested and jailed for rejecting government programs but this has not deterred their beliefs.

Ronald Mulumba the LCI Chairman of Nakasejjere village said that whenever cult followers learn about such campaigns, the children are hidden in makeshift houses in the swamps until the exercise ends.

Ponsiano Kabaale the LC 1 Chairperson of Kakoola village said he was secretly gathering information about the total number of children in the families and they intend to round them for immunization during their prayers on Saturday.

The Chairpersons have since asked the District Leadership to take up the matter and force the parents to surrender the children for immunization.

Doctor Innocent Nkonwa the Luwero District Health Officer said they were privy to information on the existence of the group and they intend to use security personnel to ensure they access children for immunization.

Erastus Kibirango the LCV Chairperson of Luwero said they would visit the villages to persuade and sensitize communities to participate in the campaign.

Sheikh Ramadhan Mulindwa the Chairperson of Inter-Religious Council in Luwero district said that immunization is not against religious faiths and parents should embrace it. It's believed that the followers of the cult have also shunned COVID 19 vaccination exercise.

In 2014, more than 300 followers of Abajiri cult in Luwero and Nakasongola districts fled their homes to evade arrest after rejecting the national population and housing census.

In 2010, the same cult followers were arrested and jailed for blocking their children from attending school but their attitude didn’t change. It is believed that they're over 500 followers of Bajiri cult in Luwero and Nakasongola districts. 


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