Smart Vaccination by Digital Vaccine Record

The Expanded Programme on Immunization (EPI) is considered the most successful public health initiative globally. It was introduced in Bangladesh in 1979 with six vaccines against six preventable communicable diseases. Periodically new vaccines were added to the program and currently the program provides vaccinations against 10 communicable diseases. The objective was to reduce child and maternal mortality rate along with polio related disabilities in children.

In Bangladesh alone, the vaccination coverage grew from 2% in 1985 to 84% by 2019.¹ At present it is neck to neck with the target of covering 90% children nationwide and 85% at the districts.²

Geographically, Bangladesh might be considered a small country, but population wise it is one of the largest countries in the world. To execute the national strategies for specific objectives, detailed planning is required. EPI is also designed with an extensive strategy to ensure the cold chain is maintained till it reaches the vaccination center (Fig-1). Government has set up guidelines that covers citizens’ buy in, health human resource planning, monitoring and evaluating progress, safe disposal of syringes and vials, follow up of adverse reaction to vaccination, disease surveillance, and implementation of vaccination through various campaigns.²

The combined effort of the government, development sector and non-governmental organizations (NGO) helped achieve this milestone. The Global Alliance for Vaccines and Immunization (GAVI) recognizes advocacy to be a key element of the success of (EPI) in Bangladesh.³

Fig-1: Cold Chain from the EPI Central Head Quarter to the Last Mile Vaccination Center²

Although, Bangladesh received multiple recognition for successfully implementing and sustaining the EPI schedule for decades, the vaccination record keeping at the individual level continues to be maintained in vaccine cards or paper formats. There is still no digital platform established to record and report the vaccinations of each child. The healthcare workers at the vaccination centers are given the task of registering the beneficiary, provide the vaccine cards, and engage in conversation with the guardian every time the child is brought to the center for maintaining the schedules and reduce vaccine drop out. The EPI also triggered the increase in birth registration. This has helped expand the social security schemes of the government for children. Any kind of registration that signs up an individual with a program are the demographic tools for a government to make national strategies related to food distribution, education, and health provision for the citizens to ensure everyone is brought under the social network. An innovative application like a digital vaccine card might play a pivotal role in assuring the people about the commitment of the government to enforce health and security of the children and bring more accuracy and accountability of the entire EPI program.

Digital Vaccine Record- A low Hanging Fruit

Bangladesh’s management of Covid 19 has been lauded all over the world. The tremendously successful vaccine roll-out program during the pandemic is a validation of how we could leverage the expertise we acquired from over four decades of EPI schedule.

The government utilized the strengths of ICT Ministry and Ministry of Health to organize a flawless execution of vaccination to come out of the health emergency. The ICT ministry developed the Surokkha app and web platform⁴ for all citizens to register for vaccine with either the national ID card, the passport or with the birth certificate. Surokkha generated a tracking system from the ZIP code of each registration and gave option to the individual to choose their designated vaccine center. Notifications were sent via SMSes with the date and time of vaccination. Once vaccinated by the health care providers, it was duly recorded and have remained in the web platform as personal vaccination record and can be generated in PDF at any given time when needed. Even without the pre-registration, there were special days of mass vaccination in millions at specific vaccine centers which were all digitally recorded.

Developing a simpler format of Surokkha or an EPI Digital App/ webplatform is a low hanging fruit at this point for the health policy makers. It will make managing vaccination schedule much easier for the health care providers since they are given the responsibilities to ensure 90% vaccine coverage.

A digital solution usually creates high impact. If the entire EPI is brought under such a solution, all information related to vaccination will directly reach the beneficiaries on one end and to the implementor on the other end to validate the success of high coverage backed by data.

Features and Advantages:

1. It will generate awareness on vaccination.
2. Deliver information to beneficiaries why vaccination is needed.
3. Auto-generated notification on upcoming vaccine schedule.
4. Record the vaccination date.
5. Monitor vaccine dropouts.
6. Instant access to vaccine record that can be shared online or printed when needed.
7. Introducing and keeping specific vaccines available that are required for migration to foreign countries for work or higher education.
8. Data will be available for retrospective analysis on the quality of inoculated vaccines if a sudden disease breakout happens.
9. Overall, vaccination tracking will be easier. In many families, the vaccine cards of children that the parents must preserve usually gets misplaced or lost. 
10. Additional information on population demography, monitoring the age of the demography for other purposes.
11. The densely populated society is a risk factor of diseases spreading rapidly. The health policy makers and providers will have a tool to track and take remedial action if any breakout happens.

Disadvantages:

1. It will be an enormous amount of data that will need to be protected and saved for a long period.
2. Patient privacy protection maintenance will require additional encryption.
3. Breach of data security may wipe out all records.

The advantages of having digital vaccine record outweighs the disadvantages. Since there is high internet penetration with millions of smart phone users, having and maintaining a digital vaccine record system can be a part of the smart Bangladesh agenda. Most developed countries have it. The solution will be an initial step to identify birth rate trends and area specific population increase that will provide data to build further societal development infrastructures.