The United Nations Children's Fund (UNICEF) expressed its concern as over one million children in the Philippines missed out their routine vaccine shots in 2021. UNICEF estimates that globally, 67 million children "missed out entirely or partially on routine immunization" between 2019 and 2021. These are vaccines against polio, measles, diphtheria, pertussis, tetanus, among others, said UNICEF Philippines Immunization Specialist Dr. Carla Orozco in a media forum on Tuesday, April. 25. In 2021 alone, at least 18 million children globally have not received a single dose of routine vaccines or the so-called “zero-dose children” and the Philippines ranked fifth globally with regards to this matter, said Orozco. “What are zero-dose children? These are children that have not received a single dose of vaccine by the time the child reaches one year old,” she said. India registered the highest number of zero-dose children with 2,711,000 followed by Nigeria with 2,247,000; Indonesia with 1,150,000; Ethiopia with 1,134,000 and the Philippines with 1,048,000. “In the East Asia and Pacific region where the Philippines belong, for 2021, Indonesia and Philippines are the major contributors to the high number of zero-dose children,” said Orozco. The top five regions in the country with the most zero-dose children are Calabarzon (146,160), Central Luzon (99,541), Western Visayas (96,774), Bicol (80,905) and the Bangsamoro Autonomous Region in Muslim Mindanao (75,671), UNICEF data showed. "The alarming number may result in possible outbreaks of vaccine-preventable diseases, disabilities, and even deaths of children," said Orozco. "There was a measles risk assessment done by the WHO (World Health Organization) and DOH (Department of Health) as well with support from UNICEF, in the 2022 measles risk assessment has shown that the whole country is really ripe for an outbreak. That was last year, So, we really advocated---WHO, UNICEF, DOH to really implement immediately supplemental immunization activity or immunization campaign for measles," she added. Orozco also noted that most of the zero-dose children live in marginalized communities or in communities considered "vulnerable to outbreaks,” and often have no access to regular health services. "Vaccine-preventable diseases affect children's physical and cognitive development and prevent them from becoming healthy, productive citizens," she said.

Factors

There are a lot of factors that contributed "to this high number of zero-dose children or under-vaccinated children," said Orozco. "Some LGUs would only have once a month vaccination sessions. And also, there is inadequate tracking of defaulters. Defaulters are those children that have not completed their immunization schedule but they have actually started it--and that is a usual scenario in the Philippines, they don't complete their vaccination schedule in time. There is lack of regular outreach immunization services, inadequate human resource," said Orozco. Another is vaccine hesitancy.  "Like religious beliefs, perceptions that vaccines are not important, misinformation--possible side effects, etc. These have contributed really to the low trust in vaccine's safety and efficacy," she said. Covid-19 pandemic also disrupted the routine immunization services, said Orozco. "Because of the urgent need to end the pandemic, the government and all sectors ---the priority, focus is really on the Covid-19 response, which overwhelmed the health system, especially human resources and funding as well. It affected the delivery of essential health services like immunization," she said.

Government should do more

Orozco said that the government should exert further efforts to address this problem. "We know that the government is doing something of course but I think the government should do more. One, I think, the first step or major step is really on the human resources---to increase the number not only the number but also the capacity of human resources for health services," she said. "Also, additional funds for the conduct of vaccination: that would include outreach immunization services, to track defaulters as well, and increase in vaccination services to improve immunization coverage," she added. It is also important to conduct "coaching" or “mentoring” sessions for health workers. "That would boost confidence and add on their knowledge and skills on vaccination," said Orozco. In a separate press briefing on Tuesday, DOH Officer-in-Charge Maria Rosario Vergeire said the government will conduct a supplemental immunization activity starting May 2 to 31. “Kailangan mabakunahan at mahanap natin ang mga kabataan na na-miss nga nating bakunahan (We need to vaccinate and find those children who we missed to vaccinate) during the times of the pandemic and even prior to that. And yung mga batang hindi pa kumpleto ang bakuna ay makumpleto na natin. Para maiwasan ang mga outbreaks na ating pwedeng mapigilan naman katulad ng polio at tigdas (And the children who have not yet completed their  vaccination. This is to  prevent possible outbreaks like polio and measles),” she said.