Immunization and vaccines development
Liberia launched its Expanded Programme on Immunization (EPI) in 1978. At the beginning, the primary goal of the Programme was to protect children from six vaccine-preventable diseases: tuberculosis (TB), diphtheria, pertussis, tetanus, poliomyelitis and measles. The EPI covers the five regions, 15 counties and 89 health districts of Liberia.
The National EPI Policy recommends the administration of:
- one dose of Bacille Calmette-Guérin (BCG) vaccine at birth;
- three doses of pentavalent vaccine (diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenza type b at 6, 10 and 14 weeks) (pentavalent vaccine was successfully introduced in Liberia in 2008);
- four doses of oral polio vaccine (at birth, 6, 10 and 14 weeks);
- one dose of measles vaccine at 9 months;
- one dose of yellow fever vaccine at 9 months.
Every woman of childbearing age (14–49 years) is also provided with five doses of tetanus toxoid vaccine at minimum intervals of 4 weeks, 6 months and 1 year.
As part of the injection safety policy, the EPI switched to the use of autodisposable syringes in 2005.
Improvement in immunization services over the years has led to a gradual increase in coverage as a result of:
- an increase in the number of health facilities
- an expansion of the cold chain
- increased outreach activities
- increased support from partners.
Administrative coverage for diphtheria–tetanus–pertussis (DPT3 or Penta-3) rose from 31% in 2004 to 93% in 2009.
Like all other components of the Ministry of Health and Social Welfare's health delivery system, the EPI operates on a well-defined EPI policy, which was introduced in the 1980s, formalized in 1993 and is regularly updated. The policy was revised in 2010 and targets nine vaccine-preventable diseases (TB, diphtheria, pertussis, tetanus, poliomyelitis, measles, hepatitis B, Haemophilus influenzae type b and yellow fever).
This list of diseases is likely to increase in the near future as the EPI introduces additional life-saving vaccines and technologies. Future candidate vaccines include, but are not limited to, those against pneumococcal diseases and rotavirus infections.
This section of the Immunization and vaccines development profile is structured as follows:
Since its inception, the Expanded Programme on Immunization in Liberia has led to a gradual increase in annual diphtheria–tetanus–pertussis (DPT) immunization coverage from a woeful 6% in 1997 to 42% in 2000. In 2000 and 2001, an attempt was made to improve the immunization coverage and Liberia received an award as best performing country in the WHO African Region, despite operational difficulties from the Task Force on Immunization in Africa.
However, the gains could not be consolidated in the country and coverage dropped by 50% to 31% in 2004 from 61% in 2001. The period from 2001 to 2005 saw fluctuations in DPT coverage from a low of 34% in 2003 to a peak of 87% in 2005.
The decline in coverage values was due to insecurity and consequently limited access to communities following the intermittent conflicts during this period, especially from 2002 to 2004. Higher coverage figures from 2005 to 2008 were achieved partly through intense supplementary immunization activities (county and nationwide outreaches).
Liberia faces an enormous challenge to achieve and sustain universal immunization coverage, which is a core indicator for the attainment of Millennium Development Goal 4.
In 2011, immunization coverage for the five antigens administered to children aged 0–59 months were:
- Bacille Calmette-Guérin (BCG) 78%
- third dose oral polio virus (OPV3) 77%
- third dose of pentavalent vaccine (Penta-3) 78%
- measles 73%
- yellow fever 71% (see figure).