Reversing Moldova’s Decline in Child Immunization

Editor’s note: Rain Barrel Associates Paula Claycomb and Teresa Stuart are working with UNICEF in Moldova to help reverse an alarming decline in childhood immunizations there – sadly, a trend we are seeing in many countries, including the United States. Paula just returned from Chisinau, the capital, and provided this report.

The Republic of Moldova, a small country of four million people wedged between Romania and Ukraine, is grappling with a disturbing question: Why has the country’s childhood immunization coverage declined from just under 98 per cent to around 90 per cent in only eight years?

In the case of the Moldova, I suspect the key reasons may not be so different from the United States and other countries that have strong health systems but declining immunization rates and an increase in cases of preventable childhood diseases.

First, evidence indicates more parents are refusing vaccinations for their children. This reluctance is compounded by doctors who may not insist on immunizations, and even further by school systems that do not uphold the policy requiring full immunization prior to enrolment in kindergarten or first grade.

Despite overwhelming evidence that immunization prevents diseases ranging from measles, mumps and rubella to diphtheria, tetanus, pertussis and polio, amongst others, some parents doubt the quality or effectiveness of vaccines. Many are susceptible to misinformation provided in abundance on social media. Others see immunization as contrary to their religious beliefs.

Recognizing the importance of halting and reversing the downward trend, the UNICEF Country Office in Moldova asked Rain Barrel to support the development of a communication strategy for the government to increase demand for immunization. So far in the project, we have been working to identify the barriers and opportunities through a literature and data review, as well as through consultations with parents, family doctors, journalists, religious leaders, health officials and other groups.

In order to flesh out the key factors, I traveled to Moldova in early November and met with mothers who accepted immunization for their children as well as some who rejected it. I also interviewed religious leaders from the Moldovan Orthodox Church, Romanian Baptist Church and Jehovah’s Witnesses as well as TV journalists and others.

All confirmed what had been identified in a 2012 study of attitudes towards immunization: parents who object to immunization are usually well educated, with access to the Internet and other sources that present immunization as unsafe. I was struck by what one mother told me, that babies are usually born healthy and with breastfeeding, are provided with additional immunities, so why immunize a healthy baby?

The Ministry of Health has a National Immunization Plan for 2016 through 2020. It sets the goal of bringing childhood immunization rates up to 95 per cent. While that sounds modest, especially given the country’s strong health system that provides free immunization services to all children, an all-out national effort will be required to address parents’ concerns and counteract the misinformation over the next four years. The communication strategy Rain Barrel will recommend will draw on cutting-edge science and international best practice, as well as local knowledge and traditions, and include advocacy at all levels; social mobilization activities that will energize people of all ages to become involved in the effort; media campaigns and inter-personal communication amongst mothers and from priests and pastors to their congregations.

Rain Barrel’s team will return to Chisinau in January to meet again with stakeholders from all groups. At that time, we will share our recommendations and invite further feedback so that the final communication strategy is both comprehensive and do-able. With concerted efforts, the 95 per cent goal will be reached by the end of 2020 and the diseases that plague childhood can continue to be held in check.