Vaccinating Syrian children: there’s an app for that

WHO/Sheahen

Dr Azza El Fadel, consultant for the Expanded Programme for Immunization, monitors the work of teams that vaccinate children in northern Syria.

“During a measles campaign in north Raqqa, [Syrian Arab Republic], it was reported through a messaging app that there were not enough vaccines in one area,” says Ibrahim*, a doctor who coordinates vaccination teams in volatile areas of northern Syria. “We immediately managed to transport the vaccines via a very complicated route, through areas controlled by different factions.”

Ibrahim is part of the Syria Immunization Group (SIG), a confederation of health organizations coordinated by WHO that makes sure children in war-torn northern Syria don’t miss out on vaccinations. Despite airstrikes, sniper fire and destroyed roads, SIG teams have managed to vaccinate millions of children against polio, measles and other diseases in the past 2 years.

Immunization work in northern Syria depends on technology

Much of the time, messaging apps help make vaccinations happen—especially because SIG monitors the vaccination campaigns from its office across the border in Gaziantep, Turkey.

“Most of our work depends on messaging apps and video calling services,” says Ahmed*, another doctor from SIG.  “In the immunization campaigns, there’s a messaging app group for data entry, finance, logistics, social mobilization, linking the team here in Gaziantep and the teams in northern Syria.”

“In a recent campaign, our target was 5 000 kids. But because families had been displaced from another area, we ended up vaccinating 12 000 children,” says SIG doctor Mousa*. Messaging apps helped the teams adapt quickly to the changing reality on the ground so that children were not left out. “Vaccinators worked late into the night,” he says.

“Sometimes the target number of children isn’t what we expect,” agrees Dr Mostapha Loutfy, a WHO consultant for poliomyelitis and the expanded programme on immunization (EPI). “Sometimes it’s that the community has moved. Sometimes it’s refusals—parents say no. Sometimes areas are very hard to reach.”

Teams must grapple with obstacles in logistics. “Sometimes when we transport vaccines from Turkey to northern Syria, we have to deal with many authorities on the front lines,” says Ahmed. “The driver is in touch via a messaging app.”

Finding many uses for technology

Messaging apps also help during those rare times when children are suspected of having a reaction to a shot. “When there are adverse events, we use a messaging app to contact the specialist doctor who’s with the child,” says Mousa. “We talk to the doctor from here in Gaziantep” to make sure symptoms are addressed.

Much of the initial training for vaccination teams also takes place using technology, via a video calling service. “Everything from the detailed planning system, to social mobilization, to the cold chain—we cover it during training,” says Loutfy.

SIG works with internet service providers to raise awareness that vaccination teams are coming to certain areas. “Every time you open your phone’s browser to surf the internet, you see an ad about the vaccination campaign,” says a social mobiliser for SIG. The group’s Facebook page also helps spread the word.

This is the high-tech side of an operation that often must go back to basics. “We’ve delivered vaccines on camels, tractors, boats, on foot,” says Ibrahim.

Hundreds of thousands of children already reached in 2017, with more campaigns planned

SIG is planning to vaccinate 1.4 million children against polio in 2017, and is already well on its way. In late February 2017, its polio teams vaccinated more than 600 000 children in the space of a few weeks, often in remote areas. The massive effort wouldn’t have been possible without messaging app groups. “If there’s a problem with access or logistics, we try to address it and solve it,” says Dr Azza El Fadel, a WHO consultant for the EPI. “At evening meetings, we analyse the field data and discuss it. We get feedback from independent monitors, and we give detailed feedback to the field workers.” The same methods work for measles and other campaigns.

Reaching so many children during a war is an enormous task. “We’re always worried and anxious about the results,” says Ahmed. Social media and apps help keep the operations running, but teams constantly encounter new challenges. “We do so much planning. Each campaign feels like the first.”

In early 2017, WHO’s immunization work in northern Syria was supported by the Department for International Development (United Kingdom), European Civil Protection and Humanitarian Aid Operations (ECHO) and the United States Agency for International Development (USAID).
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* Some names have been changed for security reasons.