This blog post was originally published on Vaccines Work

One year into the Ebola outbreak, Liberia’s health system is in tumult, impeding progress toward the country’s sustainable immunization financing solution.

As Liberia begins to recover, the Sustainable Immunization Financing Program (SIF) is working with Liberian counterparts to push for greater national funding for immunization so that Liberia can fully own its immunization program.

SIF, an initiative of the Sabin Vaccine Institute, is a vaccine advocacy program that helps countries like Liberia find long-term, reliable financing for their national immunization programs. Active in 22 countries throughout Africa, Asia and Eurasia, SIF works with key national decision makers to find ways to increase domestic immunization funding and lessen dependency on outside donors and partners.

Now that Ebola cases are receding, SIF’s partners in Liberia are refocusing their efforts on preventing vaccine-preventable disease outbreaks following a yearlong hiatus in immunization services. Legislators are picking up where they left off, scrutinizing the government’s immunization budget and taking up new vaccine legislation, reports SIF Senior Program Officer Cliff Kamara, who is based in neighboring Sierra Leone.

The Ebola outbreak not only had a severe impact on human life, but also eviscerated the health systems of both countries.

On the eve of the Ebola outbreak, Liberian government and parliamentary counterparts were organizing a Parliamentary Forum on Immunization and writing a national immunization bill, which, among other provisions, would set aside public funds for immunization.

The Parliamentary Forum on Immunization came into being following a 2012 SIF-sponsored subnational briefing, where legislators pledged to oversee budget planning and monitor program expenditures for the national immunization program. Representative Hon. William Dakel was elected to spearhead the new Forum, which crosses parliamentary chambers and party lines. Forum members follow immunization program activities and vaccine coverage levels in their respective districts. The Forum met regularly until the Ebola outbreak.

In March 2013, Forum members began working with national immunization program manager Mary Momolu to draft the pending national immunization bill. The Senate amended the bill and sent it to the House for its approval in May 2014. At that point, the legislative work came to a screeching halt as Ebola cases mounted.

During his latest visit to Monrovia in February, Kamara noted that the Ebola epidemic is nearly under control. The Ministry of Health & Social Welfare is working with the World Health Organization and other partners to draw up post-Ebola recovery plans. Parliamentarians are eager to see sustainable immunization financing be part of the plan.

On May 22, Kamara and the Parliament of Sierra Leone organized a successful inter-institutional briefing on immunization and immunization financing in the capital of Freetown. Four Liberian leaders joined the 25 members of parliament to exchange strategies: Senator Hon. Matthew Jaye, Representatives Dakel and Hon. Johnson Toe Chea, and Deputy Immunization Program Manager Adolphus Clarke. The participants shared details of their Ebola recovery strategies, focusing on rehabilitating and refinancing their immunization programs. “There is so much to do,” comments Kamara. In the rush to stop the epidemic, all available funding was shifted to Ebola control work. The line item for vaccine purchase disappeared from Liberia’s 2015 health budget and both countries stopped vaccinations for most of the past year. Campaigns are now being organized to avert expected large-scale measles outbreaks.

Adding to the challenges, many citizens associate the Ebola outbreak with the health system itself. In the early stages, health workers were unprepared for the highly contagious virus and many new cases did originate in health facilities. That fear of health services now jeopardizes the immunization programs. The Liberian immunization team views this vaccine hesitancy as their most pressing obstacle. The Ministry has requested SIF’s assistance in orchestrating a nationwide vaccine safety social mobilization drive later this year.

Having endured a year of seemingly insurmountable challenges, Liberia’s legislators and health authorities are committed to strengthening the country’s health system. This will include the ability to respond rapidly to future outbreaks while continuing to push for sustainable immunization financing.