Milko Joksimović, a specialist epidemiologist from the Institute of Public Health (IJZ), has raised concerns about the decreasing vaccination rates in Montenegro, emphasizing the need to bolster the number of pediatricians and gynecologists within primary health care.

“To achieve results that are on par with the best globally, we must address systematic issues and increase the number of pediatricians and gynecologists in primary health care,” Joksimović stated in an interview with MINA Agency.

He urged parents to ensure their children are vaccinated in order to shield them from serious infectious diseases.

“Alongside this appeal to parents, there is a message for decision-makers to embrace professional recommendations and consider enacting some unpopular measures to quickly rectify the situation,” Joksimović added.

He expressed hope that the Ministry of Health will soon implement the recommendations provided by the National Immunization Advisory Group (NITAG) late last year.

“Among these recommendations is a proposal to amend the Law on the Protection of the Population from Infectious Diseases, to ensure that mandatory immunization is enforced properly, as it is currently only mandatory on paper in our country,” Joksimović noted.

He assessed the system for controlling mandatory immunization as ineffective.

“Health centers are often slow to report unvaccinated individuals, and health and sanitary inspections have limited means to motivate parents to vaccinate their children,” Joksimović added.

He insisted that the state must take decisive steps to enhance the situation.

“I would suggest considering some unpopular measures, such as requiring proof of vaccination status for enrollment in preschool institutions for children without medical contraindications,” Joksimović remarked, indicating that several European countries have adopted similar policies.

He also mentioned the possibility of offering incentives for healthcare professionals.

“Health centers that achieve high vaccination rates and those that do not are treated equally regarding salaries and other benefits,” Joksimović remarked.

The state currently offers 12 vaccines in the regular immunization schedule, all adequately supplied.

Joksimović highlighted that these vaccines are funded by the state budget, meaning parents incur no additional costs.

“Weekend vaccination clinics are available. Parents, you have the opportunity to effectively protect your child from severe infectious diseases with a comprehensive range of vaccines; please do not hesitate or delay,” Joksimović urged.

Regarding the HPV vaccine, he shared that by September 26, 2022, over 12,600 individuals had received at least one dose, including 10,500 females and about 2,000 males.

“Vaccination is progressing, but not at the desired rate,” he noted.

Joksimović reminded that the HPV vaccine is currently the only vaccination in the regular schedule that is not mandatory, complicating its implementation.

He mentioned that the World Health Organization (WHO) has set an objective for all member states that have introduced the HPV vaccine to aim for 90% coverage among girls reaching 15 years of age by 2030.

Currently, vaccination rates for girls in the final grade of primary school stand at approximately 28%, while for boys, it is around 14%.

“This indicates that we are significantly distant from the WHO’s target,” Joksimović explained.

He noted that vaccination began in 2022 for girls aged nine at that time.

“Data shows that among this group, coverage is at nearly 33%,” Joksimović reported.

Cetinje, Gusinje, and Kotor lead in HPV vaccine coverage in Montenegro, whereas Ulcinj, Bar, Žabljak, and Šavnik show extremely low rates.

In Cetinje, HPV vaccination coverage among girls born in 2010 is 57.6%, compared to around 15% in Bar or Ulcinj.

“The discrepancies are alarming. In Žabljak, Šavnik, and Plužine, certain age groups have seen no girls vaccinated with the HPV vaccine, which is a concerning issue,” Joksimović said.

In Danilograd, 43% of boys in the final grade of primary school have received the HPV vaccine, while in Kotor, one in three boys has been vaccinated.

Other municipalities, Joksimović added, lag significantly behind these coverage levels.

He emphasized that effective HPV immunization demands collaborative efforts from health center management, pediatricians, and gynecological services in delivering recommendations and communication.

“A severe shortage of pediatricians severely hinders vaccination efforts in several municipalities. Our data suggest that nearly half of the municipalities do not have an adequate number of pediatricians,” Joksimović stated.

Montenegro has a significant problem with cervical cancer.

He underscored that the HPV vaccine offers considerable protection, particularly against cervical cancer, and also helps prevent cancers of the vagina, vulva, penis, anus, oral cavity and pharynx, as well as genital warts.

Joksimović declared that any negative narratives surrounding the vaccine are unwarranted.

Discussing MMR vaccine coverage, he stated the situation is concerning and confirmed that the Public Health Institute plans to release a report on vaccinations conducted last year and in early 2023 by the end of May, focusing on children born in 2023.

The coverage for the first dose of the MMR vaccine among these children is around 22%.

“Currently, only about 22% of children have received their first dose of the MMR vaccine on time,” Joksimović warned.

This represents a disturbingly low rate of coverage.

He indicated that 85% of first graders in 2018 received the first dose of the MMR vaccine, and around 60% received two doses.

There has been a clear trend over the past decade of delays in MMR vaccinations.

“Parents are postponing vaccinations, leading to children receiving them at two, three, four, five, or even six years old. In recent years, we’ve seen an increase in children entering primary school without a single dose of the MMR vaccine,” Joksimović cautioned.

When asked if there’s a disparity in MMR vaccine coverage across municipalities, he responded affirmatively, noting that Rožaje, Plav, Mojkovac, Kolašin, and Pljevlja usually maintain high coverage, but they too are witnessing a trend of delay and decline.

Conversely, municipalities like Bar and Budva report coverage among preschool children of less than 50%. The situation has worsened in Nikšić, with a rising proportion of unvaccinated children.

Asked about the leading causes of the delays and declines in MMR coverage, he cited persistent fears about potential links between the vaccine and developmental disorders.

“Passivity and uncertainty among some healthcare professionals in recommending vaccines to parents have also adversely affected vaccination rates,” he added, noting the insufficient number of pediatricians as a contributing factor.

Additionally, he mentioned, “People no longer observe the diseases or the suffering they cause, which leads to a more relaxed attitude towards vaccinations.”

“If this trend continues, we risk a significant epidemic with potentially tragic outcomes,” Joksimović warned.

On the topic of emergency vaccinations, he reported positive outcomes in larger municipalities, especially Podgorica.

“Approximately 1,300 children were vaccinated on a weekend from the end of January until today, which is a notable achievement,” Joksimović noted.

He revealed that substantial progress was made at the end of August and beginning of September when they revamped the certificate required for children’s admission to preschool institutions.

“In a span of three to four weeks, a considerable number of children were vaccinated. However, the momentum diminished afterward, returning to previous patterns,” Joksimović concluded.

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