Interview with Dr Mahendra Sheth of UNICEF

Dr Mahendra Sheth is the head of health and nutrition for the UN Children’s Fund (UNICEF) in Ethiopia. He tells IRIN of the vital role immunisation campaigns play in saving children’s lives, and of the current measles vaccination campaign underway in the country. QUESTION: Why is it necessary to perform vaccination campaigns? ANSWER: Vaccination campaigns are important firstly to stop the disease transmission, secondly, to reduce the morbidity and mortality, and three it is the most cost effective way of preventing disease. If you get a disease it is much more costly to treat it. Q: Why are vaccination campaigns necessary when Ethiopia has a routine immunisation programme? A: If the routine immunisation programme was covering 95 percent of the population then there would be no need for the vaccination campaigns. But because the routine immunisation coverage is low, they need to have a vaccination campaign. Then there is poor infrastructure, poor road access and the rapid turnover of trained manpower within the health ministry. Finally a lack of sufficient resources. Q: What help is UNICEF offering to boost routine immunisation? A: We are working with the government and partner agencies like WHO [World Health Organisation] and NGO’s to improve routine immunisation. We are providing the vaccine and the injection materials. We provide training, operational costs, the equipment - with other partner agencies - to support individual regions and zones. If you ask if all the requirements are met, the answer is no - there is always less money available for routine immunisation and this is what we have to work out with donor agencies so we can improve the coverage. Q: What impact does the current drought in Ethiopia have on low immunisation coverage? A: A child is weakened; the body is weakened so the child is susceptible to all kinds of diseases, measles in particular. If a healthy child gets a disease it will probably not have the same effects as a child with malnutrition. A child with malnutrition may go blind due to Vitamin A deficiency, it may have other effects - like pneumonia infections which reduce the child’s chances of survival. Q: Are there any dangers associated with a mass vaccination? A: Well you do get sometimes adverse side effects from immunisation, but you have to look at the cost benefit and the balance. Here if you are looking at something in the region of 74,000 deaths per annum from measles, surely having a reaction for one in 100,000 or a million is acceptable. It is much better to take that small risk and vaccinate your children than to expose them to the big risk of getting the disease and then getting sick. Q: This is the third year you are doing a measles campaign. Will you come back in 2004, 2005? A: The plan is to do half the country this year if we get the budget, and half the country next year. At the same time you have to improve the routine immunisation because you cannot leave it up to our campaign. The situation we are facing right now means we might have to do a campaign once every three years. Q: Why does UNICEF feel the measles campaign is important? A: Measles kills a lot of children in Africa. If you take Ethiopia alone, it contributes to something like 50 percent of the mortality. That means it translates into something like 70,000 deaths. It causes blindness, it causes deafness, diarrhoea and infections that contribute to malnutrition. So we think prevention prevents blindness and other morbidity. Q: In terms of the campaign how many children are you expecting to reach? A: We hope we will reach at least 95 percent, because then you can have a disease interruption. If you immunise a sufficient number of children they create what is known as the herd immunity, that means an immunised child and a child who is not immunised both protect each other. There is a protection mechanism. So if we get 95 percent coverage then we will have achieved our target. Q: How quickly does measles spread? A: It spreads very fast. When you see one case of measles in a densely populated area, probably many of the other children are already infected. The symptoms take seven days to present themselves so in fact you are carrying the symptoms for seven days before anyone will know. Q: Why are children still dying from measles? A: The thing is if the routine immunisation was strong, which it is not, we would not be doing this today. We have enough vaccines and syringes and all the equipment, but so far only around 50 percent of the children are being reached nationally. If you take a region like Somali Region, only 10 percent of the children are being reached. This is mainly because the routine immunisation mothers do not come forward, lack of social mobilisation, lack of motivation by the health workers also and many other factors. But if we had 95 percent we would not be talking about a campaign today. It is very sad that children are dying from this, because they need not. The technology is in our hands and in developed countries the mortality is hardly anything, they just grow up with it sometimes. You hardly ever see measles. Despite what we have, we are still seeing many children dying and it is very cheap technology.