By John James
Already devastated by the Ebola epidemic, Sierra Leone has seen vaccination rates drop as campaigns are postponed and people avoid medical facilities for fear of the deadly virus.
FREETOWN, Sierra Leone, 3 November 2014 – These days in Sierra Leone, most people do all they can to stay clear of hospitals and health centres, where those infected with Ebola virus are being sheltered and treated. It may be an understandable response to a deadly epidemic, but the wider health impact of such fears is already being felt, most notably in the steep decline in vaccinations.
National immunization rates for the pentavalent vaccine for diphtheria, whooping cough, tetanus, haemophilus influenza and hepatitis B were above the target of 90 per cent until August, when they started dropping significantly.
“The drop in vaccination levels is really worrying and really undermines the work we’ve been doing over the past few years,” says Yaron Wolman, Chief of Child Survival and Development with UNICEF Sierra Leone. “Children are now exposed not just to the Ebola virus, but also to other devastating illnesses like measles, Rota virus and yellow fever, while polio may be lurking in the corner.”
Big drop
The first Ebola deaths in Sierra Leone were confirmed 26 May. Comparing pentavalent vaccination rates for the period March–May and June–August shows a drop in almost every district, and a rise in only one: Koinadugu, also the last to register an Ebola case, in October.
For measles, vaccination rates dropped from 99 per cent in January to 76 per cent in July.
Parents hoping to get their children vaccinated also seem to be changing their approach. At the tiny vaccination post next to the Government’s Central Medical Stores in Freetown, a group of five mothers line up under the blazing sun to vaccinate their newborns, whose cries blend with the dogs barking and the local music shack blaring messages on Ebola.
Queues at this post were once a rare sight, but the nearby Kingharman Road Government Hospital and George Brook Community Health Centre have closed their doors because of an Ebola infection of health workers there.
“Since the outbreak started in May, mothers have been procrastinating about visiting hospitals due to the fear of being infected by the disease,” said one of the nurses at the vaccination post, who didn’t want to give her name. She says she’s afraid of Ebola, but confesses she’s forgotten to use the protective face mask. She uses a plastic apron as well as gloves.
“I try to change my gloves with every child attended,” she says. “But with the workload it’s easy to lose track.”
Campaigns suspended
The World Health Organization (WHO) guidelines for immunization programmes during the Ebola outbreak advise against vaccination campaigns, because of the threat of Ebola transmission. For clinics and health centres, they recommend protective gloves are worn and changed for each patient receiving vaccinations, and they call for strict hand hygiene.
In Sierra Leone, mass vaccination campaigns have already been suspended, and UNICEF is working to provide basic protection kits to vaccinators in the coming months.
Inside the Central Medical Store centre, regular vaccination for babies continues. The babies are weighed and then receive the polio vaccine and BCG vaccine for tuberculosis. Since the outbreak of Ebola, however, their temperature is no longer taken: “We do not have an infra-red thermometers, and we do not want to use the usual one anymore,” says the nurse.
More supplies are being brought in by UNICEF, with support from the World Bank, the UK Department for International Development (DFID) and the European Union’s Humanitarian Aid and Civil Protection department (ECHO). On 10 October, the first shipment of Infection Prevention Control supplies and consumables for Primary Health Units arrived, including gloves, aprons, coveralls, goggles and face shields. These supplies are crucial for small clinics like the one at the Central Medical Stores to provide malaria treatment, antenatal care, postnatal care, HIV support, nutrition services and immunization.
The supplies are being distributed starting with Primary Health Units in the districts most affected by Ebola: Western Area, Port Loko, Bombali, Tonkolili, Moyamba and Bo.