Improving the Quality of Supplementary Immunization Activities

Hosted and organized by founding partner WHO, with technical support from UNICEF and CDC, the Measles & Rubella Partnership held a six day workshop to train consultants aimed at supporting countries planning to conduct high quality supplementary measles and rubella immunization activities (SIAs or mass immunization campaigns).
This inaugural workshop enables the M&RP to further train a cadre of technical consultants with strong technical capacity in planning, implementation, monitoring and evaluation of SIAs. The workshop, funded by the Bill and Melinda Gates Foundation, was attended by 19 potential consultants from 14 countries, and introduced concepts, case studies, problem solving exercises and group work.

Over the coming months, the M&RP secretariat and partners will consult with a number of countries to match country requirements with consultants’ skills and availability for deployment to upcoming 2015 measles and rubella SIAs.

The Supplementary/Mass Immunization Approach

Mass immunization campaigns were first suggested by Dr Albert Sabin in the 1960s as a way of rapidly building up immunity through a time limited surge of mobilization, operational field implementation and close monitoring to reach traditionally unreachable populations.
Based on Gambia experience, mass immunization catch-up campaigns were employed in Cuba in 1986 with tremendous success, and subsequently applied to great effect in the Americas providing invaluable support to the elimination of both polio and measles. Since then, mass campaigns have been promoted globally through the polio eradication initiative and the elimination of maternal and neonatal tetanus.

The Measles & Rubella Partnership and Supplementary/Mass Immunization campaigns

With technical guidance from the Measles & Rubella Partnership, SIAs have been an important strategy for delivering the second dose of measles vaccine, greatly contributing to the 75% reduction of estimated measles deaths between 2000 and 2013. Since 2004, Gavi, the Vaccine Alliance has provided support to a wide range of SIAs including those for measles and rubella.
SIAs are primarily used to close population immunity gaps in addition to ongoing efforts to strengthen routine immunization. In turn, measles SIAs strengthen health systems by forging local partnerships, improving outreach for micro planning and cold chain systems, promoting and building capacity for injection safety, strengthening disease surveillance systems and promoting the use of surveillance data for program management.
Measles SIAs also provide an opportunity to supply additional health interventions including Vitamin A and de-worming tablets, tetanus toxoid vaccination to women of child-bearing age, and distribution of insecticide treated nets (ITNs) for the prevention of malaria.

Success Factors

The success of a SIA round hinges on a closely knit implementation unit of three to seven technical people at national level who are experienced, innovative and pay exceptional attention to detail. The work is intense and consistent with work days lasting 12 to -18 hours for the full six months before the launch date.
This unit is the link between national policy and decision makers and subnational level immunization managers. The logistical challenges of delivering viable vaccines to those who most need them are enormous and are amply detailed in this BBC photo essay.
To meet these challenges, the unit must develop and oversee a strict schedule of prerequisite steps, draft guidelines and cascade materials, gather intelligence and read signs from the field in order to enable corrective actions where necessary. This small implementation group must also bring other partners and actors together for success.
There is no doubt that integrating one – three experienced consultants into this national implementation unit, depending on the size of the country and the strength of the health systems, is critical for the implementation of high quality campaigns.