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Bullets vs vaccines: Africa has a blindingly clear choice

Friday August 17 2018
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A child receives an oral polio vaccine. Immunisation is the most cost-effective public health investment for controlling and eliminating life-threatening diseases. PHOTO | AFP

By RICHARD SEZIBERA

Over the past several decades, the global community has ramped up efforts to improve routine immunisation coverage.

The result has been a drastic reduction in vaccine-preventable illnesses and deaths – around 2-3 million lives are saved around the world every year.

The benefits of immunisation for public health, safety and economic growth cannot be overstated. In countries where immunisation coverage has improved over time, life expectancy has also improved.

Across the world, more children are living past their fifth birthdays as vaccine-preventable deaths have dropped significantly.

Immunisation is the most cost-effective public health investment for controlling and eliminating life-threatening diseases: every dollar spent on childhood immunisations yields $44 in economic benefits, including productivity gains and savings on medical costs.

Despite weak health infrastructure and limited financing for immunisation programmes, Africa has made giant strides. Two decades ago, more than 20 African countries were polio-endemic. Today, only Nigeria is.

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In the past decade, over 270 million people have been immunised against meningitis A across Africa’s “meningitis belt.” Today the region has made significant progress against the disease.

Rwanda became one of the first African countries to introduce the pneumococcal conjugate vaccine (PCV) to protect against pneumonia, meningitis and sepsis, as well as the human papillomavirus (HPV) vaccine to prevent cervical cancer.

Many other countries in Africa have since followed suit by introducing these live saving vaccines.

However, several countries still face challenges in increasing immunisation coverage and, ultimately, saving lives. One of the most significant barriers to immunisation is the insecurity and conflict that plague so much of the continent.

Populations in areas of conflict often have limited or no access to lifesaving vaccines. This leaves them – and neighbouring regions – at increased risk of disease and death from illnesses that are often preventable.

Almost two-thirds of the world’s unimmunised children live in fragile states, humanitarian settings, or countries affected by conflict.

Data has shown that immunisation coverage suffers in times of conflict. During the Genocide against the Tutsi in Rwanda, coverage fell sharply from 83 per cent in 1993 to 23 per cent in 1994.

Similarly, during the conflict in Burundi in 1993, coverage fell to 63 per cent, from 80 per cent the previous year. Immunisation rates in South Sudan have declined annually since civil war broke out in 2013, reaching a low of 26 per cent in 2017.

In Somalia, which has consistently ranked as one of the world’s most fragile states for the past decade, immunisation rates have never risen above 45 per cent.

Civil unrest and conflict spur widespread mass migrations; displacement of individuals, families and entire communities; and lack of access to basic necessities, such as food, clean water and shelter – creating ideal circumstances for the spread of disease. Moreover, health systems deteriorate and supply chains are disrupted, thus inhibiting the delivery of basic health services.

In such settings, delivering lifesaving services such as immunisation becomes even more important. Access to immunisation in conflict zones also offers an entry point for other essential health services, from providing nutritional screening and supplements to delivering medicines and treating basic illnesses.

This is an agenda that all sides involved in conflict can surely agree on.

In the past, we’ve managed to immunise children in conflict zones against polio. We can do the same for other vaccines as well – health authorities can set up immunisation camps at transit points; local, religious and state leaders can be engaged to negotiate access to specific communities; and health workers from local communities can be trained to deliver services during periods of calm.

Given the growing number of fragile states and the increase in at-risk populations living in conflict zones worldwide, more and more people will soon be at risk of vaccine-preventable diseases if we do not scale up efforts to deliver vaccines and other essential health services in these settings.

We cannot, and should not wait until conflicts are completely resolved for the most vulnerable to receive the healthcare they deserve.

We have come a long way, but there is still much more to do. Even in countries where we are fortunate to be free from the scourges of war, we face our own unique challenges. For example, misinformation around immunisation can lead parents to refuse certain vaccines, putting their children’s lives at risk.

In Kenya, some religious leaders have rejected vaccines such as tetanus and polio in recent years, despite their proven safety and efficacy.

Rumours that these vaccines cause infertility are not only unfounded and unscientific, but also threaten to derail the progress that Kenya and other countries have made in improving maternal and child mortality.

The progress that Africa has made on immunisation is nothing short of remarkable. But as we reflect on our achievements, it is a time to do more – not less.

Dr Richard Sezibera is a member of the Senate of Rwanda and former secretary-general of the East African Community

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