Daunting challenges to immunization efforts are disproportionately affecting the youngest children
“I will live all my life regretting seeing my son paralyzed,” Mohammad’s mother Bushra said.
Four-year-old Mohammad contracted polio in late 2021. He spiked a high fever, recalls Bushra, and his right leg suddenly went floppy and weak. Acute flaccid paralysis is the primary sign of poliovirus infection, and it was confirmed in Mohammad’s case by laboratory testing, making it one of the first cases in the ongoing outbreak.
In Yemen, 228 children have been paralyzed since 2021 by the ongoing polio outbreak. Eliminated in nearly all other parts of the world and on its way to global eradication, the poliovirus case count in Yemen is expected to rise.
“My grief for my son is enormous,” said Bushra. “He was walking and playing and suddenly he is disabled and does not move and cannot play like his brothers, he cannot move his leg at all.”
Caption: In Yemen, 228 children have been paralyzed since 2021 by the ongoing polio outbreak.
Spread of polio and other vaccine-preventable diseases in Yemen
It’s not just polio. Against the backdrop of ongoing conflict, widespread malnutrition and shortages of food and medicine, one of Yemen’s fastest growing problems, is, ironically, easily solvable: multiple outbreaks of vaccine-preventable diseases.
The numbers are daunting. Yemen recorded more than 22,000 measles cases in 2022, including 161 deaths. In 2023 to date, cases have already spiked to 9,418, with 77 children dead. Diphtheria and pertussis – whooping cough – cases are also on the rise, as are deaths from each disease.
Yemen’s already fragile and severely over-burdened health system, combined with sub-optimal population immunity against vaccine-preventable diseases, increases the likelihood of further explosive outbreaks of these diseases. Moreover, the lack of immunization has major negative socio-economic impacts on households, which face unaffordable high hospitalization costs. The human cost of these outbreaks is particularly painful in that it is children, not adults, who bear the brunt.
Caption: A child receives a polio vaccination during a national vaccination campaign in Yemen.
Yemen’s vaccine-preventable disease outbreaks are the direct consequence of increasingly low immunity levels in children. With the rapid decline in immunization coverage, an atypically high mortality rate is expected to increase, especially if malnutrition rates continue to rise.
For decades, Yemen’s high coverage rates for childhood immunization were amongst the best in the region, kept high by a steady stream of state-funded risk communications and a robust public health system. Conflict has decimated both.
Since confirmation of the outbreak of circulating variant poliovirus in November 2021, the Global Polio Eradication Initiative has been unable to obtain house-to-house access to children in Yemen’s northern governorates. As a result, the polio outbreak there has continued, and even spread to other countries in the region. Of Yemen’s 228 paralytic polio cases, 86 per cent (197) are from the northern governorates.
While multiple measles and polio vaccination campaigns have been implemented in the southern governorates over the past two years, the ongoing deadlock in the northern governorates over supplementary immunization activities puts children there at particular risk. The restriction of vaccination campaigns to only fixed-site health facilities, combined with prohibition of integrated community outreach services in all northern governorates, has led to continued multiple outbreaks of polio and other vaccine-preventable diseases, specifically measles and diphtheria. The current measles outbreak, ongoing since 2019, is disproportionately affecting children there.
Caption: A door-to-door vaccination campaign led by the Ministry of Health and Population in partnership with the World Health Organization.
For Bushra, the lack of a "pull” to immunize her children shaped the choices her household made around the children’s health. Mohammad is a zero-dose child, meaning he is completely unvaccinated.
“We didn't know we were supposed to take them to the hospital to get vaccinated, and I wasn't aware of the seriousness of these diseases or thinking that any of my children would get sick,” she said.
Bushra’s three older children, two boys and a girl, received a few vaccinations during house-to-house campaigns. However, between Mohammad’s birth and the onset of his paralysis, Bushra notes there had been no house-to-house campaigns. This is why the polio programme advocates for house-to-house vaccination: it is the method that delivers the highest coverage, delivering vaccines even to children who may have until then missed out on routine immunization.
Other challenges remain. Insecurity in parts of the country—particularly in some districts in Yemen’s southern governorates—makes accessing them difficult. The result is that most children in these districts are not vaccinated.
Caption: A health worker during a house-to-house vaccination campaign.
Over the past year or so, the lack of a “pull” towards vaccination has been joined by an aggressive “push” away from it. An escalating campaign of anti-vaccine propaganda has taken root on YouTube, television, radio and social media, calling into question established scientific fact and sowing fear and doubt in parents’ minds.
While the material is produced and broadcast in the northern governorates, its effects are increasingly felt in the country’s southern governorates. Parental refusals in the March 2023 house-to-house polio vaccination campaign there were markedly higher than in other recent rounds. The driver, according to post-campaign monitoring activities and conversations with parents, is overwhelmingly all the fear-based rumors and disinformation parents take in on social media and in WhatsApp groups. The result is a combination of mistrust, vaccine hesitancy and refusals that undermine immunization coverage.
The longer the current disinformation campaign persists, the greater the risk that parents will opt out of vaccines for their children when they are finally offered that protection, based on misguided, if well-intentioned, fears.
Immunizations are essential to prevent the further spread of these vaccine-preventable diseases and others. For Bushra, the cost of missing out on Mohammad’s childhood immunizations is a price she and her son will pay forever – and one she urges other parents to guard against.
“I was able to keep my son healthy and I didn't. Vaccination is very important – more than I could have ever imagined.”
