Ensuring every Nigerian child receives life-saving vaccination

DESPITE recent concerns over safety that led to the rejection of the Measles Mumps and Rubella (MMR) vaccine by some parents in the United Kingdom (UK) and United States (US), medical experts insist that the benefits of immunization far outweigh the risks.

Reasons: several studies have shown that immunization prevents illness, disability and death from vaccine-preventable diseases including cervical cancer, diphtheria, hepatitis B, measles, mumps, pertussis, pneumonia, polio, rotavirus diarrhoea, rubella and tetanus.

According to the World Health Organization (WH0), immunization currently averts an estimated two to three million deaths every year, but an estimated 21.8 million infants worldwide are still missing out on basic vaccines.

Consequently, the WH0 is calling for renewed collective efforts to get progress on global vaccination targets back on track. The WHO in a statement ahead of the World Immunisation Week, April 24 to 30, said globally, one in five children are not receiving routine vaccines that could avert 1.5 million deaths a year from preventable diseases and that only one of the six global vaccination targets for 2015 is on track.

My advice to parents is that the benefit of immunization far outweighs the risk. A child having whooping cough can die because of the disease but the side effects of immunization that is fever, is much milder and often goes even without treatment. A lot of people also have belief of long-term side effects but it has been shown that those side effects are minimal compared to the protection received from immunization.

WHO assistant director-general for family, women’s and children’s health, Dr. Flavia Bustreo, said World Immunization Week is an opportunity for the world to focus on and push harder toward the goal of ensuring every child, “whoever they are and wherever they live,” receives life-saving vaccination.

She argued: “It is critical that the global community now makes a collective and cohesive effort to put progress towards our six targets back on track.” At the 65th World Health Assembly in Geneva in 2012, 194 countries endorsed the Global Vaccine Action Plan (GVAP) – a roadmap to prevent millions of deaths by 2020 – through “more equitable access to vaccines for people in all communities.”

At that meeting, member states also agreed to designate the last week of April as World Immunization Week. However, a recent independent report on GVAP progress warns that vaccines are not being delivered fairly or reliably and that only one of the six targets for 2015 – the introduction of underutilized vaccines – is currently on track. The report reads:

“One of the at-risk targets for 2015 is to ensure that 90 per cent of children receive the DTP3 vaccine to protect against diphtheria, tetanus and whooping cough. Currently, 65 of the 194 countries that signed up to the GVAP are not reaching the target.

“In 2013, nearly 22 million babies did not receive the required three doses of DTP3. Many of these infants live in the world’s poorest nations.” While many countries are already vaccinating four out of five children with DTP3, one third are still struggling to reach the “fifth child,” resulting in millions remaining at risk of illness, disability or death.

In May this year, WHO are meeting with 34 countries whose DTP3 coverage is currently under 80 per cent to discuss barriers to progress and how to overcome them. Also, vaccination targets for measles, polio, tetanus and rubella are at risk. Another of the at-risk GVAP targets is to eliminate measles from three WHO regions by the end of 2015.

WHO say currently 16 per cent of children are not being immunized against measles and that in the past year, many countries have experienced large measles outbreaks and this has threatened efforts to close this gap. World immunization coverage Below are global updates on vaccination against killer diseases, according to the WHO.

Haemophilus influenzae type b (Hib) causes meningitis and pneumonia. Hib vaccine had been introduced in 189 countries by the end of 2013. Global coverage with three doses of Hib vaccine is estimated at 52 per cent.

There is great variation between regions. In the Americas, coverage is estimated at 90 per cent, while it is only 18 per cent and 27 per cent in the Western Pacific and South-East Asia Regions respectively.

Hepatitis B is a viral infection that attacks the liver. Hepatitis B vaccine for infants had been introduced nationwide in 183 countries by the end of 2013. Global coverage with 3 doses of hepatitis B vaccine is estimated at 81 per cent and is as high as 92 per cent in the Western Pacific. Human papillomavirus — the most common viral infection of the reproductive tract—can cause cervical cancer, and other types of cancer and genital warts in both men and women. Human papillomavirus vaccine was introduced in 55 countries by the end of 2013.

Measles is a highly contagious disease caused by a virus, which usually results in a high fever and rash, and can lead to blindness, encephalitis or death. By the end of 2013, 84 per cent of children had received 1 dose of measles vaccine by their second birthday, and 148 countries had included a second dose as part of routine immunization. Meningitis A is an infection that can cause severe brain damage and is often deadly.

Three years after its introduction—the end of 2013 had vaccinated more than 150 million people in African countries affected by the disease vaccinated with MenAfriVac, a vaccine developed by WHO and PATH. Mumps is a highly contagious virus that causes painful swelling at the side of the face under the ears (the parotid glands), fever, headache and muscle aches.

It can lead to viral meningitis. Mumps vaccine had been introduced nationwide in 120 countries by the end of 2013. Pneumococcal diseases include pneumonia, meningitis and febrile bacteraemia, as well as otitis media, sinusitis and bronchitis. Pneumococcal vaccine had been introduced in 103 countries by the end of 2013, and global coverage was estimated at 25 per cent. Polio is a highly infectious viral disease that can cause irreversible paralysis.

In 2013, 84 per cent of infants around the world received three doses of polio vaccine. Targeted for global eradication, polio has been stopped in all countries save three—Afghanistan, Nigeria and Pakistan. Imported virus has infected polio-free countries, and all countries—especially those experiencing conflict and instability—remain at risk until polio is fully eradicated.

Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. Rotavirus vaccine was introduced in 52 countries by the end of 2013, and global coverage was estimated at 14 per cent. Rubella is a viral disease, which is usually mild in children, but infection during early pregnancy may cause fetal death or congenital rubella syndrome, which can lead to defects of the brain, heart, eyes and ears.

Rubella vaccine was introduced nationwide in 137 countries by the end of 2013. Tetanus is caused by a bacterium, which grows in the absence of oxygen, example in dirty wounds or in the umbilical cord if it is not kept clean.

It produces a toxin, which can cause serious complications or death. The vaccine to prevent maternal and neonatal tetanus had been introduced in 103 countries by the end of 2013. An estimated 82 per cent of newborns were protected through immunization. Maternal and neonatal tetanus persist as public health problems in 25 countries, mainly in Africa and Asia.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. As of 2013, yellow fever vaccine had been introduced in routine infant immunization programmes in 35 of the 44 countries and territories at risk for yellow fever in Africa and the Americas and coverage was estimated at 41 per cent.

Nigeria’s giant strides towards polio eradication Nigeria has recorded no case of Wild Polio Virus (WPV) in the last nine months, and is three months away from being certified polio-free by the WHO. According to the Weekly Polio Update released yesterday, ahead of the World Immunisation Week, April 24 to 30, by the Global Polio Eradication Initiative (GPEI), no new wild poliovirus type 1 (WPV1) cases were reported in the past week.

The report reads: “Nigeria’s total WPV1 case count for 2014 remains six. No cases have been reported in 2015. The most recent case had onset of paralysis on 24 July in Sumaila Local Government Area (LGA), southern Kano state.

“No new type 2 circulating vaccine-derived poliovirus (cVDPV2) cases were reported this week. The most recent case had onset of paralysis on November 16 in Barde Local Governmental Area of Yobe state.

The total number of cVDPV2 cases for 2014 in Nigeria remains 30. No cases have been reported in 2015.” The GPEI report, which was corroborated by the Executive Director of National Primary Health Care Development Agency (NPHCDA), Dr. Ado Gana Muhammad, noted that the National Immunization Days took place from April 25 to 28 using trivalent oral polio vaccine (OPV) in most of the country, bivalent (OPV2) in the south-west and Injectable Polio Vaccine (IPV) in some areas of the north.

Key challenges According to the WHO, despite improvements in global vaccine coverage during the past decade, there continue to be regional and local disparities resulting from: limited resources; competing health priorities; poor management of health systems; and inadequate monitoring and supervision.

In 2013, an estimated 21.8 million infants worldwide were not reached with routine immunization services, of whom nearly half live in three countries: India, Nigeria and Pakistan. Meanwhile, parents have been advised to ensure complete adherence to all the schedules of immunization for their children and get them protected, resistant and prepared for the challenges ahead from infectious diseases.

Consultant Pulmonologist and Senior Lecturer, College of Medicine, University of Lagos (CMUL), Dr. Obianuju Ozoh, in an interview with The Guardian disclosed that parents due to some cultural, religious belief, illiteracy and hearsay deprive their children of life-saving vaccinations made available through immunization thereby, exposing them to infectious diseases that cause deaths and deformities.

A pulmonologist, or pulmonary disease specialist, is a physician who possesses specialized knowledge and skill in the diagnosis and treatment of pulmonary (lung) conditions and diseases.

Ozoh said that immunization is making a person resistant to a disease, particularly, infectious disease, and this is often achieved by vaccination. She stated that a person is given a vaccine that contains a modification of organisms that causes the infection such that when the person is exposed in the future to that organism, he is protected from that disease.

Ozoh noted that the benefits of immunization cannot be overemphasized revealing that it is important to get babies immunized because when a child is born, they have no immunity at all and are therefore prone and at risk of infectious diseases.

She however said that they are a little bit protected from their mother’s immunity but that it wanes within a short time. Reacting to the rejection of vaccination due to cultural, religious or personal beliefs, Ozoh said: “My advice to them is that the benefit of immunization far outweighs the risk. A child having whooping cough, diphtheria can kill that child but the side effects of immunization, fever, a much milder and often goes even without treatment.

A lot of people also have belief of long-term side effects but it is shown that those side effects are minimal compared to the protection received from immunization.

“The important thing is that you want to understand first when a mother is resistant to immunization, why are they resistant? You want to ask them, what is the reason of their resistance? Is it cultural belief? Is it religious belief? Is it what they heard? Because many times, it is out of ignorance.

They overheard someone talking that ‘ahh, his thing is not good’ and that means they will not give their child immunization. It is then the duty of the healthcare provider to understand why somebody is resistant and explain to her that the benefit far outweighs the risk. “It is because immunization is being done now and people are no longer seeing those diseases that killed children, some people are now taking it for granted.

It is because other people that those diseases are not even available to infect other people have taken up this immunization. So, if many people drop from the immunization programme, those diseases will come back and the risk for those who are not immunized will increase.

“So we need to encourage everybody to get immunized. Although there are risks which includes fever, swellings, abscess and others, those risks are minor as compared to protection you receive from immunization.

” Solutions The GVAP outlines three steps for closing the immunization gap: integrate immunization into other health services, such as postnatal care; strengthen health systems so vaccines can still be given in times of crisis; and ensure everyone can access and afford vaccines. Director for immunization, vaccines and biologicals at WHO, Dr. Jean-Marie Okwo-Belé, said:

“There is no one centralized approach that can ensure vaccines are delivered and administered to each child.” He says plans on the ground need to adapt not just to countries but also districts and communities.

In their statement, WHO list several ways operational needs can adapt on the ground, including: simplify vaccination procedures in the field, improve delivery to reach children living in remote areas, strengthen supply chains and improve quality of data collection and surveillance.

The other three 2015 GVAP targets that are off-track concern the elimination of polio, maternal and newborn tetanus, and rubella. According to the WHO, critical operational needs to ensure wider vaccination and delivery on the ground, include: finding ways to simplify vaccination procedures in the field; improving vaccination delivery to reach every last child, especially those living in remote and inaccessible areas; ensuring vaccine affordability and strengthening vaccine supply chains; training more health workers, skilled managers and providing supportive supervision; improving the quality of data collected by countries and using this to improve immunization operations; overcoming challenges posed by conflict, natural disasters and other crises; increasing awareness and demand for immunization by communities; and greater accountability linked to micro-planning of vaccination operations and clear lines of responsibility.

Earlier this year, donor countries and institutions pledged to meet the funding needs of Gavi, the Vaccine Alliance that brings together public and private sectors to create equal access to new and underused vaccines for children living in the world’s poorest countries.

WHO said priority needs to be given to strengthening routine vaccination globally, especially in the countries that are home to the highest number of unvaccinated children.

Particular efforts are needed to reach the underserved, especially those in remote areas, in deprived urban settings, in fragile states and strife-torn regions. On what the government can do to improve the uptake of the vaccines, Ozoh said:

“Well, the National Programme on Immunisation (NPI) is trying, the coverage is increasing and the government is trying to reach even the rural areas that were not initially covered, which is a good thing. This, they have achieved by decentralizing immunization and working with the tiers of government. “But the uptake of pneumococcal vaccine has not been high in Nigeria particularly, among adults.

This is because it wasn’t available and may be people didn’t understand that there is protection that it can give. So now that we have the vaccine more available for adults, it is for doctors to understand the indication, know the patient that require the vaccine and educate those patients to receive it.”

WHO is working with countries and partners to improve global vaccination coverage, including through these initiatives adopted by the World Health Assembly in May 2012.

The GVAP is a roadmap to prevent millions of deaths through more equitable access to vaccines. Countries are aiming to achieve vaccination coverage of greater than 90 per cent nationally and greater than 80 per cent in every district by 2020.

While the GVAP should accelerate control of all vaccine-preventable diseases, polio eradication is set as the first milestone.

It also aims to spur research and development for the next generation of vaccines. Multiple stakeholders—United Nation agencies, governments, global agencies, development partners, health professionals, academics, manufacturers and civil society, developed the plan. WHO is leading efforts to support regions and countries as they adapt the GVAP for implementation.

At the World Health Assembly in 2014, Member States discussed progress towards the GVAP goals and highlighted issues that must be addressed if they are to be achieved: sustainable access to vaccines—especially newer vaccines—at affordable prices for all countries; technology transfer to facilitate local manufacture of vaccines as a means of ensuring vaccine security; improved data quality including through the use of new technologies like electronic registries; risk communication and management to address misinformation on immunization and its impact on vaccination coverage; and evidence reviews and economic analysis for informed decision-making based on local priorities and needs.

Quote1 Despite improvements in global vaccine coverage during the past decade, there continue to be regional and local disparities resulting from: limited resources; competing health priorities; poor management of health systems; and inadequate monitoring and supervision.

Quote2 My advice to parents is that the benefit of immunization far outweighs the risk. A child having whooping cough can die because of the disease but the side effects of immunization that is fever, is much milder and often goes even without treatment. A lot of people also have belief of long-term side effects but it has been shown that those side effects are minimal compared to the protection received from immunization.

Quote 3 Critical operational needs to ensure wider vaccination and delivery on the ground, include: finding ways to simplify vaccination procedures in the field; improving vaccination delivery to reach every last child, especially those living in remote and inaccessible areas; ensuring vaccine affordability and strengthening vaccine supply chains; training more health workers, skilled managers and providing supportive supervision; improving the quality of data collected by countries and using this to improve immunization operations; overcoming challenges posed by conflict, natural disasters and other crises;

increasing awareness and demand for immunization by communities; and greater accountability linked to micro-planning of vaccination operations and clear lines of responsibility.