30 December 2017

Uganda: Inside Story of Free Yellow Fever Drugs

Kampala — The yellow fever vaccination card has become the second most important document after the passport for travellers in Uganda.

This is especially since March 2016 when half a dozen suspected cases of the yellow fever disease were reported in the Masaka area.

Travellers coming in or leaving Uganda are now required to present their yellow fever immunisation certificates at Entebbe International Airport as one of the ways to control the spread.

The increased demand for these certificates from travellers has spawned brisk business in genuine and fake yellow fever cards in Kampala, with travellers paying up to $50 (about Shs180,000) for fake cards while a real jab costs nearly the same at the few upper end clinics in the city licensed to administer the vaccine.

Then in December, free vaccinations were suddenly available to Ugandans in and around Kampala - whether they were travelling or not.

Thus for more than a week, there were long and winding queues of women, children and youth trying to get free yellow fever vaccination at Mandela National Stadium, Namboole. Earlier, there had been similar queues at Kololo Airstrip as thousands struggled to get a free yellow fever jab.

The question for many Ugandans, therefore, was why now, why free, why mass, and who was the generous donor?

A Saturday Monitor investigation has established that the Namboole and Kololo vaccinations drives were sponsored by the National Medical Stores (NMS) with the approval of the Ministry of Health.

NMS, the body charged with procuring, storing and distributing drugs in all public health centres on behalf of the government, was among the firms that had stocked big quantities of the vaccine to cater for the increased demand, but had since failed to finish their stock which was due to expire in two months, according to an internal source.

In order to avoid incurring the cost of safe disposal of the vaccines, and of course the uproar that would follow the expiry of the drugs in government stores yet citizens need them, the free mass yellow fever exercise was organised targeting more than 50,000 people in Kampala, beginning with a 10-day campaign in November, which was extended for another five days in December.

"Vaccines safe"

The yellow fever vaccine bottles used during the free vaccination exercise concluded on Friday December 22, seen by Saturday Monitor had their expiry date indicated as March 2018.

The free exercise has also been concentrated in Kampala only, which has left out would be beneficiaries in the countryside.

However, Mr Moses Kamabare, the executive director of NMS, defended the exercise, saying that until the vaccines had passed the expiry date, they were as good as ones that have two years or more to expire.

"Medicines or vaccines are either expired or not... there is nothing like about to expire," Mr Kamabare responded to our inquiry by phone text message.

Dr Vincent Karuhanga, a general practitioner at Friends Polyclinic in Kampala, also quells fears that the drugs could have long-term side effects on the beneficiaries, stating that "it is why it has an expiry date. Even during that date when it is expiring you can still use it".

Asked why the free vaccination exercise is only in Kampala, the NMS spokesperson, Mr Dan Kimosho, said it was a decision reached by the board and the Ministry of Health to increase disease prevention starting with yellow fever in Kampala.

Bought cheaply, sold expensively

Due to the high demand for the yellow fever vaccination card, select health centres and hospitals took advantage to charge exorbitant prices for the yellow fever vaccines, despite the lower prices at which the distributors sell them.

A source in one of the pharmaceutical companies which supply the vaccines, who asked not to be named, told this newspaper that the cost of multiple dose vial (bottle) containing 10 dozens, which serve 10 clients, goes for Shs390,000, while a single dose costs Shs112,000. This cost is for the more expensive patented vaccines, while the generic vaccines cost less than half of this.

With each client charged above Shs100,000 in most of the places, hospitals make a profit of not less than Shs600,000 from one multiple dose vaccine bottle. Norvik Hospital in Kampala is known for charging the lowest rate for the vaccination - Shs60,000 per client including the vaccination card. We could not establish whether it administers a patented or generic drug.


In May last year, NMS accused Kampala Capital City Authority (KCCA) of inflating the price of the vaccines since the former procured each dose of vaccine at Shs16,000 yet KCCA charged Shs73,000 for the vaccine alone, which raised it to Shs100,000 with other costs included.

The city authority, however, justified the exorbitant price it charged on account that it included cost of syringes and gloves used to administer the injections.

Information availed to Saturday Monitor by a source at the Ministry of Health states that the hospitals have also succeeded in fleecing the public by conniving with officials at Ministry of Health to limit the number of centres accredited to provide the vaccine.

Dr Diana Atwine, the permanent secretary of the Health ministry, disputes the allegations, saying they have not stopped any hospital with the requisite requirements for providing the vaccine and that they are still welcoming others.

"Concerning the accreditation of few hospitals, we only do so for those that apply and fulfill the criteria. We still welcome more," Dr Atwine said, adding that the vaccines given by NMS free of charge are still potent even though they are about to expire. She says those complaining about them are "malicious... full of pessimism".

It is not clear whether there are any special requirements a health centre must fulfill in order to be allowed to administer the yellow fever vaccine. But nearly all hospitals in the country administer various vaccines, especially to children and expectant mothers under the Uganda National Expanded Programme for Immunisation (UNEPI) that was launched in the 1990s to end the six killer diseases - diphtheria, polio, tetanus, tuberculosis, measles and whooping cough.

In March 2016, seven cases of yellow fever were confirmed; five of them from Masaka, one from Rukungiri and another from Kalangala, but only three people were confirmed dead after the outbreak.


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