As in many countries, the COVID-19 pandemic disrupted routine health services in the Republic of Moldova, including immunization programmes. Health-seeking behaviour declined and children’s vaccination schedules became disrupted, lowering population protection for childhood vaccine-preventable illnesses. Consequently, immunization programmes needed strengthening in preparation for and following the initial COVID-19 vaccine campaigns. WHO Country Office in the Republic of Moldova (WHO Moldova), with the support of the European Union, supported the Ministry of Health (MoH) and National Agency for Public Health (NAPH) to implement an awareness campaign in 10 districts with markedly lower vaccination coverage to increase concurrently the coverage of childhood and COVID-19 vaccinations. This resulted in an increased coverage of both MMR-1 and DTP3 as well as COVID-19 in target populations and targeted districts. Following this success, WHO aims to support the country to expand the campaign into other districts.
Key WHO Contributions
Conceptualization of national plan
Mobilization of financial resources for implementation
Technical expertise to contextualize each district plan according to local capacities
Advocacy with wide range of stakeholders for a whole-of-society approach
Conducting awareness-building training on vaccines and vaccine-preventable diseases.
How did the Republic of Moldova, with the support of the WHO Secretariat, achieve this?
Authorities in the Republic of Moldova observed a downward trend in vaccination coverage to below 85% during the COVID-19 pandemic, increasing the likelihood of vaccine-preventable diseases. For example, coverage with the first dose of measles, mumps and rubella (MMR-1) vaccine at 12 months of age fell from 88% in 2019 to 83% in 2021 [1]. Further data submitted by each primary health care facility in the country identified specific districts with markedly lower vaccination coverage than others for both routine and COVID-19 vaccinations.
To ensure the population in these districts were aware of the importance of immunization and how to access vaccines, WHO Moldova with the support of the European Union and together with the MoH and NAPH, conceptualized and launched the “Vaccinate yourself! Protect your future!” awareness campaign in 10 districts in the country (out of 37 in total) with the lowest coverage for MMR-1, diphtheria-tetanus-pertussis (DTP3) and COVID-19 vaccines. These regions were Strășeni, Bălți, Criuleni, Comrat, Cahul, Călărași, Căușeni, Chișinău, Sîngerei and Ungheni.
WHO Moldova provided technical support to develop the joint concept paper and established a set of national-level indicators to support the implementation of the campaign. It also arranged transportation for vaccination teams across all the districts. Based on WHO guidelines and recommendations and with the support of WHO Moldova, district plans were developed, tailored to the local context and linked to the operational capacities of immunization and other health programmes, given the scarcity of resources at local level [2]. During the three-month campaign (June–August 2022), local coordinators, immunization managers and health care workers took part in main launch events in every district. Over 3000 community members (school directors, teachers, social workers, priests, mayors, members of the police force, etc.) were identified and trained with technical support from WHO Moldova to deliver and distribute the campaign’s evidence-based messages on the importance of vaccination and risks of vaccine-preventable diseases.
Priest addressing the taskforce in Criuleni, 30 May 2022.
Photo credit: WHO Moldova.
Throughout the campaign, religious leaders were engaged to mobilize members of their communities who may have been reluctant to vaccinate. Additionally, WHO Moldova colleagues conducted door-to-door outreach to sensitize the local populations. In all these actions, community members took charge of campaign coordination for each district.
“From the first stage until the end of the campaign, primary health care worked jointly with all departments: social assistance, police inspectorate and local public administrations to inform the population and to raise awareness of the need for vaccination among people.”
- Victor Bahnaru, head of Strășeni Health Centre
Based on the national report developed by the NAPH with the support of WHO Moldova, from June to August 2022, there was a 1.4-fold increase in the number of doses of COVID-19 vaccine administered in targeted regions compared to others which did not implement targeted actions for the same period [3]. A significant increase was recorded in the number of COVID-19 doses administered in the same period compared to the previous three months, with 4.8, 3.3 and 3.2 times more doses administered in Sîngerei, Ungheni and Comrat districts, respectively. Similarly, there was a 1.2-fold increase in MMR-1 dose administration during this period in targeted regions, with a 1.2-fold increase for DTP3 vaccination. Overall, actions taken during the awareness raising campaign led to an increase in vaccination coverage by 1.2 times more for MMR-1 in the same period (June to August 2022) than in the previous two years (2020 and 2021), and by 1.4 times more for DPT3. By the end of the campaign, all administrative territories attained COVID-19 vaccination coverage of more than 70% for the prioritized groups including those with comorbidities, persons aged 60 and over, and educational and social workers. Among health care workers, over 95% coverage for COVID-19 vaccination was achieved prior to the campaign [4].
The activities and actions undertaken as part of the campaign were aimed at strengthening the capacity to increase the administration of key vaccinations and to inform the populations. It involved citizens from different walks of life, from medical and public health specialists to local political and religious figures. WHO Moldova played a critical role in this process by providing technical expertise to develop key campaign documents and conduct local training sessions and door-to-door campaigns. Advocacy for involvement of religious figures was also critical to the success of the campaign. In view of the results recorded in the 10 districts, the “Vaccinate yourself! Protect your future!” campaign is to be extended to other districts in the country, and WHO Moldova will continue to work with the national authorities to replicate this success.
References
- Ministry of Health. National Immunization Programme 2023–2027. Chișinău, Republic of Moldova; 2023. https://cancelaria.gov.md/sites/default/files/document/attachments/44-ms.pdf (accessed 21 March 2023).
- World Health Organization European Region, January 2022. https://covid.comesa.int/europe/publications/i/item/WHO-EURO-2022-4751-44514-63005 (accessed 30 March 2023).
- Ministry of Health. Results of the campaign “Vaccinate yourself! Protect your future!” 6 February 2023. Chișinău, Republic of Moldova; 2023 [in Moldovan]. https://ms.gov.md/comunicare/comunicate/rezultatele-campaniei-vaccineaza-te-protejeaza-ti-viitorul-prezentate-la-ungheni/ (accessed 21 March 2023).
- Ministry of Health. Weekly report: epidemiological report on COVID-19 infection and vaccination: 6 March 2022 [in Moldovan]. https://msmps.gov.md/wp-content/uploads/2022/03/06.03.2022_COVID-19_.pdf (accessed 21 March 2023).
