5 December 2018 – Early analysis of campaign data points to a successful vaccination round in a polio-free country at risk of possible importation.

In the last week of October, Djibouti’s Ministry of Health, working with WHO, UNICEF and other partners, successfully carried out the country’s first polio National Immunization Days (NIDs) since 2015.

While Djibouti has not had a case of polio since 1999, the recent outbreak of polio in neighbouring countries in the Horn of Africa, and the low levels of routine immunization coverage in some areas in the country, are indications that Djibouti is still at risk if poliovirus spreads through population movements. Other countries in the Horn of Africa are already cooperating to control the existing outbreak and to reduce the risk of spread, and given that Djibouti is on a major migration route in the Horn of Africa, it makes a lot of sense for Djibouti to join this coordinated response.

For Dr Ahmed Zouiten, the acting WHO Representative in Djibouti, this context demanded action.

“I prefer to deal with a campaign for prevention than to have to deal with an outbreak of polio,” he said.

With that in mind, an NID planned for 2019 was brought forward and carried out over 23–26 October. The target was 120 000 children under five years of age, a number suggested by Djibouti’s last census in 2009. Two strategies were proposed: one approach, where children would be vaccinated at fixed points (health facilities) and a complementary door-to-door approach using two-person teams (a vaccinator and a registration person).

In the days and weeks before the NID, all partners, including the government, WHO and UNICEF, used a variety of communication channels – from outdoor signage to radio spots – to ensure that communities were informed not just of the risks of polio, but also of the importance of protecting children from vaccine-preventable diseases.

The campaign’s official launch ceremony was held at the Youssouf Abdillahi Iftini polyclinic in Balbala neighbourhood, in the presence of Djibouti’s Minister of Health, WHO and UNICEF representatives, and other partners. Over the course of the following week, vaccinators surpassed targets, vaccinating all children under five they encountered living on Djibouti territory, regardless of their origin. Nomadic populations, refugees and migrant children were vaccinated.

Although final numbers are still being tabulated through independent monitoring mechanisms, initial results suggest high coverage of the target population. This means vaccinators reached the estimated target number of children and more, probably including newer cohorts of children not accounted for in earlier estimates. Catching these children helps to further inform immunization estimates for any further campaigns.

For Dr Zouiten, a result like this is something to celebrate.

“Today, our children are on their way to being better protected, and we are launching a second campaign in the near future to follow up on that,” he said.

“Before, we had some worries; we thought that the circulation of poliovirus in the region posed a risk. Now with this first vaccination campaign, we know we are on the right path to ensure the children of Djibouti are protected. These results weren’t easy to achieve, but were made possible through collaboration between the Ministry of Health, WHO, UNICEF and others.”

Given the high risk of importation of poliovirus, WHO, UNICEF and the Government of Djibouti are not taking any chances: plans are in the works for a second and third NID to roll out in 2019. With an outbreak in the region, it is critical for nearby countries to strengthen their own immunity levels and ensure routine immunization and disease surveillance systems are strong enough to detect any virus circulation. Despite the cost and effort of staging national immunization activities, in this case, all partners agree: an ounce of prevention really is worth a pound of outbreak response.