WHO’s standard causality assessment tools help officials monitor, assess, and advise on adverse events following immunization (AEFIs). Understanding these tools is important to ultimately contribute to confidence in vaccines and retention of immunization coverage.
With new members, bringing expertise beyond AEFIs in childhood immunization, Indonesia’s national and provincial AEFI committees will benefit from these tools in navigating current immunization challenges. New vaccines have been introduced since the COVID-19 pandemic, and the AEFI manual for assessing causality between vaccines and coincidental events was updated. Gaps between immunization programme and regulatory data sources remain, falling behind increased use of vaccines. These call for stronger AEFI surveillance using WHO’s tools.
In July 2023, WHO held a training in Bogor covering the fundamental AEFI concepts, the Indonesian vaccine reaction monitoring system, and global guidelines on AEFI monitoring, investigation, and causality assessment. Resource persons from the Food and Drug Authority (BPOM), the Ministry of Health (MoH), and the national AEFI committee helped facilitate the training sessions. WHO supported the MoH to extend training and workshop sessions to provincial AEFI committees and health offices in September 2023.
Dr Madhava Ram Balakrishnan from WHO headquarters presenting about AEFI investigation. Credit: WHO/Rizky Andreasari
Professor Hindra Irawan Satari, chairperson of the National AEFI Committee, extended his wishes, "Beyond childhood immunization, vaccination now spans the entire life course. This has led to the expansion of national and provincial AEFI Committees. The aim is that these training initiatives will reinforce the expanded committees, assuring the world and the public of Indonesia's commitment to vaccine safety. The ongoing commitment involves staying abreast of the latest evidence, standards, and guidelines for continual improvement."
These trainings also help pre-empt indirect impacts of AEFIs. Even if mostly minor and not arising from vaccines, AEFIs can raise vaccine hesitancy and even refusal, as indicated in a WHO-supported behavioural survey and a UNICEF report. The resultant reduced immunity against vaccine-preventable diseases can bring about significant public health outcomes.
Now the emphasis is on sustaining progresses. Continued coordination among the national AEFI committee, MoH, and BPOM as well as investigation and global reporting remain key to quality AEFI surveillance. Monitoring and evaluation of AEFI investigations and causality assessments by provincial health offices and AEFI committees will also be indispensable. WHO will continue supporting Indonesia’s AEFI surveillance, ensuring it stays robust and fit for evolving situation.
This activity is supported by the US Government through USAID.
Written by Rodri Tanoto, National Professional Officer for New Vaccine, WHO Indonesia