Litiana Sonyvalu Volavola - National Program Manager for Immunisation, Fiji

NCIRS Australia is partnering with Gavi, the Vaccine Alliance, and the Fiji Ministry of Health and Medical Service (MHMS) to support immunisation policy and programs in Fiji. 

This collaboration supports the development of locally tailored, evidence-based vaccine policy recommendations and expands options for learning and performance development of immunisation providers.  

The immunisation workforce is the backbone of the national immunisation program and is pivotal to achieving high immunisation coverage through safe and effective vaccine delivery and engaging communities to have confidence in, and take-up of, vaccines. Here we speak to Sister Litiana Volavola about the progress made by Fiji in the national immunisation program and the significant impact this has had on improving the health of the Fijian population.
 

Please introduce yourself and tell us a little about where you're from and your current job role. 

My name is Litiana Sonyvalu Volavola. I come from the second largest Fijian island, called Vanua Levu, about 60 kms from the mainland. I have been with the Fiji Ministry of Health and Medical Service for nearly 17 years, and I have been a nurse for 33 years. 

I am currently the National Program Manager for Immunization in Fiji. I support the Ministry of Health in the revision and implementation of the immunization policy and programs. I oversee the governance and leadership of the program. Part of the leadership role involves management of supply chain, working with UNICEF to supply vaccines for the Fijian people. 
 

Please give us an overview of the history of the vaccination program in Fiji? 

In those 16 years, I have been part of a growing vaccination program in Fiji. We have reached some particularly important milestones, which has been significant for the overall health of the Fijian population. 

In 2012, I was part of the team to officially introduce three vaccines at the same time [pneumococcal, rotavirus and human papillomavirus (HPV) vaccines]. 

Three years earlier, in 2008–2009, we launched a pilot roll-out of the cervical cancer vaccine to include approximately 32,000 girls, then aged 9 to 12 years who would now be approximately between 27 and 29 years old. We can now compare data from this cohort of girls when they present for testing, which is an indicator of the success of our cervical cancer control program. 

Fiji had three SIAs [supplementary immunisation activities] for measles: first in 2006 due to low vaccination coverage of 68% [2005]; then in 2016, we ran another SIA for measles – using the measles rubella vaccine, we achieved a 95% coverage rate. The WHO [World Health Organization] stated at the time that ‘the Fiji vaccination program had some of the highest rates of vaccination coverage in the Pacific Islands’. In 2020 we had another measles outbreak where two cohorts were infected for the first time, but we managed to achieve more than 95% coverage rate during that SIA.  

We have also launched vaccinations for influenza as well as COVID-19, which helps expand the life course approach. For COVID-19, we achieved coverage rates of 99% for two doses in the target population and 60% for the booster dose (target 70%). 
 

Fiji has a strong and effective immunisation program, even in the face of geographical and infrastructure challenges. Please tell us more about the scope of the program in Fiji. 

Our annual vaccination targets included 22,000 children to be vaccinated under schedule A – that's from birth to 18 months [of age] – plus 19,000 children in grades 1 to 6 and 8,000 girls (using HPV vaccine) in grade 8. We also aim to vaccinate 25,000 pregnant women in antenatal clinics who require the tetanus vaccine. Also included in our immunisation program are influenza and COVID-19 vaccines. Our fully integrated vaccination program in Fiji is enabling us to save many lives per year. 
 

Why is immunisation so important to Fiji’s population? 

It is important for Fiji. We have had diseases like diphtheria, tetanus and whooping cough and measles of course, which were killing our population. To illustrate, half of our Fijian indigenous population in 1875 were almost wiped out by diseases – nearly 30% of the population due to measles.  

Vaccines are protecting our vulnerable population, reducing morbidity and mortality rates. Our vaccination programs have been successful, and it is wonderful to look back and see what we have overcome. The strength is in the system itself. We are focused on continually building on the system and strengthening our vaccination program.

In addition, there are recurring diseases like pertussis [whooping cough], and we have babies born to HIV-positive women who need protection. Our program is for a worthy cause. We have a strong health workforce within our vaccination program who are focused on reducing morbidity and mortality and protecting our population. So, we do as much as we can to promote the benefits and the value of vaccines against the risks of not being vaccinated and the cost to the community of higher rates of disease. For Fiji, it is a worthwhile investment.  

Our vision is big – a healthy population.
 

What are the main strengths of the immunisation program in Fiji? 

I am a policy person; policy is the most important thing. I like to enforce policy in EPI [Expanded Program on Immunization] training, or any consultation. I will talk about how the implementation of policy is good practice. I advise revisiting our policy and how it is interpreted, so that all nurses and other workforce members understand it and can implement it. I say it is not right if it is not done according to the policy. 

Good leadership, governance, and good policy and strategies all bring about the continuous improvement needed for an effective vaccination program. 

I believe very much in good data collection. The implementation of any program change or improvement should be data driven. 

How we analyse data and interpret it from division level – right down to nursing station level – helps us to understand if we are reaching the population we need to reach. We achieved 95% coverage nationally and 92.5% over 12 months for the first measles, mumps, rubella [MMR] vaccination, which we reported in the JRF [Joint Reporting Form] through WHO and UNICEF, and 89% for MMR 2. There are, however, still some pockets where people are left out, where people go unvaccinated, and it is important for the program that we keep striving to reach everyone.  

Health system strengthening is also very important to reaching our immunisation program goals. The strength of our program allowed us to introduce three vaccines at the one time and we have continued to build on that. I am immensely proud of our immunisation program, that we have reached a point where we can adjust the vaccination schedule but continue to move forward. This shows great advancement in the strengthening of our health system. 

Research also plays a part in health system strengthening, for example, PCV [pneumococcal vaccine] is 3 doses, 3 + 0 [note: current schedule in Fiji]; we are looking at a mathematical model to bring it down to 1 + 1. Our nurses are our vaccinators; training and upskilling them, including in research, is a great enabler for a competent workforce, which is also a contributing factor to why our coverage rates are high, and our disease rates are low.
 

In what ways do you feel this joint Gavi-funded project will further strengthen the immunisation workforce in Fiji?  

The Gavi-funded project is assisting us through funding the necessary training package development and policy upgrades so that the Fiji vaccination program can continue to operate at the highest possible level. These enhanced levels of training offer a higher level of competency for the health worker during pre-service and in-service and as part of continuing professional development. We are also looking at accreditation for these training courses.  

Fiji has three nursing schools; however, the graduating nurses need further training to become vaccination professional. This is where NCIRS support will be highly effective in uplifting the nurses’ practical skill levels. As an example, in immunisation, one of the things that is standardised and endorsed by the clinical services network is that a nurse must be EPI-trained, which is a 3-day basic course. 

So, in the future, we are looking at standardising education levels, accrediting all nurses, providing an equivalent to a university degree.
 

Note: This interview has been lightly edited for length and clarity. NCIRS has not independently verified the statistics included in this article. For more information on the immunisation program in Fiji, see Supporting middle-income countries to improve immunisation outcomes in the Asia-Pacific region