Community health workers in Brazil work tirelessly to reach children who missed out o
Discover how they navigate rural rivers and bustling cities to reach those who need them most.
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Whenever Dynnhyfer de Souza helps to protect the health of a child, it has a profound impact on her. “I get emotional when people line up to be vaccinated by me,” says the nursing technician who lives in the Brazilian city of Baturité, Ceará. “They say I have a light hand, which is very rewarding. I like to help! What I want for children is health and immunization to avoid diseases.”
The efforts of health workers like Souza are particularly important at this time. Since 2015, vaccination coverage for children in Brazil under the age of 5 has been falling. That’s placing children at much greater risk of vaccine-preventable diseases like polio and measles. During the COVID-19 pandemic, the situation got worse. Families faced additional challenges when it came to accessing public health services and an increase in vaccine hesitancy has also been a factor. However, the country is showing some encouraging signs.
National coverage for the measles vaccine went from 73 per cent coverage in 2021 to 81 per cent coverage in 2022. That’s still short of the 91 per cent coverage mark that was achieved in 2019, prior to the COVID-19 pandemic.
On average, across different routine vaccines, Brazil is bouncing back and recovering
The situation in Brazil reflects some of the trends that we’re seeing globally when it comes to making sure that children are protected from potentially deadly diseases with the routine immunizations they need to live healthy lives.
New data from UNICEF and WHO reveals that after the largest sustained decline in routine immunization in a generation – largely due to the COVID-19 pandemic – there are some signs of recovery. But the recovery is uneven. In a few countries, immunization rates are on the rise, but in most nations, particularly low-middle- and low-income countries, the rates are either stagnating or even worse, they continue to decline.
According to the new data, regions of Southeast Asia and the Eastern Mediterranean are experiencing resilient recoveries. But in parts of the Americas, which had experienced long standing declines in vaccine coverage prior to the pandemic, that trend has continued.
UNICEF/U.S. CDC/ UNI408795/Hiller
UNICEF/U.S. CDC/ UNI408802/Hiller
To continue to boost immunization rates, sustained investment in vaccination campaigns is imperative and that’s what’s happening in Baturité. The city is one of the places in Brazil where UNICEF and its partners are leading a pilot programme called Busca Ativa Vacinal (Active Vaccination Search). The initiative is expanding vaccination efforts beyond hospitals, offering services in an array of convenient locations, including day care centres.
UNICEF/U.S. CDC/UNI408799/Hiller
UNICEF/U.S. CDC/UNI408816/Hiller
Dynnhyfer de Souza is helping to lead one of these outreach campaigns at an early childhood education centre. On one day alone she provided 27 vaccines to 21 children. “When people want to get vaccinated with me, it shows that they like my work and makes me try to serve them better and better,” Souza reflects as she sifts through the children’s vaccination cards to check if their vaccines are up to date.
UNICEF/U.S. CDC/UNI408808/Hiller
UNICEF/U.S. CDC/UNI408820/Hiller
The efforts of Souza and the larger campaign that she’s a part of have had a significant impact. At the close of the campaign in Baturité, which ran from May to November 2022, more than 95 per cent of children in the city had been immunized (either during or prior to the campaign) against polio and other preventable diseases.
Reaching children in the city that’s the gateway to the Amazon rainforest
The latest global data reveals that during 2022 there were some positive trends, including a 2.5 million reduction in the number of zero-dose children worldwide. A zero-dose child is one that has not received a single dose of a diphtheria, tetanus, pertussis vaccine. But the reality is that about one in five children are still zero-dose or under-vaccinated, meaning that they’ve missed out entirely or partially on routine immunization. Those are levels we’ve not seen since 2008.
Reaching those children requires the development of vaccination campaigns and strategies that are unique to the circumstances facing specific communities. That’s the case in the city of Manaus, which lies on the banks of the Negro River in northwestern Brazil. The city is the capital of the vast rainforest state of Amazonas and while the city itself has a population of more than 2 million, it’s surrounded by incredibly remote areas. Therefore, reaching children with vaccines requires different approaches and creative modes of transport.
UNICEF/U.S. CDC/ UN0846734/Hiller
Lindalva de Freitas, a community health worker in Manaus, is often seen walking the city’s streets, going up and down hills, balancing on improvised wooden bridges and when necessary, crossing the river in a canoe. The purpose: reaching a child with health services in their own home.
UNICEF/U.S. CDC/ UN0822149/Erico Hiller
“We know that vaccines are important for the child's health, but many parents delay it because they don't have the time, because they have to work, because they don't have money, they can't come to the Health Unit. So, our job needs to be to search for these families on a daily basis,” she says.
UNICEF/U.S. CDC/UNI410669/Érico Hiller
“For many families who don't have financial conditions, the most important thing is to eat. It is the reality that we see. So, we go out with the boxes and take the vaccine to homes, to vaccinate those who need it.”
In addition to the field visits, which sees her traversing the waterways by canoe, Lindalva de Freitas also provides services at the Lago do Aleixo Health Unit in Manaus, where she’s worked for more than 20 years.
Health workers from that same facility have been providing care to 4-year-old Gabriel de Oliveira. When Gabriel was a baby, he was orphaned along with his brothers Kauan, 10, and Kennedy, 5. The three boys had no medical records at the time, and no vaccinations. Their grandmother, Elmira de Oliveira, took care of the boys, and for her, accessing health care for her grandchildren was paramount.
UNICEF/U.S. CDC/UN0846733/Hiller
UNICEF/U.S. CDC/UN0846751/Érico Hiller
“I just want to be healthy and strong enough to take care of them and not abandon them,” she says. “I want that one day, when they grow up, they can say, 'my grandmother didn't give me good clothes or new shoes, but she gave me a roof over my head, took care of me and fought for my health.’” Thanks to the efforts of the health workers and the care of their grandmother, Gabriel, Kauan and Kennedy are now receiving the vaccinations they need to protect them.
With these children vaccinated, they’re offered protection against dangerous diseases like measles, polio and diphtheria that were previously controlled but have recently been reemerging in different parts of the world.
We know that vaccines are the best way to protect every child against more disease outbreaks, epidemics and pandemics, so a continued, concerted effort globally to address the declines that have been witnessed in vaccination coverage worldwide is absolutely paramount.
Hard-to-reach riverside communities in Abaetetuba are getting access to essential health care services
The Active Vaccination Search initiative has also been operating in the municipality of Abaetetuba, in northern Brazil, which is formed by 72 islands.
Childhood immunization is starting to recover and this is what needs to happen next
Immunization initiatives like the Active Vaccination Search project in Brazil highlight how important it is moving forward that governments of countries that have been particularly affected by the decline of immunization rates among children continue to focus on the following:
- Repurpose available financial resources to increase vaccination rates, including leftover COVID-19 funds
- Renumerate and support community health workers as an essential step in reaching under-vaccinated and zero-dose children, preventing more catastrophic disease outbreaks
- Restore immunization services and catch-up the children who missed out on their routine vaccinations during the COVID-19 pandemic
By taking these steps, we can reach those children in remote villages, urban slums and conflict zones that are so often overlooked, ensuring they’re given the chance they deserve to live healthy lives, protected with the vaccines they need to thrive.
