Africa: Why Surveillance of Essential Vaccines is Important

At the Samir health centre in Sudan’s capital Khartoum, this baby was one of the first of tens of thousands of children to benefit from Sudan’s introduction of rotavirus vaccine into the national immunisation programme (file photo).
24 January 2019

Immunization is one of the most effective public health interventions that prevent millions of deaths every year in all age groups from vaccine-preventable diseases. Despite all the efforts by the World Health Organisation to have all children vaccinated no matter their economic circumstances, one in every four children still misses essential vaccines.

To highlight the urgency of Vaccine Preventable Diseases (VPD) surveillance in Africa three officials from the World Health Organisation African Region share information on the current status of surveillance for these diseases and details about the current Ebola situation in region. Dr Richard Mihigo is a Program Area Manager, Immunization and Vaccine Development, Professor Helen Rees is the Chairperson of the Immunisation Technical Advisory Board and Dr Felicity Zawaira, the Director of the Family and Reproductive Health Cluster.

There is a number of vaccine preventable diseases, they include measles, polio, tetanus, diphtheria, meningitis, yellow fever, hepatitis B, tuberculosis, pneumonia, diarrhea and cervical cancers. Among these diseases, measles remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine.

With the second wave of the Ebola outbreak that hit the DR Congo in 2018, health authorities had to move fast to control the epidemic, immunisation has proven to be effective in minimising the number of deaths. Close to 60 000 people received the Ebola vaccine in DR Congo including close to 20 000 health workers in frontline work. In Uganda, over 2 600 health workers have been vaccinated in over 100 health facilities.

As the 2020 global and regional immunisation targets deadline draws closer and polio is on the brink of eradication, a group of independent global experts who advise the WHO regional director looked at what must be done to ensure that the progress in the regional immunisation goals - particularly on diseases such as measles and yellow fever - is not reversed.

As part of the Regional Immunization Technical Advisory Group (RITAG), Felicity Zawaira describes vaccines as one of the most valuable tools to dramatically reduce child mortality around the world.

"Immunisation saves between 2 to 3 million lives each year, since 1990 vaccine-preventable diseases have decreased by 70% but has been stagnant at 72% in the region for the last five years, as a result pneumonia and diarrhea continue to be the leading cause of death in children under the age of five years in Sub-Saharan Africa."

Over the years polio has been the major focus and has received focused funding, does that mean rotavirus, pneumonia, and measles, etc., are taken less seriously?

Richard Mihigo says that is not the case as polio is an eradication program and requires more intensive disease surveillance to find each and every paralysed child and investigate accordingly. The other diseases are targeted by elimination and control programs, which do not require such intensive degree of surveillance.

To highlight the urgency of VPD surveillance in Africa, the WHO Regional Offices for Africa has developed a country maturity grid classifying 47 countries in Africa on the basis of the strength of their surveillance programme. Each country has been rated from 1-4 with level 1 referring to low maturity and level 4 to the highest level of maturity. By the end of 2018, based on the maturity grid, 28 African countries had weak surveillance systems.

The surveillance maturity grid was developed using: Government ownership and funding of surveillance activities, the documented performance with case-based surveillance for polio and measles/rubella over the last three years, the presence and accreditation status of VPD surveillance laboratories, and operational readiness and coordination systems for outbreak preparedness and response.

Speaking on the polio transition strategy in Africa and the need to strengthen surveillance, Richard Mihigo said big progress has been made across the continent, with 37 countries developing their plans to improve their healthy security capacity, including surveillance and laboratory networks.

"The global polio eradication initiation has 16 polio laboratory across the region that processes samples not only for polio but for other vaccine's preventable diseases such as measles, yellow fever, cholera and many more. Surveillance not only prevents disease breakouts but also informs policy and monitors progress particularly for immunisation programmes," he said.

He also emphasised the importance of data diagnostic tools and techniques using unique identifiers, and mobile technology which has also played a big role in strengthening surveillance in the region.

For the past two decades, VPD surveillance in Africa has been heavily supported by funding from the Global Polio Eradication Initiative (GPEI), as the world nears polio eradication, funding has begun to run low. This means countries must quickly secure funds for their national surveillance programmes to make sure that they don't reverse the progress already made. "We urge member states to raise necessary domestic and external financial resources to maintain and strengthen their surveillance and laboratory networks in the post-polio eradication".

Data from the study on the importance of vaccines from the WHO business scale for immunisation activities in the African region found that curbing four major vaccine-preventable diseases like measles, rubella, retrovirus and pneumococcal diseases could save over 1.9 million lives. Sicknesses and lack of vaccines cost the region U.S.$13 billion every year which is funding that could be channeled towards censoring health systems, fueling economies and saving lives.

Felicity Zawaira says the next 9 months are a critical time for immunisation in Africa. "We are months away from the target set by the regional strategic plan for immunisation including eradicating polio and eliminating measles, African countries must work harder and faster to ensure that we have a great story to tell in 2020, there is hope as countries across Sub-Saharan Africa have introduced many new vaccines like the vaccine for retrovirus, hepatitis vaccine and many more."

Helen Rees says when it comes to measles the data shows that the African region won't meet the 2020 measles target, as of 2017 only 8 countries had met the target of over 95% national immunisation coverage for the measles containing vaccine.

"There is an enormous task ahead, there is a lot to be done but progress has already been made."

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