Ethiopia’s immunization transformation

By GAVI Alliance Managing Director for Innovative Finance & Private Sector Partnerships David Ferreira

IMG_2163 - Copy (2)Dr. Tebebe Demane Berhan, eminent scientist and a leading members of Lions Clubs International in Ethiopia, a GAVI Matching Fund partner, administers GAVI-funded pentavalent vaccine at the Meshuwalekiya Health Centre in Addis Ababa in October to Amen as his mother looks on.

I am a believer – in immunization, in equity and in the vision that all countries can and should provide health care for their people.

I just returned from Ethiopia, which with GAVI support, launched the rotavirus vaccine last month, following an October campaign against meningitis A and a May-June campaign against measles.

Let’s put this in context. Just a decade ago, Ethiopia’s immunization coverage rate was as low as 28 percent, by measure of the World Health Organization/UNICEF, and no more than 51 percent by Ethiopia’s own estimate. Either way, millions of its children were not being vaccinated against deadly diseases.

Today, Ethiopia has a health system that is becoming a model, transformed through a decentralized, robust approach led by the country’s Ministry of Health. Under the plan, Ethiopia:

- Has hired 38,000 health extension workers to provide direct care for children and women, empowered to help make decisions about targets and budgets.

– Is recruiting a “Health Development Army” of three million female volunteers, each assigned to a handful of neighbourhood families, to encourage healthy behavior, including immunization.

– Has increased the number of local health centers to 3,200 from 949 a few years ago, and is assigning to them Health Information Technicians to make data collection more accurate and complete.

- Is upgrading the country’s supply chain system, building a 17-hub, direct route distribution network for pharmaceuticals, vaccines and medical supplies, with giant warehouses and cold storage facilities being constructed nationwide.

The result is that Ethiopia’s child mortality rate has plummeted from 204/1,000 a decade ago to 68/1,000 today, according to UN statistics. Remarkably, Ethiopia has met – almost three years early – UN Millennium Development Goal 4, reducing child mortality by two-thirds.

I am a believer in Ethiopia’s type of approach, which has provided protection against the most severe childhood diseases to the three million children born there each year, including one precious boy that I cradled briefly at the Meshuwalekiya Health Center.

His name is Amen Desalegan (see him getting immunized in the photo above). At age four months he was brought there by his mom to receive three routine vaccines: pentavalent and pneumococcal vaccines, introduced with GAVI support in 2007 and 2011, respectively, and polio vaccine.

“Many bad things have happened in my life,” his mother explained through an interpreter. “Having him is a good thing. That is why we named him Amen.”

Amen now will have the chance also to receive rotavirus vaccine, as Ethiopia became the 17th GAVI-funded country to introduce it. Rotavirus – highly contagious – causes severe diarrhea and takes the lives of more than 38,000 Ethiopian children every year, making it the second biggest killer of young children there. Ethiopia aims to immunize 2.8 million against the disease.

Rolling out any one vaccine is enormously difficult, particularly in a place as large (1.1 million square kilometers) and challenging (84 million people and a per capita GNI of US$410) as Ethiopia. Partners such as Lions Clubs International and LDS Charities have joined GAVI to help with challenges such as these.

This is why I was accompanied in Addis Ababa by Lions Chair Wayne Madden and LDS major initiatives manager Jamie Glenn. We all came to see the remarkable story of how Ethiopia is reaching children with vaccines.

GAVI has been a proud partner with Ethiopia for 11 years, and has disbursed around US$ 500 million to support its immunization programs. When I see the faces of its children like Amen, I see the future of this inspiring and ancient land and appreciate the lasting difference that immunization is making. I am a believer.