For over a decade, Guinea has been working to provide immunization for vaccine-preventable diseases to all people, particularly the underserved ones. This process is also known as the Expanded Programme on Immunization and WHO has been supporting Guinea in many activities along the way. One of these activities is regular monitoring of the immunization progress. And numerous data gathered in this way point in one direction: fewer children and pregnant women got vaccinated between January and April 2020.

Indeed, more than 26% of children missed the first dose of BCG vaccine in this period, which endangered the vaccination plan for the rest of the year. Almost the same percentage of children was not immunized against chickenpox and measles – a 16% reduction compared to April 2019. Similarly, there was nearly 45% decrease in immunization against tetanus and diphtheria of pregnant women, coupled with irregular attendance of pre-natal consultations.

As the first case of COVID-19 was recorded in March 2020 in Guinea, its influence on the routine immunization became apparent very soon. Aware of the dangers of multiple epidemics, Guinea focused on community engagement to contain the spread of the known and emerging pathogens.

WHO staff are on the ground

Motivated by a good practice of a nurse, who bought a low-cost mobile phone and used it solely to remind mothers of vaccination appointments, WHO supported the scaling up of this approach. Beginning with two health centres, WHO strengthened capacities of technical teams on surveillance and follow up on immunization schedules. And the Vaccine Alliance, Gavi, provided the teams with more helping hands, by deploying a skilled technical assistant.

As outreach to people improved, health workers learned more about reasons behind the falling vaccination coverage: a steady flow and volume of information makes it challenging for people to tell the difference between facts and rumours. Giving rise to fears, rumours tend to spread quickly, if not counteracted with balanced and evidence-based messages. To this end, WHO and UNICEF assisted to build capacities of technical teams in effective communication. Not waiting long to apply new skills, health workers used phone calls not only to remind of vaccination appointments, but also to answer many questions people had related to COVID-19. This strengthened the mutual trust between health workers and Guineans. Finally, to make these efforts sustainable and available to the many, the Ministry of Health of Guinea funded the employment of more health workers.

Present impacts and future lessons

At Lambanyi health centre, one of the two pilot health centres, combined improvements in monitoring and community engagement lessened the impact of COVID-19 on routine immunization. In the same period between January and April 2020, Lambanyi recorded only a slight drop in vaccination rates: the number of children vaccinated with BCG went down from 260 to 230; vaccinations against chickenpox fell from 241 to 211; while the number of women immunized against tetanus and diphtheria sunk from 212 to 180. The same continuity could not be maintained in other health facilities. For example, a health centre in the neighbouring prefecture Matoto experienced higher fluctuations: BCG vaccinations declined from 313 to 213; vaccinations against chickenpox cut back from 301 to 71; while the number of women immunized against tetanus and diphtheria plummeted from 350 to 130.

With this impact in mind, WHO and the Ministry of Health went ahead to support the implementation of the call-to-the-appointment approach at 39 additional health centres throughout the country. 

Working on the ground also gave more insights into the quality of health interventions and Guinea’s preparedness for possible health emergencies. Some of the insights have already informed the response to the COVID-19 pandemic. Others will serve as a time-proven approach in containing the re-emergence of Ebola in the first months of 2021.

Photographs and visuals

1. WHO hands over COVID-19 posters to health authorities in Conakry, to be distributed to 27 public and 40 private health facilities / WHO Country Office, Guinea
2. Members of the municipal health authority visit private clinics in Gbessia / WHO Country Office, Guinea
3. People wait for immunization at the health centre “Berney Fotoba” / WHO Country Office, Guinea

Photo caption: Mothers attend routine immunization after receiving a reminder by phone.

Photo credit: Ahmed Jallanzo