Ebola's Legacy

Ebola Is Destroying Liberia’s Vaccination Program

With many Liberian health facilities shut down, and patients and health workers alike scared of the Ebola virus, childhood vaccination rates are plummeting.

Remko De Waal/AFP/Getty

MONROVIA, Liberia—Josephine Paye, 26, is a mother of three who lives in Monrovia’s pipeline community with her sister. She is an internally displaced woman who fled her home in Gbatala Bong County due to the high deaths from the Ebola outbreak.

Paye came to Monrovia with her third child, who is only four months old. She said that when the baby was born, he was given just one shot of the polio vaccine (the vaccine requires another shot at 4 months of age, and a third shot at 6 to 18 months of age). In Monrovia, she could not find a hospital to get her son vaccinated. Even if she had found one, she would think twice before taking him there.

Thankfully, Paye is one of the few mothers who turned up at the Pipeline Community Health Center, where routine vaccination is taking place this week.

“There were no hospitals opened, so there was no way for us to get vaccines and because of the virus, some of us are still afraid to go to hospitals. That’s why my child has not been vaccinated,” she tells me.

Nurses say that without Personal Protective Equipment (PPEs)—a scare resource in Ebola country—many clinics and health centers will not open their doors to patients. Pipeline Community Health Center has partially opened its doors to mothers and their babies so they can get vaccinated and avoid illness from other preventable diseases.

“During the Ebola outbreak, when we did not have PPEs, we would ask the mother what was happening to the child,” says Mabel Sesay, a nurse and head vaccinator at the clinic. “She would explain and we would then prescribe drugs based on the explanation without touching the child or the pregnant woman… We could not touch them because we were afraid they might have Ebola.”

Sesay says the clinic has been serving the community to the best of its ability despite the Ebola outbreak, but there was a time when they and their patients could not trust each other. She says health workers continue to be afraid that they could contract the deadly virus while providing routine health-care services.

Yassa Gayflor, 30, brought her four-month-old daughter to the clinic because she is sick. She says the nurses have done some tests and say her daughter has malaria. The child also has to be vaccinated against other diseases. Gayflor says she feels happy that she can bring her daughter to the clinic knowing that she will get treatment—unlike some months ago when she could not because of the Ebola outbreak.

“I want to tell other mothers to bring their sick children here to the hospital. It is good to bring the children for vaccines because it keeps them from getting sick,” Gayflor says.

The clinic also provides routine checkups for pregnant woman, but it has limited capacity. Comfort Reeves, another patient, did her prenatal treatment at the clinic, but when it was time to give birth, the clinic could not open its doors to her. “When I was in pain, it was late and the hospital was closed. I didn’t have the money to go far away to another hospital, so I gave birth [with a midwife] in the community,” Reeves tells me.

Nurses at the clinic say the facility cannot run a 24-hour shift due to fear of Ebola. Nurses are afraid that if they stay late to treat patients or help pregnant women give birth, they could contract the deadly virus.

“We are here from morning to 7 p.m. Sometimes we refer [patients] to JFK [another Monrovian hospital], or we ask them where they want to go. If they have any other place in mind, we refer them there,” Sesay explains.

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During immunization, the health worker who administers the vaccines has to use one pair of gloves at a time to a patient with constant washing of hands. Health workers at the facility say that is the only way to stay safe because you never know who is carrying the deadly virus.

“[In] July [and] August, patients were afraid of us and we were afraid of them. Especially when they heard that nurses were dying, they felt that we were the carriers of Ebola. But now, some have understood the reality,” says Sesay. “When the Ebola crisis came about, you know, nurses, we were all afraid. We left facilities. Even the patients were afraid to come to hospital to receive treatment. It was when they began to supply the PPEs, then, we started to come back to work.”

The United Nations Children’s Fund (UNICEF) is providing vaccines, as well as protection for vaccinators. The organization also provides PPE and gloves to keep health workers and patients safe from the deadly virus during vaccination. Laurent Duvillier, regional communications officer for UNICEF, says the group is committed to providing these materials to ensure patients’ and health workers’ safety.

“If we want to stop Ebola and the cycle of transmission, it will happen here. By protecting health workers, by protecting vaccinators and making sure that the people trust the health system and they feel secure enough to come by because they feel we are serious about protection and safety,” he said. “We need to step up and we need to bring more gloves and more PPEs. The number of gloves or PPEs is not sufficient and is not up to the standard so far,” he says.

“We are here in the frontline of the fight against Ebola; it is the first line of defense,” Duvillier continues. “People are coming here; some have high fever, some have other kinds of diseases, but if they come here and they don’t trust the system or they don’t trust the health workers, they would not get vaccinated.”

Duvillier says with adequate protection, health-care workers can easily identify Ebola cases among patients without getting infected themselves. Liberian children in other communities continue to miss out on immunization because of the deadly Ebola virus, with many health facilities shut down indefinitely.