Immunization in Dubai, a city in the United Arab Emirates

The impact of child immunization on survival rates is so significant for our world. Several diseases have been eradicated and millions of children have been saved, which makes this practice so influential on the entire planet. Since I had studied and worked as a pharmacist for about ten years, I have experience with vaccinations from the dispensing, storage, and efficacy perspective and so my interest in this field will always remain keen.

Though I am American, and had studied the CDC vaccination requirements, I had my two children in the United Arab Emirates, in a city called Dubai, which is where I work in a nursery as well. So I have chosen this city for a study of immunizations as a public health measure.

The United Arab Emirates is only 42 years old, and for a nation so young, the mandatory immunization policy is quite impressive. Interestingly, the nation has several governing bodies when it comes to healthcare: the Ministry of Health governs the entire country but the two big cities (AbuDhabi and Dubai) have their own health authorities.  Under the Ministry of Health's Preventive Health Services, they have an immunization program which is offered to all residents of the country (free for citizens but for a reasonable fee for non-citizens). They proudly boast that polio has been eliminated here, and they have clinics all over the country, as well as hospitals with clinics operating daily on site, which offer immunizations.

The Dubai Health Authority (DHA) has published their guidelines for vaccinations for all children (DHA, 2014). Almost 90% of the country's population is non-citizens, and they are very transient and very diverse. This means that the vaccinations of each individual can vary tremendously. In the brochure you will find that they have addressed this issue. They have schedules for children born in this country, and schedules for children or adults to catch up with immunizations, who moved to the country. I find this quite interesting and quite relevant to the nature of the population. One of the vaccines that are not given routinely in the west is the BCG vaccine, but it is given here at birth and recommended to children who move to the country later. BCG vaccine protects from tuberculosis infection, which is not prevalent in the west anymore, but still prevalent in countries that neighbor the UAE and where many of the workforce comes from. I find that this is a fabulous added public health measure, where the country's population and its influence on disease has been taken into consideration, to protect all children living in this country.

The DHA guide to immunizations also addresses many related issues, like storage of vaccinations, immunization during different conditions including pregnancy and recommendations for travelers.

So who gets vaccinated and how? The country offers free healthcare to all its citizens, which includes all immunizations, but public health serves are paid for by non-citizen residents. Most of the population has private health coverage, with some insurances covering immunization and others not. The citizens of the country are only 10% of the population, so what about the rest of the 90%? The DHA has mandated that all children get immunized in Dubai, and they enforce it by checking with schools and nurseries and pediatricians for records to prove this.  It is the responsibility of the family that works here to access the private health care serves and get the necessary immunizations. It becomes part of what people sign up for, when they decide to work here and raise their families here. At our nursery, we get inspected several times a year and the children's immunization records are inspected almost each time. In addition, recently the school my children go to has offered discounted vaccinations for anyone who needs to catch up with the UAE schedule.

The transiency of the country's population poses an additional challenge to creating an immunization policy for a few reasons: not everyone is born here, not everyone accesses the same healthcare services, children move here with various immunization history, and the various nationalities that live here can pose an added infection risk which they may be carrying.

To have an idea of the success of the immunization program, I found a report published by the AbuDhabi health authority in the neighboring city and the incidence of communicable diseases in children was impressively low.  In addition, the leading cause of deaths did not include communicable diseases.  To me, this is an indication of success although various factors play a role in the statistics.

At the nursery where I work, we ask all parents to give us a copy of their child's immunization records, and our fulltime nurse checks that they are updated based on the DHA recommendations. What I did notice in my research, which I will address immediately, is that the UAE Ministry of Health and the Dubai Health Authority has not made the Rotavirus vaccine mandatory. Even though most of the children in our care have been vaccinated for rotavirus based on their pediatrician's recommendations, I feel that this may be a worthy cause to advocate for. Through this assignment I may be initiating a study at work, of how many children are vaccinated for Rotavirus, and then accordingly, make a recommendation to all our families and hope to be supported by pediatricians or the government clinics.

Dubai Health Authority, 2014. Government of Dubai. Immunization Guidelines. Retrieved from:http://91.74.184.65/videoplayer/Immunization%20Guidelines.PDF?ich_u_r_i=e05592d03d0478b945099bc3eedc5f1a&ich_s_t_a_r_t=0&ich_e_n_d=0&ich_k_e_y=1445038914751463022401&ich_t_y_p_e=1&ich_d_i_s_k_i_d=8&ich_u_n_i_t=1

Health Authority Abudhabi, 2012. Health Statistics 2012. Retrieved from http://www.haad.ae/HAAD/LinkClick.aspx?fileticket=JY0sMXQXrOU%3d&tabid=1243