Health and Vaccination – Bosnia & Herzegovina (BoHeMSA)

Name of the activity: Health and Vaccination

Country/NMO: Bosnia & Herzegovina (BoHeMSA)

Program: Children Health & Rights

Contact information: [email protected]

Type of the activity: Campaign

General description:

In the last five years, the FB&H registered a continuous fall in vaccine coverage ordinated from the Mandatory Immunization Program. The coverage fall varies individually for each type of vaccine and is generally significantly lower than the recommended percentage of 90/95% for most vaccines. In 2016, a high coverage by immunization of 96.4% was achieved only by the tuberculosis vaccine. The average vaccination of children with three doses of Hepatitis B vaccine in the Federation of Bosnia and Herzegovina is 71.1%, while the vaccination incidence for diphtheria, tetanus, whooping cough and infantile paralysis is 71.3%, but the lowest coverage is provided by the vaccine against measles, rubella and mumps (MRP vaccine) with the incidence of 64%. In 2016, there was a lower incidence of immunization in all cantons of the FB&H, bellow the recommended number.

The situation is not better in the Republic of Srpska (RS). After there was a fall recorded in 2013 when it came to infectious diseases preventable by vaccination, in 2014 there was a drastic increase in the number of measles patients from 6 to 1.662 people. The increase was also recorded in 2015 when 2,410 people were affected. In that year, there was a decline in the incidence of the OPV (infantile paralysis/poliomyelitis), MRP (measles, rubella, mumps) and HBV (Hepatitis B) vaccines.

The reason for all of these events is the lack of quality information and general ignorance spreading. In a country where the rate of university-level educated people is only 12.7%, and a very small percentage of them being doctors, more attention should be focused on this particular problem. Only then, the people will understand the causative and consequential links and with that they will be able to understand why the existing regulations are as such. At the moment, only the media is reporting this problem, but unfortunately in most cases they are spreading disinformation which only adds to the problems in total.

Focus area:

Early childhood vaccines and preventable diseases, Children’s rights with emphasis on the right to health and access to healthcare services

Problem statement:

Lately, we are facing the problem of an increased number of non-vaccinated children, which resulted from poor informational sources and lack of parents’ education about the importance of vaccination and the risks of non-vaccination. Previous researches and the latest statistical data about the numbers of vaccinated children on the territory of Bosnia and Herzegovina are devastating.

The highest rate of vaccination in B&H was recorded in 2012 when 98.8% of children were vaccinated with all vaccines (According to the provisions of the World Health Organization (WHO), one population is considered to be protected against infectious diseases if the percentage of vaccination is greater than 90% and 95% respectively). Since that year, there has been a constant decline in the number of vaccinated children and an increase in infectious disease spreading. According to the Law on the Protection of Population Against Infectious Diseases and the Regulations on the Mandatory Immunization Program, vaccination against 10 infectious diseases is required in the Federation of B&H (FB&H): diphtheria, tetanus, whooping cough (pertussis), infantile paralysis (poliomyelitis), measles, rubella, mumps, tuberculosis, hepatitis B and diseases caused by Haemophilus influenzae type B.

As can be seen from data of the Public Health Institute of FB&H, most children regularly receive tuberculosis vaccines, while other vaccines remain in decline, especially vaccines against measles, rubella and mumps. In 2013, 87.3% of children received MRP1 vaccine and 85.9% MRP2, which are given against the previously mentioned diseases. In 2014, this percentage rose to 89.1% for MRP1 and 91.5% for MRP2. But since the 2015, there was a drastic fall, with 77.9% of children taking MRP1 vaccine, and 81.5%. MRP2

This can lead to an epidemic of measles, rubella and parotitis, and in part to all of the 10 infectious diseases which are subjected to the mandatory vaccination. According to the WHO´s data, we see that the situation is alarming and that B&H has one of the lowest levels of immunization in the region. All the inhabitants in B&H should be aware of this, because if we continue to observe such a fall, then we will see that which has happened in Romania where there were 4,800 people registered with measles by April, and where 21 of them have died. What caused the epidemic, was a result of a declining immunization program.

Target groups and beneficiaries:

Parents of children under the age of 18 and children under 18 years of age.

Objectives and indicators of success:

General objectives:
1. Educating the population about the basics of vaccination
2. Increase in the degree of immunization, with over 95% total in the next five years

Project objectives:
• Data collection about the general population´s attitude in Tuzla Canton, in a sample of 2,500 filled originally-made research surveys, on the topic of vaccination and the use of vaccines in modern medicine, over the course January-February 2018

• Education of 100 students from medical and related branches in the fields of vaccination, immunology, epidemiology, infectiology and pediatrics through a 2-day intense education session with clinical and academic experts from the above-mentioned fields during March 2018

• Conducting an intense public campaign in Tuzla and other municipalities which show unsatisfactory results in the research survey, before the last week of April 2018

• Organizing competitions on vaccination related topics for 200+ secondary school students in the area of Tuzla Canton with the aim of information and knowledge spreading about vaccination-related topics during February-April 2018, with the semifinal and final laps being held in the last week of April

• Recording, editing and broadcasting videos on social and other media outlets, whose messages support the overall goals of the campaign

• Panel discussion organization, as a central project activity, with the experts from the fields of vaccination, immunology, epidemiology, infectiology and pediatrics, with an open access and over 300 participants

• Enhanced presence on public information channels (social networks, all forms of media, public presentations, etc.) with the aim of reaching a wider number of project audience both nationally and internationally

Methodology:

The project will be implemented in several phases.

I) The first stage of the project is conducting a general survey of the population in the Tuzla Canton in 5 municipalities (Tuzla, Lukavac, Živinice, Gračanica and Gradačac) with over 40,000 residents. The survey will be conducted in kindergartens, Health centers and the University Clinical Center Tuzla (UCC). The goal of this project phase is to find out the opinions and attitudes of citizens about vaccines and vaccinations, from where do they get their information and where do they go for advices. That way we will have an insight about which municipalities are the ones who are most compromised, as well as from where the problem of the anti-vaccine movement arises from.

II) Student education is the second phase of the project. Students must be familiar with all details of the vaccination process, its benefits and disadvantages, in order to adequately deal with the issues and attitudes of parents and everyone else who is against vaccination. The education will be held at the Faculty of Medicine, University of Tuzla and will last for two days. The education will be held by doctors in UCC Tuzla who have specialized in the fields of immunology, infectiology, microbiology and pediatrics.

III) The third phase includes the recording and promotion of a video titled “I am immunized” which will be promoted on all the social networks and media outlets, until the end of April. The slogan of the project to be used in the video is: Love. Care. Immunize!

IV) The fourth phase of the project is a public event in a form of a street action where the distribution of informative material with the basic questions and answers related to vaccinations is planned. We have planned to assemble a plywood labyrinth in the main city center, next to which there will be paint bowls. Hands will be dipped in paint and then imprinted onto the walls of the labyrinth. In addition to the imprints, participants will write a slogan “I’m vaccinated too!” together with their name. Further, at this stage, according to the results of the survey, street actions and educations will be conducted in the municipalities which have shown the worst results.

V) In the fifth phase, we have planned the organization of an oral competition quiz for high school students to test their knowledge about the importance and significance of vaccination. The competition is designed so that an unlimited number of teams can apply, coming from different high schools with a maximum of three members per team. The form of the competition is simple. The moderator asks the question, and the fastest team gives the answer, if the answer is correct then they get points, if the answer is inaccurate, then the points are taken away from them. The competition will be held from February to April 2018 at the Faculty of Medicine, University of Tuzla and will go up until the level of the quarterfinals. The quarter-finals, semifinals and finals will be held in the last week of April, which is in the main week of the project implementation. Before the competition, teams will be provided with the material from which they will be preparing for the quiz. We have prepared valuable prizes for teams who win first places.

VI) The sixth phase of the project is the organization of a panel discussion with an open participation. The panel discussion will be attended by experts in the field of pediatrics, immunology, infectiology and epidemiology. Representatives of the government, representatives of the WHO and UNICEF in Bosnia and Herzegovina will also be invited. It is important to note that all interested citizens will be able to take part in the public debate. As part of this phase, there will be awards for the most active participants of the competition.

VII) The seventh phase, which also applies to all the previous phases, is the promotion of the vaccine importance and immunization in the media. We will cooperate with the media to follow our work and to promote our activities with the purpose of quality information distribution.

Plans for evaluation:

In the terms of general project objective evaluation:

Developed awareness in the population about the importance of vaccination and the increase of immunization rate above 95% during the following five years. This data will be available to us through the statistical work of the Public Health Institute of FB&H in the period 2018-2023.

In the terms of project objective evaluation

• Collected data from 2,500 population members about their personal opinions on vaccines and their use in modern medicine, which gave us an insight into current public opinion and enabled us to tailor our activities

• Educated 100 students of medicine and related faculties in the field of vaccination with reviews on the immunological, epidemiological, infectious and pediatrics characteristics of vaccines. All students have been awarded certificates which have been graded by the Medical Chamber of Tuzla Canton.

• Implemented street open-air actions in 5 municipalities, or only in those who have shown low scores based on the research surveys, in the Tuzla Canton area with the distribution of promotional material

• Held public educations with the experts in the field of epidemiology, immunology, infectiology and pediatrics, in municipalities who have shown low scores based on the research surveys

• Organized competition with participants coming from different high schools in the Tuzla Canton area, with the winners being chosen in the last week of April 2018 and being promptly awarded for their efforts

• Recorded and promoted videos via social networks, public and media appearances and outlets by the end of March 2018

• Successfully organized panel discussion with over 300 participants which included members with the professional clinical and academic background, relevant sponsor and project partners, students, as well as the members of the general public.

• An intense media campaign was organized through all the means of mass media outlets, with over 50 media and public appearances