26 Apr Time to roll up and roll out: immunisation services in Somalia must be scaled up now
27 April 2021
By Joseph Seriki, Senior Technical Health Specialist, Somalia Country Office, Save the Children
Vaccines save lives. They’re one of the most successful and cost-effective health interventions, helping children survive, thrive and lead productive healthy lives as adults. For every dollar spent on immunisation, the return on investment is estimated to be $54 . According to Gavi, the Vaccine Alliance: “the increase in immunisation has helped halve childhood mortality by preventing more than 14 million future deaths and dramatically reducing the incidence of deadly and debilitating infectious diseases”.
Things are difficult in Somalia
In Somalia, decades of civil war and political unrest have contributed to an almost complete breakdown of the health system – with infrastructure destroyed, health workers put at risk, and communities left isolated and unable to access basic health services. This already precarious situation is exacerbated by the triple threats of drought, locust infestation and the COVID-19 pandemic.
Within this context – and in stark contrast with overall global progress on vaccines – in Somalia less than 11% of children aged 12–23 months are fully immunised and more than 60% have not received a single vaccine. A significant proportion of children who have no access to vaccinations live in communities that are hard to reach due to conflict or in newly liberated communities where basic health and immunisation services are not available.
Somali children dangerously exposed to pneumonia
Somalia has one of the highest under-five mortality rates in the world – 117 under-five deaths per 1,000 live births in 2019. 18% of these child deaths – 14,200 of the estimated 80,600 children who died in 2019 – were due to pneumonia, making it the single biggest killer of Somali children. Child pneumonia deaths in Somalia rose by 3% in the past decade. If this trend continues, for every 1,000 children born in 2030 in Somalia, 17 children will die from pneumonia; the global minimum standard is three.
And unless drastic measures are taken now to change the pneumonia trajectory, Somalia will not achieve the child mortality target in Sustainable Development Goal 3 – 25 deaths of children under five per 1,000 births – by 2030.
This is a severe crisis. The lack of an adequate immunisation programme with a routine immunisation package, and which includes high coverage of all the ‘pneumonia-fighting’ vaccines – pertussis, Hib, pneumococcal conjugate vaccine (PCV) and measles – is a glaring gap that needs urgent action. Currently, just 42% of Somali children are protected with three doses of the diphtheria, tetanus, pertussis (DTP) and Hib vaccines; 46% have received one dose of the measles vaccine; and no child has yet received any doses of the PCV. While this situation continues, Somali children are dangerously exposed to pneumonia.
What needs to be done
The global response to the COVID-19 pandemic has shown that when health is prioritised by governments and donors, it is possible to mobilise much needed resources to protect the health of all, especially the most vulnerable. Essential health services, good nutrition, and access to water, hygiene and sanitation must be strengthened and maintained during the COVID-19 pandemic to reduce the risk of secondary disease outbreaks and loss of life. Universal health coverage is no longer debatable. The pandemic has shown that it is a necessity. A strong health system will mean that children will not die from vaccine preventable diseases.
Dr Fawziya Abikar Nur, Somalia Minister for Health and Social Care, made a bold commitment at the first-ever Global Forum on Childhood Pneumonia in January 2020 to end child pneumonia deaths. But this commitment cannot be realised without explicit support from global health institutions, donors, and the international community to first and foremost build a strong routine immunisation programme, on the back of which the PCV and COVID-19 vaccines can also be rolled out.
Gavi’s decision to remove the eligibility criteria for new vaccines like PCV and rotavirus – which had previously required at least 70% coverage of the third dose of DTP – paves the way for their introduction in Somalia. This is not only critical for saving lives but contributes to strengthening cold chain and supportive systems to improve wider routine immunisation programmes.
Propping up a fragile health system
Since the onset of the pandemic, Save the Children has been working with the Ministry of Health, in partnership with UNICEF and WHO, to provide routine immunisation services and coordinate immunisation campaigns. The organisation has provided technical and logistical support, including:
- training staff
- supplying personal protective equipment for vaccinators, who do such vital and often arduous work
- trialling digital technology to train, coach, mentor and supervise frontline health workers
- engaging in awareness-raising campaigns with community groups.
Save the Children has also advocated with the government and with donors to increase investment in immunisation services and promoted the importance of the introduction of the PCV and rotavirus vaccine as part of the routine immunisation package.
Time to roll up and roll out
Somalia needs long term, sustainable solutions to reduce the number of child deaths from vaccine-preventable diseases, including pneumonia. As a matter of urgency, the country’s immunisation infrastructure and systems need to be strengthened to roll out routine immunisation, including new vaccines such as PCV, rotavirus and COVID-19 vaccines.
The challenge is clear and the danger all too real. COVID-19 threatens to reverse any progress Somalia has made.
Right now, donors must be bold. Building on what Gavi has already done, they must develop bespoke engagement plans with Somalia.
This is a moment of opportunity. Now is the time to act.
Every Breath Counts Recommendations
The Every Breath Counts Coalition calls on the Government of Somalia, in partnership with Gavi and other international health and development agencies, to:
- establish a timetable for the introduction of the PCV in the next 12 months
- ensure that routine childhood vaccination – with three doses of DTP and Hib, and two doses of measles – rises to above 80% by 2025 and to above 90% by 2030
- integrate the prevention, diagnosis and treatment, where appropriate, of child wasting services with vaccine delivery to protect the most vulnerable children