WHO/Phoonsab Thevongs.
* The article was prepared by WHO and DFAT in May 2024
Lao PDR makes significant strides in measles prevention – campaign reaches 95.2% of target
- Measles cases are rising globally, including in the Western Pacific Region, driven in part by impacts from the COVID-19 pandemic.
- Lao PDR’s Ministry of Health, with support from WHO, Gavi, the Vaccine Alliance, the Australian Government, and UNICEF, launched a Measles and Rubella Supplementary Immunization Activity (MR SIA) in May 2024.
- The extensive nationwide campaign targeted 633 849 children across all 148 districts, successfully reaching over 603 000 children, 95.2% of the target group.
Measles remains one of the world’s most contagious diseases, capable of causing severe complications and death, particularly among children. While almost entirely preventable through a two-dose vaccine, a global resurgence of measles cases has been observed in recent years, including in WHO’s Western Pacific Region.
“The Western Pacific Region had lower levels of measles infections in 2021, with 1080 cases, but in 2023 cases jumped to 5044, impacted by COVID-19 related disruptions,” said WHO Lao PDR Representative Dr Tim Armstrong. “In Lao PDR, the COVID-19 pandemic disrupted routine immunization services, leading to a decline in measles vaccination coverage.”
“A coverage rate of 95% is required to prevent measles outbreaks. Unfortunately, in 2022, rates in Lao PDR were 82% for the first dose, given to children between the ages of 9–11 months, and 61% for the second dose, given at 12–18 months. This created a heightened risk of outbreaks and a need for urgent action.”
To address this gap and protect Lao PDR’s children, the Ministry of Health, in collaboration with WHO, Gavi, the Australian Government, and UNICEF, launched a Measles and Rubella Supplementary Immunization Activity (MR SIA) in May 2024.
The nationwide campaign targeted 633 849 children across all 148 districts. Through the dedicated efforts of hundreds of vaccinators, the campaign successfully vaccinated over 603 000 children, reaching 95.2% of the target group.
WHO/Phoonsab Thevongsa & Soudaphone Viravongsa
“This campaign was a critical step in safeguarding our children from the devastating impacts of measles,” emphasized Dr Bandith Soumphonphakdy, Director of the National Centre of Maternal and Child Health, Ministry of Health.
“By achieving such high coverage, we have significantly reduced the risk of outbreaks and protected countless lives. At the same time, vaccinators were able to administer vitamin A supplements to children. Vitamin A is essential for the functioning of the immune system and a healthy child’s development, while a deficiency increases the risk of death from common infections, such as measles.”
Recommended by WHO technical experts in 2022, the SIA aimed to reach all children between 9 months and 5 years old with a MR vaccine, regardless of their previous immunization status.
WHO/Phoonsab Thevongsa.
Preparing for the SIA was a complex undertaking spanning 12 months and requiring the coordinated efforts of multiple partners. The Ministry of Health’s National Immunization Programme (NIP) led the campaign, coordinating with other departments and relevant ministries, such as the Ministry of Education and Sports, the Ministry of Home Affairs, the Ministry of Information, Culture and Tourism, the Lao Women’s Union, and the Lao Front for National Construction.
The NIP was also responsible for the immense task of coordinating and preparing thousands of staff and volunteers in provincial and district health offices and health centres to ensure that the campaign was implemented as planned.
WHO/Phoonsab Thevongsa
“Importantly, this rapid-reach approach is possible because of the safety of the MR vaccine, the same vaccine used for routine immunization, as well as the danger measles poses,” said WHO Lao PDR immunization team lead Dr Nyambat Batmunkh. “An SIA aims to close immunization gaps, prevent an outbreak, and protect those most likely to be at risk.”
“At the same time an SIA has limitations, with significant logistical and financial burdens, impact on routine activities, a focus on just one vaccine, and – due to skipping verification of existing immunization status and records – being unable to combine the MR SIA figures with the national coverage rate. However, in this instance, the risk of a measles outbreak was simply too high to risk not acting.”
A large WHO team of more than 15 from the Lao PDR Country Office and Western Pacific Regional Office – via Gavi, Australian Government and CDC support – assisted the Ministry of Health in almost all aspects of planning, developing and implementing the campaign, including: overall strategy and design of the MR SIA; selection of target groups to ensure the greatest protection; budgeting and logistical planning; developing standard operating procedures, training of trainers and supervisors; national and subnational readiness assessments; data collection and reporting; adverse event surveillance; risk communications; and mop-up vaccinations.
More than 35 WHO staff and 10 UNICEF staff deployed across the country alongside Ministry of Health teams to support implementation and monitoring.
“The rapid increase in measles cases globally underscores the importance of timely and effective immunization campaigns and routine vaccination,” said Nadia Lasri, Senior Country Manager and Coordinator of Gavi support in Lao PDR. “The SIA in Lao PDR is a prime example of strong partnership and collaboration, demonstrating the country's commitment to protecting the health and well-being of its children by reaching the most vulnerable groups with the vaccines.”
As a crucial partner in the campaign, UNICEF Lao PDR supported the NIP in many areas, particularly cold chain management, supply logistics, and deployment of a nationwide multimedia outreach campaign. UNICEF supported the Center for Health Statistics and Information in rolling out a social mobilization and community engagement effort involving thousands of village leaders and volunteers as well as organizations such as the Lao Women’s Union and the Lao Front for National Development.
WHO/Will Seal & Soudthida Thepsouvanh; UNICEF/Phiennachit.
This grassroots engagement played a crucial role in raising awareness about the importance of vaccination and encouraging parents to participate in the campaign.
The Australian Government was a key supporter of the MRSIA. “This vaccination campaign is critical to protecting children across the Lao PDR from measles and rubella,” said Dan Heldon, Deputy Head of Mission, Australian Embassy in Laos. “Australia is proud to have supported the Ministry of Health to roll out this live-saving work, in partnership with Gavi, WHO and UNICEF.”
WHO/Phoonsab Thevongsa
In provinces and communities, reaching 95.2% of the national target means significantly differing activities and responses, depending on the population, geography, infrastructure, existing coverage rates, and many other factors.
Phongsaly is Lao PDR’s most northern province. Sharing a border with China and Viet Nam, it is mountainous, remote, rural and home to a diverse mixture of cultures, communities and ethnicities, often living with limited transport or communication infrastructure. In the past it has faced challenges with vaccination coverage – but in this campaign, it exceeded the 95% target rate in all seven of its districts.
WHO/Rachel Lorimer.
Crucial to this success was strong planning and coordination, a focus on hard-to-reach, remote areas from the start of the campaign, and effective community outreach, particularly with ethnic communities.
“Prior to the campaign, we focused on increasing routine coverage rates at every opportunity, and ensuring our planning was as strong as possible,” said Ms Chanping Yindalakham, Deputy Head of Hygiene and Health Promotion in Phongsaly’s Provincial Health Office.
“Central to this was micro-planning with village leaders, ensuring their and our lists of children requiring vaccination aligned, to make the most of outreach, and achieve our targets efficiently. Following this, we began outreach, working with the most remote or challenging locations.”
Na Hok village is one example. A nine-hour drive from the provincial capital through mountainous terrain, it is comprised primarily of people belonging to the Yao ethnicity, who speak their own language. Vaccine acceptance is often low, making the village a focus for outreach by the Provincial Health Department.
WHO/Rachel Lorimer.
“When we arrived in the village to begin immunization activities, many children were away with their families in the fields, or avoiding the vaccination team,” said Ms Yindalakham. “But, the joint group of national, provincial, district and health centre staff, with good support and collaboration from the naiban [village chief] acting as a local advocate, began visiting families and conducting health education.”
“The naiban was crucial, helping to mobilize community members, translate for those that didn’t speak Lao, or have low literacy, and help convey messages from health educators. The results were significant – in the end, we reached 37 out of 42 children that day.”
While results in Phongsaly and many other provinces were extremely strong – with 13 out of 18 provinces managing to reach the 95% coverage target – a small number encountered challenges in reaching their targets.
Xaysomboun was one such province, facing historical vaccination coverage gaps, difficult logistics and remoteness, and hesitancy from ethnic and marginalized communities.
“The high coverage rate achieved nationwide is a testament to the hard work and dedication of our health workers and partners,” said Dr Ketkesone Phrasisombath, Deputy Director General of the Department of Health and Hygiene Promotion, Ministry of Health.
“However, we recognize the areas where we need to improve and will continue to work towards ensuring equitable access to immunization services for all children – including utilizing the Ministry of Health and Ministry of Home Affairs CONNECT community engagement and local governance strengthening initiative.”
WHO/Phoonsab Thevongsa
Facing vaccination challenges, health officials in Longshan district, Xaysomboun province – with a particularly low coverage rate – worked with the CONNECT initiative, supported by the Australian Government, to enhance community engagement in 10 high-risk villages: Namkhui, Khonewat, Xamkhone, Hinxor, Naxay, Thamdin, Vangluang, Phonelao, Mueanglong and Huaysiat.
Local officials, including Longshan district’s Head of Health Promotion, Dr Xaylee Sayaxang, collaborated closely with village heads, Lao Front, Lao Women's Union, and health volunteers to develop expanded plans for better targeting in high-risk or “missed” communities, and new strategies to engage residents and families.
A father of four, avid sportsman and life-long resident of Xaysomboun province, Dr Sayaxang is passionate about his work and his province – he says health education can improve the lives of everyone, and empower them to have longer, healthier lives.
WHO/Phoonsab Thevongsa.
“I love what I do, and the communities I work with. Our goal is to reduce infections and outbreaks, and keep people safe – effective health promotion is a key tool to achieve this. We can always improve our work to support the community to remain safe and healthy. Health providers should not just prepare a vaccine box and wait for children to come… proactive measures are necessary.”
Strategic planning sessions brought together all parts of local governance – including district-level education, home affairs, information and cultural tourism officials, as well as local leaders and mass organizations.
Vaccinators and local officials divided into four teams, each assigned to collaborate closely with village heads, Lao Front, Lao Women's Union, and health volunteers.
WHO/Phoonsab Thevongsa.
Dr Sayaxang emphasized the importance of collaboration: “Yesterday [during outreach], the village head and village health volunteers visited target households. Today, we saw a significant increase in the number of children coming forward for vaccination.”
"Collaboration with local governance and leaders, and healthcare providers, is essential for increasing vaccination rates and promoting community engagement. Through the CONNECT initiative, sharing responsibility, we have established strong partnerships with village leaders, mass organizations, healthcare providers, and community members. These efforts played a pivotal role building collaboration and trust and achieving substantial improvements in vaccination coverage."
In Longshan district, overall, the MR SIA coverage was only 70.7%. However, coverage reached an average of 84% in the 10 villages which CONNECT supported, with more than half of the villages achieving coverage above 90%.
The 2024 MR SIA in Lao PDR was a collaborative initiative with the Ministry of Health, Gavi, WHO, UNICEF and multiple other partners. WHO’s effort to ensure all children across Lao PDR are protected against measles and rubella was supported by Gavi, with assistance from the Australian Government supporting CONNECT, risk communications and other technical support.
