By Sharon Atieno
Vaccine is one of the important health tools available, saving roughly 2-3 million lives annually. Despite this, immunization coverage in Africa is still low with 1 out of 5 children missing essential vaccines.
Over the last five years, vaccination coverage in the continent has remained stagnant at 72 percent. This has resulted to several disease outbreaks and left populations not only susceptible to vaccine preventable diseases (VPD) but also death.
In 2015, Africa accounted for 33 percent of VPD incidences among under-fives globally, with more than 30 million cases. Africa’s under five mortality rate is more than twice the global average mortality rate, hence the need to heighten immunization activities in the region.
“Disease outbreak in the region is a wake up call that much needs to be done in strengthening immunization and disease surveillance,” noted Dr. Felicitas Zawaira, director of family and reproductive health cluster World Health Organization (WHO) regional office for Africa during a telephone briefing.
Currently, there is an outbreak of ebola, measles and yellow fever in different parts of the continent. From 2015- 2017, many African countries experienced pneumococcal diseases, yellow fever, measles and rotavirus outbreaks. The recurrence of VPD outbreaks indicates vulnerability of surveillance system.
During the 2014 ebola outbreak in West Africa, though thousands of lives were lost in different countries, the Nigeria disease surveillance system which was working as an emergency operating centre was able to rapidly identify and stop the spread of the disease leaving only 7 dead. Improved surveillance technology allows timely interventions and control of disease. Stronger surveillance system will be critical in the coming years with increase in VPD from 18 to 22 by 2030.
In a meeting held in Brazzaville, Congo, the Regional Immunization Technical Advisory Group (RTIAG) emphasized the need for greater government ownership of disease surveillance programmes to ensure that the progress made in curbing VPD is not reversed. This comes at the backdrop of dwindling funding for polio in the region, with the continent set to be certified polio free.
“Countries need to secure funds for their national surveillance programmes to ensure progress achieved in support of polio is not reversed,” said Dr. Richard Mihigo, programme manager for immunization and vaccine development at the WHO regional office for Africa during the briefing. “Countries need a greater ownership of their surveillance systems once the funding is closed.”
The WHO has urged member states to raise the necessary domestic and external financial resources to maintain and strengthen their epidemiological surveillance and laboratory networks in the post polio eradication.
“If current vaccination efforts are not maintained, there is a risk to reverse progress made, leading to more than 2.4 million deaths and a negative economic impact of USD 59 billion,” cautions the 2017 Deloitte health-economic impact calculator.
In 2017, African heads of state endorsed the Addis Declaration on Immunization (ADI) in a bid to deliver on the promise of universal immunization coverage. ADI came as a follow up to the Global Vaccine Action Plan (GVAP) 2011-2020 which set ambitious targets to improve access to immunization and tackle VPD. GVAP specified two targets for immunization: 90 percent national coverage and 80 percent coverage in every district or administrative equivalent with all expanded programme on immunization (EPI) vaccines in national programmes.
Progress towards improving immunization coverage in Africa has been faulted on gaps in country ownership, lack of prioritization of immunization, competing development priorities, and insufficient investment in reaching marginalized and underserved communities on the government side. On the other hand, low community awareness and limited acceptance of immunization programmes in some communities also pose a major challenge for Member States.
The ADI roadmap outlines three strategies for Member States to include into existing efforts to improve immunization coverage: generating and sustaining political commitment and funding for immunization through advocacy and communications, addressing gaps in immunization and work with key partners to overcome barriers to access and utilization of immunization services as well as monitoring progress to drive impact and ensure accountability.
According to estimates by the 2017 Deloitte health-economic impact modeling, reaching the WHO 2030 ambition for four major VPDs (measles, rubella, rotavirus and pneumococcal diseases) will save at least 1.9 million lives, avert 167 million cases and save up to USD 58 billion over ten years. The return on investment from immunization is set to be 37 fold.
With African countries being off track in achieving GVAP goals, it is necessary to accelerate action towards universal access to immunization; as it will contribute to attaining the sustainable development goals and other global development efforts, including the African Union Agenda 2063.