Non-inclusion of rotavirus vaccine in NPI fuels 150,000 annual deaths

At the Nassarawa Primary Health Centre, in Yola, capital of Adamawa State, nine-month-old, pale and thin Baby Habibat, being cuddled by her mother is suffering from malnutrition induced by acute diarrhea, which is caused by rotavirus.

“First she started stooling frequently, then vomiting and gradually started losing weight,” her mother Aisha summarised how her baby got to that point.

After being treated for acute diarrhea, Habibat was admitted at the Community Management of Acute Malnutrition (CMAM) programme at the centre, where she received the United Nations Child’s Fund (UNICEF) Ready To Use Therapeutic Food (RUTF)- an intervention for severe cases of malnutrition.

According to experts, Habibat’s diarrhea could have been prevented if she had received rotavirus vaccine as part of the routine immunisation, but the vaccine is not available at the health centres across the country.

Rotavirus is the most common cause of diarrheal disease among infants and young children. It is a genus of double-stranded RNA viruses in the family Reoviridae.

The World Health Organisation (WHO) maintains that rotavirus is responsible for most severe diarrhoea, vomiting, and fever leading to rapid dehydration in children.

Found in all countries, rotavirus is responsible for the death of an estimated 600, 000 children worldwide each year, 80 per cent of whom live in developing countries.

Due to a lack of routine rotavirus surveillance in some regions, the extent of rotavirus disease mortality is unknown in many countries.

The virus causes nearly two million hospitalisations yearly, and in Asia, up to 45 per cent of the children hospitalised for diarrhoea are infected with rotavirus.

Almost every child in the world will suffer at least one infection by the time he or she is three-year-old, according to the WHO.

Although baby Habibat is lucky to be alive, about 150, 000 under-five children die yearly from diarrhea in the country.

According to the United Nations Children’s Fund (UNICEF), the diarrhea prevalence rate in the country is 18.8 per cent, one of the worst in sub-Sahara Africa, and above the average of 16 per cent. It is also said to be one of the leading causes of child mortality in the country, accounting for over 16 per cent of child deaths.

Each year, an estimated seven million children are born in Nigeria, with each child experiencing an average of five episodes of diarrhea, according to National Demographic and Health Survey (NDHS) 2013. Without intervention, many of these children become malnourished and may end up dead each year, a UNICEF report said.

Experts are worried at government’s inability to introduce this life-saving vaccine in the Routine Immunisation (RI) programme, even when rotavirus has been found to be responsible for many of these diarrhea-related deaths in children.

Investigation by The Guardian revealed that the vaccine is presently not available at public health facilities in the country.

For instance, Ibafo Primary Health Centre (PHC) located at Ajeromi, Lagos State, has never been supplied rotavirus vaccine ever.

“What we have are the BCG, Oral Polio Vaccine (OPV), Diphtheria, Pertussis and Tetanus (DPT), Measles, Yellow Fever and Hepatitis B. But rotavirus and meningitis vaccines are not available”, the officer in-charge, Oluborode Cecilia explained. The situation was the same at the Gwagwalada General Hospital, Abuja, and other health centres visited.

At private hospitals, it was discovered that parents pay as much as N20, 000 for two doses of rotavirus vaccine to be administered on their children or wards, but a nurse claims that the vaccines may be ordinary water.

“These rotavirus vaccine claims at private hospitals are lies because the vaccine is not just available. It could even be water that these infants are being ‘vaccinated’ with for N20, 000,” Oluborode alleged.

The WHO had recommended that all countries, particularly those with high diarrhea mortality rates in children such as Nigeria, should introduce rotavirus vaccines into their immunisation programmes.

This is because by the age of five, nearly every child in the world has been infected with rotavirus at least once. And according to WHO, “With each infection, immunity develops, and subsequent infections are less severe; adults are rarely affected. There are five species of rotavirus and they are classified as A, B, C, D, and E. Rotavirus A, the most common specie causes more than 90 per cent of infections in humans,” the world health body explained.

In the midst of this frightening scenario, a statement from Save The Children, (an international non-governmental organisation that promotes children’s rights, provides relief and helps support children in developing countries) maintained that countries that have introduced the rotavirus vaccine have documented a “tremendous reduction” of severe diarrhea and rotavirus diseases, with some of them documenting substantial decreases of between 22 to 50 per cent in diarrhea mortality among children under five years of age following vaccine introduction.

Last year, the immediate past Executive Director of the National Primary Health Care Development Agency, (NPHCDA), Dr. Ado Mohammad, informed The Guardian of plans by the Federal Government to introduce rotavirus vaccine as part of the routine immunisation regimen for 2018.

“Between 2013 to date, three new vaccines- Pentavalent, Pneumococal Conjugate Vaccine (PCV) and Injectable Polio Vaccine (IPV) have been introduced into the RI schedule. These new vaccines remain very vital to achieving our collective goal of preventing death and morbidity amongst children, especially infants.

PCV is used against pneumococcal disease- pneumonia, which is reported to cause death in over 177, 000 children in the country annually. This figure represents 22 per cent of the global burden. Consistent with the government policy of protecting lives, we have plans to introduce more new vaccines into the routine immunisation schedule of the country; Meningitis A vaccine in 2017, Rotavirus vaccine in 2018 and Human Papilloma Virus (HPV) vaccines demo in 2017 and 2018, and into the RI schedule in 2019,” Mohammad said.

However, with the prevalent unavailability of funds in the country, experts are of the view that it may be an uphill task to fund rotavirus vaccine in 2018 due to the exorbitant nature of the vaccine.

“Nigeria cannot fund the vaccine on her own since the national allocation for immunisation is not even enough to sustain the old programme, except GAVI agrees to fund the vaccine, but GAVI is withdrawing and they are not ready to fund since Nigeria is said to be a rich country,” International Vaccine Access Center (IVAC) Consultant, Shola Molemodile, told The Guardian last weekend.

According to a report by the National Immunisation Financing Task Team (NIFT) advocacy committee members, the country faces an enormous funding gap for the immunisation programme due to the cost of procuring additional vaccines, increase in new births, loss of donor funding following GAVI graduation, and insufficient budgetary allocation to vaccines.

Speaking during a recent meeting for NIFT advocacy committee members in Abuja, organised by Community Health and Research Initiative (CHR), in collaboration with Partnership for Advocacy in Child and Family Health (PACFaH), the National Primary Health Care Development Agency (NPHCDA) and International Vaccine Access Centre (IVAC), the committee noted that without adequate funding for vaccines, the routine immunisation system will experience stock-out, which will subsequently lead to more deaths from vaccine preventable diseases in future.

The committee, which also noted that since GAVI is withdrawing its support, the country needs to fill the gap, added that the National Assembly has approved Federal Government’s request for a loan of $125 million from the World Bank to finance the 2017 Polio Eradication Programme and other routine immunisation vaccines.

According to the committee, the said loan would cater for 80 per cent of the country’s immunisation funding requirement in 2017 and make-up the 20 per cent allocation for polio eradication and immunisation programme in the 2017 budget.

However, “To fill the gap, Nigeria needs to secure progressively more money for its vaccine programmes starting from N29bn and raising it to an estimated N63bn by 2020. The Director Communications, Advocacy and Communications Department, NPHCDA, Eugene Ivase, said.

Deputy director of finance of the same organization, Ganiyu Salau, who provided updates on immunisation funding requirement for 2017, said the World Bank loan will sustain the immunisation programme for 2017.

He emphasised the need for improved political will on the part of the Federal Government to fund immunisation programmes.

However, The CHR/PACFaH Project Director and Co-chair of the Advocacy Committe of NIFT, Dr. Aminu Magashi, said the $125m approved was still not enough to meet the $181m immunisation fund requirement for 2017 and 2018.

“As the country begins its transition process from GAVI, its funding requirement has increased. Nigeria is expected to commit $181m out of the $264m to fund immunisation programmes for 2017 and 2018. Government needs to meet this demand by increasing the health budget and commencing local production of some of the vaccines needed to reduce the funding burden. There is also need to improve private-public partnership for immunisation financing in Nigeria,” he added.

The NPHCDA representatives during the meeting said the agency is looking towards 2018 to commence consultation for innovative immunisation financing and getting full commitment of the Nigerian government to self-fund its immunisation activities.

Country Lead of International Vaccine Access Centre (IVAC), Dr. Chizoba Wonodi, in his remarks said; “There has to be a developed transition plan as we co-finance immunisation with Gavi, and the Vaccine Alliance during the transition period as well as sustainable and innovative ways of funding after Gavi exits.”

Partnership for Advocacy in Child and Family Health (PSN-PACFaH) PsN-PACFAH representative, David Akpotor, told The Guardian that there is need to include rotavirus vaccine in the immunisation programme, just as he called on government to keep its promise in 2018 in order to reduce the high diarrheal death.

“Government needs to consider childhood diarrheal death a health emergency. There is need for more advocacy on the use of low osmosis Zinc/Oral Rehydration Solution (Zn/ORS) for treating childhood diarrhea, which would drastically reduce deaths occasioned by the disease”, he said.