By Kemo Cham
Despite a dramatic increase in the global vaccination rates in the last two decades more still needs to be done to tackle life threatening diseases prevalent in Africa, the World Health Organisation (WHO) warned last month.
Ahead of the first ever Ministerial Conference on Immunization in Africa (February 25 – 26), the UN’s health agency said one in five children on the continent did not receive basic life-saving vaccines particularly against diseases like measles, rubella and neonatal tetanus. These illnesses have virtually been eradicated in some parts of the world but remain prevalent and deadly on the continent.
Child vaccination rates rose from 57% in 2000 to 80% in 2014. But WHO said Africa’s routine immunization coverage of 80 % is still the lowest of any region in the world.
The ministerial conference held in Addis Ababa, Ethiopia, was convened by WHO and co-hosted by the African Union. Its main thrust was to renew commitments towards achieving the goals of the Global Vaccine Action Plan (GVAP).
GVAP, reached in 2012 at the annual World Health Assembly in Geneva, Switzerland, was designed to prevent millions of deaths by 2020 through vaccination. It basically aims at strengthening routine immunization to meet vaccination coverage targets; accelerate control of vaccine preventable diseases with Polio as a top priority; as well as introduce new and improved vaccines and encourage research and development for the next generation vaccines and technologies.
Africa has been unable to reach five of the six GVAP goals, according WHO. The ministerial conference ended with the signing of a declaration committing nations to prioritising immunisation as a means to reduce child deaths and disabilities.
The GVAP target at least 90% immunisation coverage and at least 80% coverage in every district for all nationally available vaccines. In the declaration, ministers acknowledged that their countries were off track on the targets. They urged increased efforts to mobilise resources to strengthen national immunisation programmes. They also called upon member states, partners, and development banks to support the implementation of the declaration.
"Current national budgets for immunization are inadequate,” WHO Director General Margaret Chan said via a video message to the conference.
“Countries can apt their immunization programmes on a path to long term sustainability by increasing domestic investments,” she said.
AU Commission Chairperson, Nkosazana Dlamini Zuma spoke about the need for high level political support at country and continental levels.
In the last 25 years some African nations have made progress towards universal access to immunization. Rwanda, for instance, has achieved close to 100% immunization rates; Tanzania has close to 98% coverage, while Senegal is around 89%.
Conspiracies
Sierra Leone also made significant improvement. According to the Ministry of Health and Sanitation (MoHS), it reached 88 percent coverage by 2014, before an 8% decline occasioned by the Ebola outbreak. At the height of the epidemic, fear of contracting the virus at a time healthcare workers were seen as sources of infection caused many parents to shun hospitals.
The view of the government on this was summed up by Dr Denise Marke, Director of the Expanded Programme on Immunization (EPI), as “a cause for concern.” He told a programme review session of the civil society coalition on Nutrition and Immunization late last year that urgent action was required to bridge the immunization gap in the country amidst growing threats of many infectious diseases.
Globally, about 19 million children are still not fully vaccinated with even the most basic vaccines. Nearly one quarter of these children live in Africa which is home to five out of the six countries in the world with immunization coverage rates of less than 50%.
Consequently, a child born in sub-Saharan Africa is 14 times more likely to die before their fifth birthday than children born in developed regions. Yet more than half of under-5 child deaths are due to preventable and treatable diseases through simple, affordable interventions like vaccinations.
"This report is an urgent wakeup call to Africans of all walks of life and at every level," Matshidiso Moeti, WHO regional director for Africa, told the Addis Ababa conference.
"For Africa to achieve its full potential and secure a bright future, we must unite to ensure that every child on the continent receives the vaccines he or she needs to survive and thrive," she said.
Investment
A study by US-based researchers released ahead of the ministerial conference makes an interesting link between vaccination and economic development. It reveals that spending US$1 (one dollar) on childhood vaccines can save US$44 in future savings in poor countries like Sierra Leone.
The study, supported by the Bill and Melinda Gates Foundation and its implementing partner, the Global Alliance on Vaccine and Immunisation (GAVI), considered 10 different antigens, including measles, rubella, human papillomavirus, and rotavirus in 94 low-and-middle-income countries. They found that investing in national immunization programs against these diseases resulted in a return that was an average 16 times greater.
The researchers took account of the savings that vaccination provided in terms of avoiding treatment and transportation costs, lost productivity due to disability or death, and loss of productivity in caretakers of sick people.
Sub-Saharan Africa, alongside south and Southeast Asia, were found to stand to see the greatest return on childhood vaccinations.
The study from Sachiko Ozawa at the Johns Hopkins Bloomberg School of Public Health estimates that between 2011-2020, the majority of countries in Africa will collectively see a net economic benefit of $224 billion by investing in immunisation programs.
“This moment presents the perfect opportunity to acknowledge the benefits of vaccine programs, celebrate the successes on the continent, look seriously at what needs to be done to make sure all children get the vaccines they need, and then commit to making that happen,” said Ayo Ajayi, director of the Bill & Melinda Gates Foundation’s Africa programme.
Sierra Leone has 11 vaccines on its routine vaccination programme, covering diseases like Polio, TB, neumococus, rotavirus (introduced in 2014), and measles.
Measles is proving problematic for the country. Late last year the MoHS announced the addition of a second dose of vaccine, after realizing that that one dose wasn’t enough. Children used to be vaccinated for it once in every nine months. They will now be administered with a second dose at the 15th month.
Polio is also a concern. WHO targets it for eradication by 2018. There is also diarrhea which accounts for a high percent of the diseases that lead to infant deaths in the country.
Doctors say hepatitis is becoming a major health problem. Even before Ebola, the rate of pediatric tuberculosis was at an alarming stage.
Religion, culture, corruption
A whooping sum of US$5Million is spent annually on vaccination in Sierra Leone, most of it coming from GAVI. The government accounts for only five percent of that amount and, according to Dr Marke, local contribution increases yearly.
“GAVI is not going to be funding the program for ever. Eventually government will take over and it is our tax [money], so we have to use it,” he said at the forum in December organized by Focus 1000.
Campaigners have warned that religion and culture are particularly proving problematic for vaccination. The Fullah ethnic group was singled out as proving particularly reluctant to cooperate because of the widely-held view that the vaccine causes infertility, said Hamid Turay of Hellen Keller International.
There have been suggestions for the government to consider legislating to force parents to immunize their children.
But official corruption and maladministration have also been known for frustrating the efforts of the government. In 2014 the Inspector General of the Global Fund unearthed massive corruption within the MoHS, in the form of procurement irregularities. It found “evidence of fake invoices and fictitious vendors in the procurement of office equipment.” The ministry was given an ultimatum to refund the money or face sanctions.
A little earlier, in 2013, GAVI froze over US$5 million to the country after about US$1million meant for the procurement of vaccines went missing.
The Anti Corruption Commission subsequently indicted over a dozen top officials. Almost all of them ended up walking free.
(C) Politico 09/03/16
