Evaluation of ways to increase vaccine uptake in Timor-Leste

Professor Peter McMinn is the Bosch Chair of Infectious Diseases at the University of Sydney. He has developed extensive research and teaching collaborations in Southeast Asia and has spent long periods in Malaysia, Indonesia, Timor-Leste and Vietnam training local microbiologists in communicable disease diagnosis and research and in epidemic and vaccine-preventable disease surveillance.  

Timor-Leste is a newly independent nation, which is currently ranked 162 of 182 countries in the UN Human Development Index. In 2010, the under-five mortality rate was 64 per 1000 live births and the neonatal mortality rate was 44 per 1000 live births. Acute respiratory and diarrhoeal infections, many of which are vaccine preventable, are the major causes of morbidity and mortality of under-five year old children. In 2010, only 46% of Timorese children were fully immunised and 23% had received no immunisations at all. Consequently, there is an urgent need to increase he uptake of vaccination in Timor-Leste.

The reasons for poor vaccine uptake in Timor-Leste are many, including the remoteness of many communitiesfrom existing health facilities and low levels of literacy and health knowledge, especially in remote rural communities. The poor state of the roads in Timor-Leste compounds the problem of getting vaccines tothe children who live in remote communities.

We are currently engaged in a project with the Timor-Leste Ministry of Health to identify possible ways to increase childhood immunisation uptake from the current 46% completion level to 90% or greater.

One means of achieving this will be through the introduction and road-testing of an electronic immunisation registry, in which newborn infants will be uniquely identified by fingerprint scanning. Infants presenting to mobile and fixed primary healthcare clinics or in their homes (see below) will be identified by the fingerprint scanner and immunizations due for that child will be displayed. We will evaluate the feasibility, suitability and acceptability of the registry under local conditions as well as to examine how well it improves the uptake of immunsation. A pilot study of the electronic immunisation registry will be undertaken in the Dili District.

Given the current state of road and health facility infrastructure in Timor-Leste, it is currently necessary to take a more proactive approach to bringing vaccines to children living in remote communities. This necessitates a door-to-door approach to finding children and providing them with immunisations. Vaccines will be transported to remote communities rather than expecting mothers to walk their children over long distances in mountainous terrain to reach the nearest health post. We propose to train health workers to deliver vaccines to children in their homes. The health workers will bring the vaccines to the remote villages by motorcycle or, if necessary, by carrying the vaccines on the backs of Timor ponies.

We hope that the introduction of an electronic immunisation registry plus the initiation of door-to-door delivery ofvaccines will increase the uptake of vaccines toward 90% of Timorese children, thus preventing the circulationof many vaccine-preventable diseases and leading to a major improvement in children’s health.