R Dhaarmika, a Public Health Nursing Sister, often works long hours. After a full day's work as a supervisor at a maternal and child welfare centre in Colombo, Sri Lanka, she frequently stays behind to meticulously record what happened that day, such as how many vaccines were used, and what materials need restocking.

It's a demanding job, but Dhaarmika says she loves it: "I enjoy my work very much. What we (health workers) do is a community service. It is nice to see children in my area healthy."

What makes it even better? When Dhaarmika's contribution helps the country to achieve important health milestones. On January 17 this year, the World Health Organization (WHO) announced that the Maldives and Sri Lanka have achieved hepatitis B control, having "consistently high coverage of hepatitis B vaccine doses in infants and a low prevalence of the deadly disease".

“Simultaneously, we did the same survey with pregnant mothers. The prevalence (of hepatitis B) among them was also zero. This is a very good sign. We are on track to go for elimination."

– Dr Samitha Ginige

"Hepatitis control continues to be an important public health initiative in the South-East Asia Region of WHO that comprises of 11 countries and is home to a quarter of the world's population. The Region has an estimated 60 million people living with chronic hepatitis B and 218,000 dying every year of hepatitis B and C," WHO stated in a news release.

Prevalence: zero

In Sri Lanka, a 2022–2023 survey for hepatitis B infection among children aged over five conducted by the Epidemiology Unit of the country's Ministry of Health, found a prevalence – that is, number of positive cases – of zero.

"Simultaneously, we did the same survey with pregnant mothers. The prevalence (of hepatitis B) among them was also zero. This is a very good sign," Dr Samitha Ginige, the Head of the Epidemiology Unit said.

"We are on track to go for elimination," he added.

Public trust

According to Dr Ginige, Sri Lanka achieves such milestones because of the well-established public health infrastructure that can cater to any demand. As in most countries, in Sri Lanka, immunisation is incorporated into the primary health care delivery system, and vaccines are administered free of charge to all children and pregnant mothers.

"We provide the pentavalent vaccine that gives protection against five diseases including hepatitis B and polio to children who have completed two months, four months, and six months," Dr Ginige explained. 

Hepatitis B vaccination is also given to health care workers and those in identified high-risk groups, such as sex workers and people using injectable drugs. 

Dr Ginige said the recent success reflected the high acceptance of immunisation among mothers. Even during the COVID-19 outbreak, despite temporary delays, the country was able to sustain its nearly 100% immunisation coverage.

"People understand the value of vaccines. It is also a free health care delivery system. Without any cost, all children are eligible to get their due vaccination without any hassle. We also have a good tracking system in place.

"Children are registered at birth. Midwives follow up periodically and provide due vaccination on time. There is also a good evaluation mechanism in place," he said, adding that the main thing is 'public trust' in the public health system. "When a midwife asks to vaccinate their children, mothers do without resistance."

“People understand the value of vaccines. It is also a free health care delivery system. Without any cost, all children are eligible to get their due vaccination without any hassle. We also have a good tracking system in place."

– Dr Samitha Ginige, Head of the Epidemiology Unit, Ministry of Health

Reflecting on the recent achievement, Dr Ginige said that this was a "significant" milestone in Sri Lanka's immunisation programme.

"It is a collective thing. Vaccination is the key governing factor for this achievement," he said.

Complacency risk

At the Maternal and Child Welfare Center where Dhaarmika works, the day starts early in the morning. The waiting room gets crowded with mothers and their babies. A medical officer, pregnant herself, informs the mothers what needs to be done.

"Stay for at least 20 minutes after the vaccination. If your baby develops a fever, give paracetamol. If it persists, consult a doctor," she says.

Thirty-eight-year-old Chenashi Dinsadi, is with her baby, who has received all three doses of the pentavalent vaccine.

"This is my third child. My other two children were also vaccinated here. The medical officers here are very nice and give us advice about children's health. What they are doing is an important service," she says.

But a new challenge that health care workers are experiencing is vaccine refusals on the part of mothers who have opted for home deliveries.

According to Dr Chintha Jayampathi, Deputy Chief Medical Officer of Health, this is because they don't see vaccine-preventable diseases. "So, they think, why do they need to take a risk by vaccinating their children," she says.

Health officials who work at the grassroots level are making sure that these babies don't fall between the cracks.

"It is a team effort. We have midwives going to homes to meet mothers. The relationship between mothers and midwives is very strong. And these midwives encourage all mothers to vaccinate their children, because prevention is better than cure," she says.

This article is republished from VaccinesWork under a Creative Commons license. Read the original article. VaccinesWork is an award-winning digital platform hosted by Gavi, the Vaccine Alliance covering news, features and explainers from every corner of global health and immunisation.