By Kemo Cham
Ignorance about vaccines is fuelling safety fears in Sierra Leone with health authorities and campaigners warning of a threat to progress in immunization in the country.
The government and its partners are designing a response to counter a growing campaign of misinformation which they blame for these fears which are becoming paranoia.
Immunization is considered by the World Health Organization (WHO) as one of the most cost-effective interventions to public health. Yet, a larger number of children, especially in Africa, die of vaccine-preventable illnesses. According to the UN health agency, one in five children in the region still do not have access to all the necessary and basic vaccines a child should receive. It says every year more than 30 million children under five years old in the region fall ill as a result. And of these, more than half a million die – representing 56% of the global deaths related to vaccine-preventable diseases.
Several factors connive to hinder vaccine coverage across the world. But opposition due to misconceptions, strengthened by religious beliefs, poses the strongest challenge.
Dr Tom Sesay, Manager of the Expanded Programme on Immunisation (EPI) in the Ministry of Health, says fears of vaccine safety in Sierra Leone have been fuelled by people’s inability to explain their side effects, which include fever, fatigue, muscle and joint pain, dysentery and headache.
“We cannot dismiss such observations. We need to look at them critically and reassure the people that vaccines are safe and ensure uptake are high,” he told a forum validating the first ever KAPs (Knowledge, Attitudes, and Practices) study on immunisation uptake in the country.
“There is nothing that is completely safe. You can have one or two situations wherein after immunising two or three million children you can have one or two reactions. What is important is how we manage the aftermath of such reactions,” he added.
The KAPs study, conducted by the health NGO Focus 1,000, was designed to identify factors limiting uptake of immunisation services in four low performing parts of the country: Kono, Kambia, Moyamba and the Western Area Rural districts.
Fear of side effects was identified among the top reasons for which caregivers were reluctant to immunise their children. Educational levels of parents as well as trust in the healthcare provider and the facility were also found to be influencing acceptance of vaccines.
Sierra Leone has about a dozen vaccines in its routine vaccination programme, to which it is due to introduce the Rubella Vaccine.
According to the EPI, the current average national vaccination coverage is 79%.
The KAP study, which is part of efforts to develop a national immunisation communication strategy, is one of a series of studies being carried out by the government and its partners designed to unearth reasons for low immunisation coverage.
ICAP, a Columbia University-based programme, is implementing the Urban Slum Study targeting urban settings where health authorities say immunisation levels are lower than expected. Also in the planning is the Equity Assessment Study, which aims at identifying reasons why children are not being immunised, where such children are located and strategies to reach them.
The anti-vaccine campaign is growing largely due to the influence of social media. And this is well articulated in the KAPs Study which was due to be published within weeks of its validation in mid-April.
In the most recent incident, a video message being shared on WhatsApp, believed to have been made in the northern Kambia District warns people against participating in a planned vaccination campaign by the district health authorities.
Successes of Immunization
Immunization has always been a challenging line of work, and in some countries such as Nigeria, Pakistan and Afghanistan, it can even get deadly.
While some believe vaccines cause autism, others say they carry debilitating chemicals. Religious fanatics cite a ploy of birth control by Western countries.
Yet, there is plenty of evidence of the success recorded by immunization. Smallpox, which used to terrorize the world, has been eradicated. Other diseases like diphtheria and polio are getting closer to being eradicated. Cases of polio have been cut down from around 350,000 in 1988 to 30 in 2018, according to WHO figures. In fact, Nigeria, Pakistan and Afghanistan are the only three countries currently recording wild polio cases.
Vaccines are under development for malaria, HIV and cancer. The world’s first malaria vaccine was launched just last month. In South Africa scientists are testing a vaccine for HIV. Already there are vaccines that are reported to be responding to two types of cancer: cervical and oral cancers caused by the human papilloma virus and liver cancer caused by the hepatitis B virus. Research for breast cancer is said to be far in advance.
This growing trend of resistance to vaccines has the potential to reverse these tremendous scientific gains, as already illustrated by delay in meeting target dates for eliminating rubella and maternal and neonatal tetanus as well as the apparent come back of measles.
In the last two years, about a dozen countries have recorded cases of measles, which is a highly contagious viral disease that was nearing eradication. Measles accounts for 13% of all vaccine-preventable deaths in children below five years in Africa, infecting nine in ten people who are not vaccinated, according to WHO.
Between 2017 and 2018 Sierra Leone declared two separate measles outbreaks. As of 2017 only 16 countries in the WHO’s Africa Region had achieved 90% or more immunization coverage of the first dose of measles vaccine (MCV1), according to coverage estimates of WHO and Unicef which note that MCV1 coverage across the region has stagnated, at between 70% and 73% since 2009. Immunisation has been identified as one of the best health investments relevant to the achievement of the UN SDG 3, which primarily seeks to ensure healthy lives and promote wellbeing for people of all ages.
WHO also says vaccine-preventable diseases have serious economic implications with Africa said to be losing about US$ 13 billion annually.
The Addis Declaration on Immunization (ADI) commits African Union heads of state to reach all children with life-saving vaccines in line with regional and global targets.
The World Health Assembly in 2012 endorsed the Global Vaccine Action Plan which committed the 194 member states to realize 90% national immunization coverage by 2020. The Africa region, as part of efforts to achieve this, adopted the Regional Strategic Plan for Immunization, which sets ambitious targets, including eradicating polio and eliminating measles, rubella and maternal & neonatal tetanus by 2020. The ADI is a pledge by the AU Heads of State to increase the political will to achieve these goals.
For Sierra Leone, the drive to increase vaccine uptake is part of a bigger fight to safeguard the future of a nation which is struggling to contain the highest rate of maternal mortality and one of the highest rates of infant mortality in the world – 1,195 per 100,000 live births and 157 per 1,000 live births respectively, according to government and WHO figures.
Most of these under-five deaths are caused by vaccine preventable diseases like pneumonia, diarrhoeal diseases, and neonatal tetanus. And these are mainly diseases that can only be transmitted from one person to another. And the only way to end them is by breaking the chains of transmission.
Sierra Leone’s battle with childhood killer diseases has been a long one and the EPI has been at the forefront of it since its formation in the 1960s. The programme attained Universal Child Immunisation in 1990, with coverage of 75% for measles.
Those gains were reversed by two major events over the last two decades – from the civil war (1991-2002) to the Ebola outbreak (2014-2016). While the war destroyed the infrastructure, the epidemic eroded trust in health care facilities and service providers.
Nonetheless, many believe that accomplishment reinforces the fact that the country can achieve greater coverage for various vaccines if the appropriate resources, backed by an appropriate program, are available.
As the country continues to make relentless efforts to leap out of the era with the worst set of health indicators, available statistics reveal that Vaccine Preventable Diseases alone constitute a substantial proportion of the causes of death among children under the age of five years.
Pa Ousman Manneh, Communications for Development Specialist at Unicef, who served as UNICEF focal person in the KAP study, said that while Sierra Leone appeared to be doing well in national vaccination coverage, it needed to do more to close the gap.
“If every child is vaccinated, that will seriously reduce the under-five mortality,” he said.
© 2019 Politico Online
