The Maldives Expanded Programme on Immunization (EPI) was among the first in South-East Asia to introduce a Hepatitis B vaccine birth dose, achieve maternal and neonatal tetanus elimination, eradicate polio, eliminate measles, and control rubella and congenital rubella syndrome. While programmatic data indicates that vaccine coverage has remained over 95% for the past decade, decreasing coverage had been signaled by survey results and the anti-vaccination movement had been growing. To ensure the accuracy of vaccination coverage estimates, an Electronic Immunization Registry (EIR) was developed. Its pilot by WHO and partners was a success and the EIR launched nationwide in October 2022. More than 9000 children and more than 65 000 vaccination events had been entered by November 2022 [1]. By ensuring vaccine record accuracy – and therefore that the right vaccination is provided at the right time, the EIR should also increase increase Vaccine Preventable Disease protection for individuals and for the whole community, even those who cannot be vaccinated.

 

How did Maldives, with the support of the WHO Secretariat, achieve this?

 

WHO Maldives conducted a review of the country’s vaccination programme in 2019 and a COVID-19 and HPV vaccines post-introduction evaluation (cPIE) in 2021 with the support of WHO headquarters, WHO Regional Office, and other invited international experts. Based on the results of the review, Ministry of Health (MoH), Maldives, expressed the need for an Electronic Immunization Registry (EIR) to ease some of the challenges currently being faced by the data users and the public.

 

WHO is the lead technical agency in the Maldives and has a good working relationship with the MoH. WHO Maldives Vaccine Preventable Disease and COVID-19 vaccination teams collaborated with the MoH to conceptualize the EIR as a single digital platform through which children’s vaccine information from all vaccination centres of the Maldives could be routinely tracked and managed securely. Financed by WHO and GAVI, the EIR was developed by WHO Maldives digital health team based on DHIS2 [2] with technical support from WHO Regional Office and Health Information Systems Programme (HISP) Sri Lanka [3]. DHIS2 is a globally accepted, free and open-source health information management platform.

 

“Digital technologies are integral to daily life, and the world’s population has never been more interconnected. WHO is committed to transferring technology to the Maldives to sustainably build immunization information system capacity”

-          Dr Nazneen Anwar, WHO Representative to Maldives

 

The EIR captures and stores individual-level information on all vaccines delivered and displays immunization performance as well as coverage at the health centre, sub-national, and national levels using dashboards. This enables vaccination centres to easily verify routine childhood vaccines, optional vaccines, influenza vaccines, special vaccination campaigns, and vaccines for pregnant women, travelers, and health workers. Tailored functions for the Maldives context added by HISP include a beneficiary portal that helps parents track the vaccination status of their children and download digital vaccination certificates. The system also enables SMS alerts and planning functions for vaccination, as well as customized, advanced data analytics.