As the head of UNICEF’s immunization team in Bangladesh, Dr Riad Mahmud regularly visits the headquarter of the Expanded Programme on Immunization (EPI) in Dhaka. The relationship between UNICEF and EPI goes back a long time. “We engaged in EPI from the start in 1979. And we will continue to do so.”

Dr Riad Mahmud is standing on the veranda of the second floor of the EPI Headquarters, chatting with the EPI Deputy Manager and some colleagues. Although Dr Riad just joined UNICEF as Team Lead (Immunization) last year, he knows many EPI staff from his earlier job as a Maternal and Adolescent Healthcare Expert at UNICEF and as Policy and Technical Advisor of USAID. He is a trained general health practitioner with a master’s in Public Health, with more than twenty-four years of national and international experience. EPI feels like his natural habitat, with carton boxes full of syringes pilling up at the warehouse and in the corridors and staircases, it emanates a sense of urgency.

Preparations for the first HPV vaccine campaign to protect girls and young women against cervical cancer have been going on. “We just finished the final planning for the campaign,” explains Dr Riad. He is confident that the HVP campaign will be successful. While global confidence in vaccination protection has declined after the COVID-19 pandemic according to UNICEF’s State of the World Children report 2023, Bangladesh coverage rates of routine vaccinations remain high. “Our people have full trust that vaccines will protect them and their children against diseases.”

Dr Riad takes pride in the vaccination work in Bangladesh. Seated in one of the EPI offices, accompanied by EPI and UNICEF colleagues, he elaborates on the long-term role of UNICEF and WHO as core partners of the government of Bangladesh and Gavi, the Vaccine Alliance. While WHO specialised in disease surveillance, UNICEF is involved in the other aspects of the immunisation process, like procurement and supply of routine vaccines, cold chain system development strategic planning, implementation and monitoring and vaccine and logistic management. The lockdown during the COVID-19 pandemic interrupted immunization activities temporarily. “But we did not take much time to catch up,” emphasises Dr Riad, gesturing appreciation for the colleagues. “We worked long hours setting up guidelines to show people the way how to handle immunisation during Covid. We went on, providing 365 million doses, achieving coverage of more than 100% in 2021, as we also took in children up to 3 years old, instead of the regular age up to 2 years.”

The Covid action approach, going house to house to catch up, showed the immunisation partners a sustainable way to keep the process going, says Dr Riad. “Microplanning at subdistrict level.” While UNICEF developed the tool and supported the government to develop District Evidence-Based Planning and Budgeting (DEPB) on immunization in 16 low-performing districts and eight city corporations, UNICEF and WHO have started implementing DEPB in these areas. UNICEF supports DEPB in 08 districts and 08 city corporations while the rest of the areas are covered by WHO- he added. The innovative approach goes hand in hand with a focus on equity, on zero-dose children and missed communities, with the introduction of the Equitable Impact Sensitive Tool, in short, the Equist tool and Evidence-based planning.***

“The main challenge is to reach the zero-dose children and the under-immunised.” According to Dr Riad,  Bangladesh’s 1% zero-dose children, some 30,000, is definitely a great challenge to the overall immunisation program, but the larger number of under-immunised children, the drop-outs and invalid-dose children who don’t receive their routine vaccines at the right time should also be emphasised with the same priority. 

E-tracking might offer a solution, thinks Dr Riad. Unicef initiated a pilot project with E-tracking- which has been scaled up to three districts and five city corporations, ensuring children are digitally registered and thus traceable. The first results are good and recently published in Lancet [1]. A recent demonstration of the E-tracking system by health officials involved in the pilot project resulted in requests to expand the project. For Dr Riad, these innovative strategies are a source of optimism and confidence. He still has a lot of work to do, but is one step closer to reaching immunisation for all.

Reference:

1. Digitalized to reach and track: a retrospective comparison between traditional and conditional estimate of vaccination coverage and dropout rates using e-Tracker data below one-year children in Bangladesh during-COVID and pre-COVID period. The Lancet Regional Health – Southeast Asia; Volume 16, September 2023. Elsevier.com. [cited 2023 Jul 31]. Available from: https://authors.elsevier.com/sd/article/S2772368223001129