Feature story |

Interview on strengthening the Expanded Programme on Immunisation: Lessons from Chad

MSF has been treating patients for malaria in the Moissala district of Chad for two years, but the team has also responded to outbreaks of contagious diseases such as measles and meningitis. These outbreaks continue to occur because in recent years, the national Expanded Programme on Immunisation (EPI) has suffered from neglect.

Florence Fermon, Head of MSF’s Vaccine Working Group, sets out her concerns about the lack of support for EPI within the country, which has led to continued outbreaks of disease and unnecessary loss of young lives:

What we are seeing in the country as a whole, and in Moissala in particular, is that the EPI has not been getting the support it needs from the Ministry of Health and its partners. There is competition for resources from a growing number of specific vaccination initiatives – including polio eradication, maternal and neonatal tetanus elimination, measles elimination, and the introduction of the new meningitis A vaccine.

Each of these individual vaccine initiatives conducts its own self-contained staff training programmes, funds its own vaccines and mobilises people to take part in the vaccination campaigns.

There is limited support in the country to reinforce EPI as a whole. A basic strategy to provide routine vaccination is not in place, by making sure for example that any eligible child receives their due vaccines at each contact with a health post. Another example in Moissala district is the absence of systematic vaccination at birth, when deliveries occur in a maternity ward. There are globally recommended policies to support this, but in Chad they have not been implemented. In fact, the last national EPI training in Chad took place as far back as 2004.

Moissala district provides clear illustration of this: the cold chain storage facilities are insufficient, and there isn’t even a cold chain officer in place. Should the cold chain break down, there is no technical support available in the district. And only minimal social mobilisation support is at hand to inform and encourage people to bring their children to be vaccinated.

As a result, we see many vulnerable pockets where people in this area are simply not being reached and immunised – either at all or fully. That is why, despite large scale vaccination campaigns in the country, we are still encountering persistent outbreaks of diseases such as measles and pertussis.

In January 2011, a nationwide measles vaccination campaign was launched. But although the incidence of measles has decreased in most districts, there are still around 300 – 400 new suspected cases of measles declared each week in some places. Clearly the campaign has failed to reach some of those who were targeted. Additionally, there hasn’t been an investigation to determine why these outbreaks continue so that we can implement an adequate response.

MSF is working with partners on a strategy to respond to this situation, and reverse this neglect specifically in Moissala district. The proposed strategy includes catch-up vaccination activities in the district for all children up to two years of age for all the basic antigens, and vaccination for all children up to five years of age for measles and yellow fever. Altogether, we hope to reach the target population in this area of more than 10,000 children.

Depending on support from our partners, we are also interested in introducing the pneumococcal conjugate vaccine, at present not included in the national programme, despite a high number of pneumococcal disease cases in the district. In addition, we propose to provide technical assistance to improve planning for the EPI system, support the improved functioning of the cold chain, as well as offering local training and suggestions for improved methods of managing waste.