Tracey Koehlmoos: Immunisation in Bangladesh: who takes priority?

Tracey KoelhmoosThe team and I have a new project. We are embarking on a multi-country study that is looking at the Impact of Measles Eradication Activities on Immunization Services and Health Systems. To that end we hosted a meeting with the key stakeholders in Bangladesh on immunization activities (EPI, Expanded Programme on Immunization) to include multiple representatives from our Ministry of Health, particularly from the Directorate General of Health Services; UNICEF; WHO; and a few more.

While I am still a bit awed by the potential impact of this small study in the coming decision by the World Health Assembly to move toward eradicating measles from the planet or not, it was the discussion between my guests while we were waiting for the chief guest to arrive that has pushed me to write.

The small supply of H1N1 vaccine that is due to arrive in the New Year was the topic of our informal discussion and it foreshadowed the issues that would also happen if we do move toward measles eradication. Is there sufficient cold storage space? Will the emphasis on another vaccine overwhelm the field-level health workforce?

Specifically to H1N1, the decision has been made to provide the vaccine to front line health workers first. However, who is a front line health worker in Bangladesh? As in other countries nurses, physicians, health assistants and paramedics; however, in Bangladesh more than half of first line sources of healthcare comes from informal, unlicensed providers or small drug vendors serving in the private sector.  The discussion raged as to the need to include them in the first group to be vaccinated.  And if so, how? The official government response is that registered private providers—so physicians, would be vaccinated but that the drug vendors and “village doctors” would not be included.

The discussion had turned to whether or not our H1N1 vaccine supply could potentially be diverted to one of our neighboring countries with greater need just as our chief guest arrived, having finally navigated his way through the dense, mid-day traffic in Dhaka.  The timely H1N1 discussion was over and we moved down to the official business of measles eradication.

Tracey Koehlmoos is programme head for health and family planning systems at ICDDR,B and ajunct professor at the James P. Grant School of Public Health, BRAC University.