Economic status affects children’s immunization
Parental challenges that lead to missed vaccines
Lamitan City, Basilan, 03 April 2024 – Nurina Dalpaki, 30, has six children aged 2 months old to 10 years old, none of whom goes to school. Neither are the children immunized against life-threatening diseases, such as polio and tuberculosis.
“I’m so busy working,” says Dalpaki. “I don’t have time to take them to the health station.” Dalpaki peddles fish every day, and every three days, she washes clothes for a family with better means. Her husband left her and their children when she was pregnant with their youngest child.
Belonging to the ethnic group Sama Banguingui (often called Bajaus by outsiders), Dalpaki and her children live in a stilt community in Lamitan City, Basilan, around 1,400 kilometers south of the capital, Manila.
The household includes Dalpaki’s parents and four siblings, and like her, the other adults in the family earn barely enough for their daily needs.
“Health workers sometimes come to our house and explain to us the importance of vaccines,” says Dalpaki. “But work is our priority. We have to ensure that we have something to eat. We even run out of money often and have to get items from the store on credit.”
Zero-dose prevalence
Dalpaki’s children are classified as “zero-dose,” which means that they have not received any vaccinations. The Philippines has more or less 1.5 million zero-dose children, according to The State of the World’s Children 2023, a report published by UNICEF.
Based on the same report, women who are less “empowered” are also less likely to have their children vaccinated. In the Philippines, mothers who rank low in the empowerment scale have 28.5 percent prevalence of zero-dose children. Mothers who rank in the middle have 15.5 percent prevalence, and mothers who rank high have 11 percent prevalence.
To measure women’s empowerment, researchers took into account social independence, which includes schooling attainment, access to information, age at pivotal life events and spousal asset differentials.
Same place, different situation
Sonia Lambung, 21, also lives in a stilt house not far away from Dalpaki’s, but all of Lambung’s three children are vaccinated. Twins Najil and Ajil, 4, are listed at the barangay health station as “fully immunized,” which means that they have received fifteen doses of seven types of vaccines within first year of life, and Aldrin, 11 months old, has received his vaccines on schedule.
“I’m home every day taking care of my children,” says Lambung. “I have time to take them to the health station.” Her husband, a fish vendor at the public market, earns enough for the family.
“I want my children to be immunized because I’ve observed that immunized children are healthy and do not get sick often,” Lambung adds. “My husband shares my views. He’s supportive. If he’s free, he goes with me and the children to the health station.”
Health workers do not need to exert extra efforts for Lambung. “Sometimes no one tells me that there’s a schedule for vaccination. I just see that people are taking their children to the health station, and I ask them why. When they tell me that it’s for vaccination, I take my children too.”
More funds and incentives
Overall, routine immunization in Lamitan City has fallen to an alarming rate. “We admit that it has been neglected,” says city health officer Afreen Amerin. “Currently, we have given about 30 percent only of the necessary vaccines.”
Preventing measles, whooping cough and rubella and other childhood diseases is critical in densely populated areas. However, even in remote areas like on Basilan Island it is important. If children don’t get routine immunization, it means they do not get other important child health services. Unless measles vaccination coverage reaches 95 per cent, deadly outbreaks may return.
Due to the pandemic, the City Health Office had to prioritize COVID-19 immunization. “There was also a shortage of supply for routine immunization,” explains Amerin. “But now that the situation is getting back to what it used to be, we are giving due attention to routine immunization.”
Inadequate financial resources hinder the implementation of health programs. “We already have strategies in place,” says Amerin. “Our health workers strive to change the mindset of those who are against vaccination. But we don’t have enough funds. We need to hire more personnel. We need to give incentives to barangay health workers and to people who participate in immunization programs.”
The doctor observes that incentives are effective. “During the pandemic, the city government gave out grocery packs to those who had themselves vaccinated. Many Bajaus participated.”
The same strategy may be applied to routine immunization. “Many people nowadays have difficulty making ends meet,” says Amerin, “so if the government asks them to do something and they don’t get anything in return, they would rather do other things.”
“I know that vaccines are good,” says Dalpaki. “When my older children were young, they got sick often and had to spend up to two months in the hospital. Their health would have been better if they had been vaccinated. I want my children to be vaccinated, especially the youngest ones, but I can’t have it done due to work.”
