Memories of a bad 2010 epidemic are spurring on the country’s health workers, as leaders say the campaign will run until every child is reached.

9 May 2023 by Pascalinah Kabi

Nurse Kekeletso Motiki addresses a measles campaign drive at Ha Jimisi on 20 April 2023. Credit: Pascalinah Kabi

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“Do not blame us, these are not our children. Their mothers brought them to us unvaccinated,” called out Masalome Rasetina, a grandmother and caregiver from the village of Ha Jimisi in Maseru, Lesotho’s capital, interrupting healthcare worker Kekeletso Motiki mid-flow.

Just a week earlier, on 13 April, Lesotho health officials had announced a measles outbreak in the capital city, after four cases of the deadly, highly contagious viral disease were confirmed, and Motiki had implied, Rasetina felt, that children’s guardians shouldered the responsibility.

“COVID-19 created a big gap between the vaccinated and unvaccinated. A campaign to close the gap on routine childhood immunisation was held towards end of 2022.”

– ‘Matumello Mokuku, Maseru District Health Officer

Measles, the gathering had heard, was not to be taken lightly. The tiny country’s previous epidemic, in 2010, had claimed the lives of “many children” according to Maseru District Health Officer Matumello Mokuku. “Death toll was high. In one orphanage, children were buried by other children,” Mokuku recalled.

Fearing a repeat, the health department had moved fast to respond. A vaccination campaign targeting 114,000 children was announced, along with a series of awareness-raising events like this one, in Ha Jemisi, where health workers sought to enlist the help of parents and community leaders to get children to vaccination centres.

‘Masalome Rasetina, middle, attentively follows discussions at the Ha Jimisi measles drive. Credit: Pascalinah Kabi

Rasetina, seated on the grass of the chief’s compound with the rest of the gathered villagers, began to explain her objection. Many elderly people in Lesotho did not know whether the children in their care had been vaccinated or not, she said. Their biological mothers, who had emigrated to South Africa or urban areas in Lesotho for employment opportunities, left children in the care of their grandparents, but hadn’t handed over their health booklets, she went on.

“My understanding is that you (health officials) have come here to prevent the spread of measles. No child should be left unvaccinated, even those that do not bring booklets from home must receive their dose because some children do not have those booklets; their mothers bring them to us unvaccinated and without booklets,” Rasetina urged.

The reality was, as Motiki knew well, that there were many such social realities that could act as logistical hurdles to immunisation. Mokuku suggested that a local tendency to enrol children in crèches at a young age meant that often, children were in school in the hours they’d otherwise have been brought in for immunisation. Motiki said a preference for home-births was another. “Some children delivered at home are not taken to health facilities and remain unvaccinated,” she told the crowd. It worried her particularly when those mothers were HIV positive, meaning they risked passing on the virus to their newborns.

“When diseases such as measles hit, their already weak immune system gets even more compromised. It is therefore important to ensure that our children receive vaccines to boost their immune system. A vaccinated child is stronger than the unvaccinated one,” she explained.

But there were larger currents at play here too – global-scale ones. Maseru District Health Officer Mokuku said the emergence of COVID-19 had come as a major blow to the routine immunisation programme in Lesotho – lockdowns had prevented parents and caregivers from having children vaccinated.

“Let us take our children for vaccination during this campaign and on normal routine childhood vaccination schedules. Do not wait for campaigns like this one,” she said.

– Nurse Kekeletso Motiki

“The situation became worse when the country rolled out the COVID-19 vaccination campaign because all personnel were deployed there. Many children were unvaccinated during this period. This created a big gap between the vaccinated and unvaccinated. A campaign to close the gap on routine childhood immunisation was held towards end of 2022,” Mokuku said.

She said while more than 10,000 Maseru children were vaccinated in 2019, in 2022 coverage was comparatively low, with 7,903 immunised in the district.

In the current campaign, Mokuku said that children were receiving polio vaccine, supplementary vitamin A, and the dewormer, albendazole, alongside the measles-rubella (MR) vaccine.

The responsive drive was initially scheduled to run from 17–21 April. Following a brief suspension after Lesotho ran out of stock, the campaign recommenced on 2 May after the country took delivery of 100,000 further doses of the MR jab.

“It will run until all the targeted children are vaccinated: we no longer have fixed dates for the campaign,” Dr Moseme Makhele, Maseru District Medical Officer told VaccinesWork.

In Ha Jemisi, nurse Motiki urged her public to make sure childhood immunisation became a norm in their community . “Let us take our children for vaccination during this campaign and on normal routine childhood vaccination schedules. Do not wait for campaigns like this one,” she said.

“Right now the world is in a very difficult time. There are many dangerous diseases and it is my responsibility as a mother to ensure that my son lives a healthy lifestyle by taking him for vaccination,” Mohale said, just after her 11-month-old son’s vaccination.

– Matlhokomelo Mohale

On 20 April, some 20 children and their caregivers waited at Paki Health Centre – just a few kilometres from the local primary school, and not far from the site of the gathering – for the vaccine.

A nurse at Paki Health Centre administers a measles vaccine to a 11-month-old boy while his mother, ‘Matlhokomelo Mohale, holds him. Credit: Pascalinah Kabi

‘Matlhokomelo Mohale, aged 28, told VaccinesWork that she arrived at the centre shortly after 10am. “Right now the world is in a very difficult time. There are many dangerous diseases and it is my responsibility as a mother to ensure that my son lives a healthy lifestyle by taking him for vaccination,” Mohale said, just after her 11-month-old son’s vaccination.

Meanwhile, Lesotho is working hard to ensure that momentum isn’t lost once the campaign ends. “Ministry of Health has secured free radio slots for health education programmes and this will include lessons on routine childhood immunisation,” Mokuku said. “We are still going on with monthly outreach campaigns post this drive. Most facilities have four outreaches every month, going to remote villages to administer routine childhood vaccines.”

This story was produced and first published by the VaccinesWork.