Behind every successful vaccination campaign, there lies a strong immunization system. And behind each of those systems, a vast array of activities: coordinating logistics, preparing facilities, training health care workers, creating educational materials for the public, and more. Such activities are sometimes referred to as systems strengthening.
In Laos, a new immunization systems strengthening partnership between PATH and the Ministry of Health (MOH) is bolstering the country’s COVID-19 response by building on a decade of progress against Japanese encephalitis.
Edging out Japanese encephalitis
Japanese encephalitis (JE) is a deadly infection of the brain that’s transmitted by mosquitoes. “The disease is endemic across Southeast Asia and the Western Pacific, particularly in rural areas where rice fields are a breeding ground for mosquitoes and conditions are good for wading birds and pig farming, all of which contribute to JE transmission,” said Bill Letson, MD, Scientific Advisor on PATH’s JE projects. “JE mostly infects children, killing 30 percent of those who fall ill with the disease and leaving up to half of all survivors with permanent neurological damage. It’s a devastating disease—and it’s preventable."
“Japanese encephalitis mostly infects children, killing 30 percent of those who fall ill with the disease and leaving up to half of all survivors with permanent neurological damage. It’s a devastating disease—and it’s preventable.”— Dr. Bill Letson, PATH Scientific Advisor, JE programs
Laos suffers a heavy JE burden. In 2013, with support from international partners and a JE vaccine donation from PATH in partnership with Microsoft, Laos conducted its first-ever JE vaccination campaign using a newly available vaccine called CD-JEV. In 2014 and 2015, PATH provided support to expand the program into two other provinces.
Later in 2015—after CD-JEV had received the World Health Organization’s stamp of approval—Laos became the first country to implement JE vaccine in its nationwide routine immunization program, with support from Gavi, the Vaccine Alliance.
Nurse Orladee Nonnavongsa administers JE vaccines to schoolchildren during a 2014 campaign. This campaign expanded Laos’ JE vaccine coverage to 8 provinces in advance of the nationwide introduction of JE vaccine in 2015. Photo: PATH/Aaron Joel Santos.
A need for reinforcements
Although JE vaccine was incorporated into Laos’ routine immunization system, vaccine uptake declined rapidly after initial introduction.
In May 2018, the MOH and development partners, including the World Health Organization, the United Nations Children’s Fund, the US Centers for Disease Control and Prevention, PATH, Gavi, and the World Bank, conducted a review of the country’s immunization program to try to figure out what was going on. The team found two major gaps: Lao parents had little knowledge about JE, and the government was having difficulty procuring and distributing the vaccine within the country, leading to inadequate and inequitable vaccination coverage. In response, PATH conducted field surveys in three provinces in 2019–2020 to help broaden understanding of the gaps.
“It became clear these gaps were leaving Laos short of reaching disease control targets and liable to future outbreaks, so we wanted to see how PATH could help,” said Tham Chi Dung, MD, Vaccine and Immunization team lead for PATH’s Vietnam Country Program.
So, over the last two years—and despite complications due to the COVID-19 pandemic—PATH and Laos have partnered to strengthen the country’s immunization system to reach more children with lifesaving vaccines. With primary support from PATH’s Vietnam Country Program and Laos-based consultants, Laos planned and launched a nationwide JE vaccination catch-up campaign—ongoing in early 2022—to reach children who had previously missed out on vaccination.
Dr. Dung noted, “In tandem with the catch-up campaign, we also worked with the Laos MOH to conduct advocacy workshops, e-learnings, and trainings for provincial, district, and local leaders, health staff, and volunteers to educate them about JE and clear up any questions about vaccines in general. This was important to help address vaccine hesitancy and improve knowledge on vaccine procurement.”
In addition, a public immunization education program on vaccination helped spread messages on vaccine safety and effectiveness via loudspeakers, smartphone applications, and social media. “One of my favorite results of the MOH’s public advocacy efforts was a series of three JE vaccine advocacy videos featuring talking cartoon elephants,” added Dr. Letson. “They help explain to the public why JE vaccines are needed and how we know they are safe.”
A still frame from one of three JE vaccine advocacy videos featuring talking cartoon elephants (linked above).
A foundation from which to tackle COVID-19
With the advent of the pandemic, new concerns arose. PATH and the Laos MOH identified additional needs to be addressed to help the country prepare for and implement COVID-19 vaccination campaigns in addition to continuing the work to strengthen Laos’ routine immunization system.
Beginning in 2022, PATH and the MOH launched a new partnership to bolster Laos’ national COVID-19 vaccination deployment plan while continuing immunization systems strengthening activities. Speaking at a launch event for the new work, PATH Southeast Asia Hub Director Nguyen Tuyet Nga, MD, stated, “A strong immunization system is the backbone of a country’s public health services and will set Laos up for success against COVID-19 and future pandemics.”
“A strong immunization system is the backbone of a country’s public health services.”— Dr. Nguyen Tuyet Nga, PATH Southeast Asia Hub Director
PATH and Laos’ continued partnership will seek to finalize and implement the Lao national COVID-19 vaccine introduction and deployment plan. Because COVID-19 vaccine supply in Laos remains limited—as in many low- and middle-income countries—the MOH will work with PATH to identify the target population for the campaign according to vaccine supply and priority populations.
Laos and PATH will also continue to strengthen routine immunization by conducting vaccination trainings for health care workers at all levels and disseminating information, education, and communication materials on vaccines to the public in three provinces. By integrating these efforts with the COVID-19 vaccination campaign—by providing public vaccine education materials at COVID-19 vaccination sites, for example—the MOH seeks to decrease vaccine misinformation and increase uptake and public health benefit. Lessons learned from these trainings and materials will be consolidated and disseminated to other provinces for reference and use.
“Lao PDR is committed to protecting its people against COVID-19 and other vaccine-preventable diseases,” stated Phonepaseuth Ounaphom, MD, Director of the Department of Health and Hygiene Promotion within the MOH. “Building on years of work with PATH in building our Japanese encephalitis vaccination program, we look forward to continuing this partnership to strengthen our COVID-19 vaccination deployment plan.”
