Fighting Measles in Marawi
Immunization drive aims to end outbreak in Bangsamoro region
Marawi City, Lanao del Sur, 19 April 2024 – At Basak Malutlut, a densely populated barangay (village) in this city, about 800 kilometers south of the national capital, Manila, Ramona Pascual walks quickly along business establishments, avoiding every now and then the various merchandise displayed on the pavement.
The middle-aged midwife has to conduct home visits and vaccinate dozens of children every day as part of an intensive immunization programme to end the continuing measles outbreak in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM). Organized by BARMM’s Ministry of Health – with support from the national government’s Department of Health, as well as UNICEF Philippines and World Health Organization – the programme aims to vaccinate 1.3 million children aged 6 months to below 10 years old.
BARMM has recorded 630 measles cases in the first quarter of 2024, accounting for almost half of the 1,356 cases nationwide1. Within the region, the city of Marawi holds the fourth highest number of cases, with 932. Basak Malutlut, with 6 cases, has the third highest number among the 33 affected barangays in the city.
“Majority of those who are sick with measles have not received any vaccination,” says Dr. Martin Parreño, UNICEF Health and Nutrition Specialist. He also emphasizes the importance of a quick response. “Measles is highly infectious. One infected person can transmit the virus to 16 other persons per day, and the complications are deadly.
Complications include pneumonia, encephalitis (brain infection), ear infection, diarrhoea and blindness. To detect measles early, Dr. Parreño calls for parents to be on the lookout for symptoms of the disease. “These include the three C’s – coryza (runny nose), cough and conjunctivitis (red eyes) – plus fever and rash.”
A pro-vaccine family
Pascual goes around her barangay with the nurse who supervises her and three volunteer workers who help her with the records and vaccine paraphernalia. They enter an alley between two retail stores, and on the dead end they find a mother washing clothes outside her house.
The midwife explains that all children who fall within the specified age range must be vaccinated, even if they have been vaccinated before, but if they are sick or they received their last dose of measles vaccine within the last four weeks, they’re exempted. The mother, Mairah Abdulfattah, readily agrees. She calls out of the house her eligible children.
Of Abdulfattah’s 10 children, 6 fall within the specified age range, but 1 is not around and living with relatives. When the midwife inspects the 5 children one by one, she finds out that 2 of them have a rash. Since the 2 children seem to have measles or another disease, the midwife defers their vaccination until their skin is cleared. The remaining 3 children undergo vaccination without any problems.
“I support vaccination. It protects children from serious diseases. I trust healthcare workers. I can see that their activities have good effects on the community. I even try convince other parents to have their children vaccinated.”
Parents’ fears
“I’ve been serving the village for more than 20 years,” says Pascual. “Most of the residents here listen to me and participate in the health programs of the government. But some are difficult to persuade. They wrongly believe that vaccines are harmful instead of good. They fall for rumors and fake news.”
From the Abdulfattahs’ house, the healthcare workers return to the road. Pascual spots some children helping in a grocery store. She informs the parents of the ongoing immunization drive, but the parents tell her that the family does not live in the city and the children have been vaccinated back in their town.
As the capital and component city of Lanao del Sur, Marawi is home to at least 200,000 people and attracts thousands of transient workers and traders. When asked about the children’s vaccination cards, the parents say that they have left the cards back home. “Situations like this is a challenge for health workers,” says Pascual. “Whether the parents are telling the truth or just distrustful of vaccines, I have to take them at their word.”
“We are struggling with vaccine hesitancy,” says Dr. Ali Dalidig, head of Marawi’s City Health Office. “We send vaccinators to people’s doorsteps, only to be turned away by many parents. Some parents say that vaccination is against their religious or traditional beliefs. Others became wary of measles vaccines due to the stigma surrounding COVID-19 vaccines.”
As a response, the City Health Office are taking actions to lessen refusals and vaccinate at least 95 per cent of the target population, the necessary coverage to stop the ongoing outbreak and prevent a new one.
Current and future solutions
“We’ve coordinated with the city’s ulama (scholars) council so that pro-vaccination teachings are incorporated in the khutbah (sermon) during the Friday congregational prayer,” says Dr. Dalidig. “We also conduct vaccinations in the weekly caravan of the city government wherein different services are given.”
As to transient families that refuse vaccination, the City Health Office plans to take their names and refer them to their respective municipal health offices. Dr. Dalidig also calls for more support for healthcare workers. “They should be given allowance and incentives aside from their salary. They need more training to improve their skills. They also need bigger vaccine carriers since the carriers that they have now have a short cold life.”
The doctor shares that Marawi is near the standard ratio of healthcare workers to population, but the number does not suffice in the current situation. “We need more vaccinators. Since last year, the city government has augmented our workforce with 12 vaccinators, but we need to hire more, even just temporarily. If our regular workforce have to continue focusing on measles, their routine work might be neglected and an outbreak of another vaccine-preventable disease may occur.”
“Healthcare workers need more support from local government units and other stakeholders,” says Dr. Parreño. “To end vaccine-preventable diseases, we must work together to provide vaccines to every child, especially in the most vulnerable and disadvantaged communities.”
At Basak Malutlut, many of the alleys that Pascual enter lead to multilevel houses shared by extended families. The children inside are in close contact most of the time, making for easy transmission of communicable diseases.
“I hope all the children in Marawi will be vaccinated. It’s difficult when we fight the same thing again and again.”
1 Department of Health. Measles-Rubella Situation Update as of April 8, 2024.
2 Measles-Rubella Reported Cases in BARMM as of April 8, 2024.
