This post is part of a series produced by Fusion and the Clinton Global Initiative in recognition of the latter’s CGI University meeting (March 6-8 at the University of Miami). CGI University gathers more than 1000 student leaders to create solutions to some of the world’s most pressing challenges. For more information, click here.
Click here to read more of Fusion’s coverage of the event.
Throughout my global health work in Jordan, local doctors have told me about dealing with parents so eager to vaccinate their children that, day after day, they inundate medical practices with phone calls during stock-outs. So, as measles struck the United States this winter, I’ve struggled to understand the choice some parents make to turn down protection against a plague risen from the grave.
Immunization rates are generally high in the Middle East, where mostly middle- and upper-income countries have strong public health systems and international organizations fill in the gaps for the poorest.
Vaccine skeptics might take some advice from Haneen, a mother in Jordan who contracted rubella as a young woman. “I had small red spots spread all over my body,” she said. “I couldn’t believe it. Ever since then, I have been determined to make sure my daughter gets all the immunizations she needed.”
However, children still miss immunizations in this part of the world – and sometimes for very different reasons than their U.S. counterparts. In America, the skepticism of parents may keep kids from receiving life-saving shots. In the Middle East, violent conflict is an unfortunate, and less widely known, barrier between young people and access to vaccines.
Vaccine skeptics might take some advice from Haneen, a mother in Jordan who contracted rubella as a young woman.
War and Shots
In the battle against infectious disease, truce is fragile: diseases do not back down in the face of international condemnation, and they have a pesky habit of disregarding borders. The 2013 reemergence of polio in Syria serves as one of the most chilling reminders. Only a small fraction of polio carriers become paralyzed, but as of last summer more than 100 Syrian children were displaying symptoms.
As immunization scheduling becomes unpredictable during times of conflict, missed appointments become more common, leaving vaccines limited to a first-come, first-served basis.
The wrath of preventable disease was never more evident than just days prior to last summer’s war in the Gaza Strip, when my office learned of a typhoid fever outbreak in the territory. These cases were quickly followed by tens of thousands of Gazans crowding into shelters, overwhelming sanitation facilities and creating fertile breeding ground for infection.
Girls in particular are significantly more likely to miss appointments, and the gender gap increases with each subsequent set of shots. Nearly all children who miss their vaccines at 18 months are girls at the clinics I have studied. And in the Gaza Strip, my colleague met girls who used their hijabs to cover the trademark swelling of mumps so that they wouldn’t be removed from school.
Cell phones: a safeguard against disease?
Fortunately, there are reasons to be optimistic. One of the reasons: cell phones, which are popular even among people in conflict-afflicted countries. The Middle East’s increasing mobile penetration rate has enabled innovative solutions such as Uhuru Mobile, an app developed by fellow CGI University participant Patrick Oathout to support the entrepreneurial efforts of refugees in Jordan.
From Syria to Saudi Arabia, mobile technology drives businesses, relieves boredom, and facilitates political debate. And now, public health workers can use cell phones to increase access to immunizations as well.
To demonstrate the power of mobile technology to positively impact immunization, I am collaborating with the U.N. Relief and Works Agency, which has adopted Maternal-Child Health Handbooks, used widely in Japan, for Palestinian refugees. This simple intervention provides a schedule of future medical appointments at birth, giving mothers the tools they need to care for their children and helping clinics predict future supply needs.
As part of a commitment we made at the Clinton Global Initiative University in 2014, my team and I augmented this resource with text message reminders that reach mothers when children miss or delay vaccine appointments. And our efforts haven’t gone unnoticed. “The [text message] reminders make me feel like the agency cares about me,” one patient said.
Six months later, that patient’s statement still reverberates in my head. I have heard from so many parents who want nothing more than health and peace for their children. When governments and agencies fail to provide that, they get frustrated – and look for alternative, sometimes forceful, means of being heard.
My work in the Middle East has left me absolutely convinced that investing in reliable, trustworthy health and development programs is essential to halting the cycle of violence and disease – and vaccines are a simple part of that equation.
In a region where health access can quickly fall apart, vaccines are considered critical. Those lucky enough to be safe from war should seize the chance to safeguard their communities from preventable disease as well.
Jordan Schermerhorn is a master’s student at the Duke Global Health Institute, where she explores the relationship between health access, regional stability, and national security in the Middle East with her nonprofit, Dunia Health. Her research involves tracking immunization delays during times of conflict, implementing culturally sensitive health technologies, and examining the political influence of health resources provided by extremist groups.
Prior to enrolling at Duke, Jordan worked in technology and innovation at a philanthropic foundation, blogged on development issues for the New York Times, and designed a low-cost apnea monitor for premature infants.