With a strong and solid strategy over the last 25 years, in researching, organising, communicating, teaming up with WHO, Republic of Moldova has made a significant evolution in addressing the issues of access to essential medicines, vaccines, diagnostics and devices for primary health care, through National Immunization Programme (NIP), now at its 5th edition.
The immunization process of the population, through vaccinations, was recognized as a public health priority and the positive results were achieved in the last years through the direct technical support of the WHO Country Office in the Republic of Moldova. NIP aimed to eliminate or reduce morbidity, disability and mortality by providing the population with mandatory immunizations, guaranteed by the state.
There were many issues to address in 1996, when NIP began, and some still linger as the general immunization coverage in the Republic of Moldova is below the regional target of WHO European Region. Vaccine coverage decreased in the Republic of Moldova from 2005 to 2019 by over 6% for all antigens in the national immunization schedule. Besides vaccine hesitancy, there were other impediments, like a lack of human resources specialised in health, data quality issues or budgeting of the campaign. Also, national internal funds for public health actions were very limited and had wide spread of actions in public health domains.
But with a coherent strategy and implementation, these problems are being addressed and some solved.
The WHO Country Office in the Republic of Moldova has included rise of vaccination coverage in priority actions by implementation of new approaches in communication, development of information immunization system and research activities for national, regional and global level.
A well-developed electronic Immunization information systems (IIS) in partnership with EPI (note: The Expanded Programme on Immunization, developed by WHO) for the public health system was developed and implemented in pilot areas. From 2021 the IIS will be used in order to increase quality of data not only for vaccination status, but for a well function stock management evidence of vaccines, in real time, at all levels, national, regional and local level. All 1380 vaccination points from Republic of Moldova will have access in 2021 to the IIS platform, so that the information technology improves efficiency and accuracy of immunization information management and reporting.
Another fundamental project implemented recently in the Republic of Moldova, a collaboration of WHO with Robert Koch Institute and National Agency for Public Health in Moldova, was the development of research, by conducting a serosurvey for vaccine preventable diseases, in order to evaluate the impact of the Hepatitis B (HBV) vaccination in the Republic of Moldova and also whether the control goal of ≤ 0.5% of HBsAg prevalence in vaccinated cohorts has been achieved. This study was conducted with a response rate of more than 96,5% during COVID-19. To date, no seroprevalence survey has been conducted in Republic of Moldova to determine the impact of HBV vaccination, so this is a premiere, and a successful one, as from the total initial proposed 3352 samples to be taken from children (born in 2013), 96.5% were collected, and data (to be issued later in 2021) will serve not only for national level, but for international level at the same time, and will deliver significant important data.
This 25 years long process of continuous effort, in different stages, has resulted in the construction of a national integrated system - logistic, human resources, financial wise – to raise the access of general population to immunization services, to build up a functional model, at all levels, in order to gain increase demand for vaccines (through innovative communication campaigns), equipment to sustain the logistics (like the development of cold chain principle, referring to the reception, storage and distribution of vaccines), or to obtain political commitment and financial sustainability.
The access of children to vaccines is now free of charge in Moldova and vaccination is mandatory at enrolment in educational institutions (except HPV vaccine, which is recommended for 10 years girls).
Photo caption: Gabriela Suleac is 28 and the mother of two children: a four-year-old girl named Jaclin and a three-year-old boy called Benjamin. She strictly follows the national immunization schedule as she is convinced that this is the only way to keep her children safe, "Through vaccines I can protect my children from deadly diseases that have affected many people in the past”.
Photo credit: WHO
