Wira Rizki Ramadhan frowned and closed her eyes when her left arm was injected with measles-rubella (MR) vaccine. The 10-year-old girl was one of 89 students of SD Inpres Inti Lebo elementary school in Parigi Moutong District, Central Sulawesi Province, who was vaccinated in June 2022.
“I thought it would hurt, but it was okay,” Wira said after the injection. “Immunization is important so we can be healthier and protected.”
Wira is among more than 36 million children who are targeted by the National Child Immunization Month (BIAN), an initiative of the Government of Indonesia. Supported by WHO, UNICEF and other development partners, BIAN seeks to catch up on the lags of complete routine immunization coverage in children due to the COVID-19 pandemic. The programme aims to leave no child behind, so their future is safe from vaccine-preventable diseases. This will allow them to grow and develop optimally for their age.
In 2019, Indonesia managed to reach 93.7% complete vaccination coverage, but in both 2020 and 2021 it decreased to 84.2%. Various factors were responsible for this decline, including disruptions to the supply chain, activity restrictions, and overstretched health workers, causing suspension of some vaccination services at the peak of the pandemic.
When children’s routine immunization is not completed, they become individually and collectively vulnerable. They are at higher risk of vaccine-preventable diseases such as polio, diphtheria, pertussis, tetanus, Hepatitis B, Haemophilus influenzae type b, measles and rubella.
Persuading the parents
A 2020 survey by the MoH and UNICEF found that around half of parents and caregivers surveyed were reluctant to take their children to health care facilities over concerns of COVID-19 infection or low compliance with health protocols. Such reluctance is also common among parents in Central Sulawesi.
“I have tried to explain, but parents usually say their children have already completed their routine immunization. Some parents said if this is COVID-19 vaccine, don’t inject it to my children,” said Martinus, Immunization Officer of Parigi Primary Health Care (Puskesmas).
To ensure higher acceptance, BIAN emphasizes that children are administered routine immunization, not COVID-19 vaccine. The MoH also works hand in hand with the Ministry of Education (MoE), civil society organisations and development partners to promote and implement the programme.
“After we received the immunization schedule from Puskesmas, we gather the students in the morning to tell them about why we need BIAN and what the benefits are. Then, the students relayed the message to their parents,” said Dewi Sri Wahyuni, Principal of SD Inpres Inti Lebo.
“Not all parents could understand the message. We visited several of these parents at their homes and tried to persuade them to let their children be vaccinated. Other parents were also invited to school, so we can help them to understand,” Dewi explained the school’s methods of persuasion.
Martinus added, “For parents who refuse the immunization, I say this is not COVID-19 vaccine, but routine immunization we usually do each year. We have BIAN because during the pandemic, school students immunization month (BIAS) were not effective since students had to learn from home, so we need the BIAN programme as the substitute. Then, parents will tend to let their children get vaccinated.”
Faradilla, mother of three children in Palu City, the capital of Central Sulawesi Province, is among those parents who consented their beloved offspring to participate in BIAN. “I want my children to be healthy and safe from diseases such as measles and rubella. This is why I let them get vaccinated,” she said.
Her sons Moh. Fathir Ramadhan, 9-year-old, and Moh. Fahrul Hidayat, 11-year-old, received their shots at their elementary school, SDN 1 Baiya. Meanwhile, her youngest son Moh. Farouq Syabil, 7-year-old, was vaccinated in his kindergarten.
Support from local leaders
Heads of subnational governments also contribute to the efforts of BIAN implementation.
When the joint MoH-WHO team went to Central Sulawesi to monitor BIAN implementation in June 2022, Deputy Mayor of Palu City, dr Reny A. Lamadjido went along to one of the sites and promoted BIAN to the elementary school students.
“BIAN will give optimal protection so all children can be safe. Do you want to be protected?” she said in front of the SDN 1 Baiya students.
“Yes, we do!” the students replied loudly.
Just one day after the BIAN monitoring visit, the Deputy Mayor initiated a BIAN coordination meeting attended by all of Palu’s elementary school and kindergarten principals, heads of Puskesmas (primary health care centre), officials of the Education Office and chiefs of villages. The meeting sought to accelerate BIAN implementation in the city.
At the end of the meeting, participants concluded that daily coverage of BIAN should be reported directly to the Deputy Mayor, all village chiefs would participate in BIAN mobilization and socialization, and Puskesmas and schools would coordinate more closely to implement BIAN. In addition, the city government would map schools and areas with low coverage and slow progress for the Deputy Mayor’s follow up.
At the province level, governors have released policies to support BIAN. The Governor of Central Sulawesi, H. Rusdy Mastura, is among these governors. Signed on 23 May 2022, the Circular Letter of the Governor instructed governments of cities and regencies in the province to promote the programme, mobilise multi-sector actors, fund BIAN activities and report progress.
Currently, BIAN is in its first phase, with immunizations administered in 27 provinces on the islands of Sumatra, Kalimantan, Sulawesi, Nusa Tenggara, Maluku and Papua. The second phase for the remaining 7 provinces in Java and Bali will start in August 2022.
Source: World Health Organization