M&RI Supports Resumption of Immunization Program in Post-Ebola Liberia

More than half a million Liberian children have been vaccinated against measles in the country’s first major immunization campaign since last year’s outbreak of the Ebola Virus Disease (EVD).

The unprecedented EVD outbreak that began in Liberia in late 2014 killed more than 4,700 people and infected over 370 health workers, more than half of whom did not survive. It also severely disrupted the country’s health system, forcing the cancellation or postponement of a wide range of immunization activities. This included a follow-up measles vaccination campaign, originally scheduled for the 4th quarter of 2014, which was postponed on the advice of the World Health Organization amid fears it might exacerbate EVD transmission.

As such, at the height of the Ebola outbreak, measles immunization rates had dropped to a staggeringly low 16 per cent, opening up an immunization gap that measles—a virus far more contagious than Ebola—was quickly able to exploit. On average, a case of Ebola results in two new infections, whereas a person infected with measles can generate up to 18 new cases among susceptible persons.

The first cases of measles following the EVD outbreak showed up in December 2014, and within five months, 562 cases, including seven fatalities, had been reported nationwide. In response to the outbreak, the Measles and Rubella Initiative (M&RI)—together with partners including the Ministry of Health, GAVI – the Vaccine Alliance, the World Bank, and the United States Centers for Disease Control and Prevention (CDC)—began pre-positioning material, training healthcare workers, and preparing a robust advocacy and awareness drive for a measles immunization campaign to be launched as soon as the Ebola virus had been contained.

The nationwide measles immunization campaign was launched by the government in early May 2015, just days after Liberia had been declared Ebola-free. The 8-14 May campaign vaccinated more than 600,000 children who had missed routine immunization opportunities as a result of the EVD crisis. According to preliminary estimates, over 90 per cent of children under five years of age received measles vaccinations.

The measles campaign required a robust social mobilization and community engagement strategy to rebuild people’s confidence in immunization, dispel rumors, and address lingering concerns raised during the Ebola outbreak.

Dutch Hamilton, the UN Children’s Fund (UNICEF) Community Mobilization Coordinator in Liberia’s Bong County, said that fear and misinformation had been holding parents back from accessing essential health services.

“Liberians know about the importance of vaccinations for diseases like measles and polio, and before the Ebola crisis didn’t need convincing,” he said. “But now it’s different.”

The same extensive national, county and district level network of trained social mobilization staff and partners that responded to the EVD was key in driving the measles immunization campaign. More than 4,000 social mobilization personnel were deployed along with doctors, nurses, and other health officials. The campaign organized over 2,700 community meetings and reached more than 229,000 households with messages nationwide. A print, radio, and television drive complemented community discussions and door-to-door awareness raising.

In addition to Liberia, the M&RI is also working closely with the governments of Guinea and Sierra Leone to restart measles control and other immunization activities, strengthen case-based surveillance, and provide the financial and technical assistance necessary to ensure communities can regularly access essential vaccines to protect their children in a post-Ebola era.

Originally established as the Measles Initiative in 2001, the M&RI is a collaborative effort founded by the American Red Cross (ARC), the CDC, the United Nations Foundation (UNF), UNICEF, and the World Health Organization (WHO). The Measles & Rubella Initiative mobilizes resources, provides technical expertise, and assists with planning and implementation of quality supplementary campaigns.