CNS: Uganda in plan to vaccinate 3 million children against pneumonia

World Pneumonia Day, 12th November
Lung Week: 12-17 November
Ms Mary Musoke of Kampala in Uganda is expecting to have her third born child in late March or early April 2013, making the delivery timely for the newborn to get its Pneumococcal Conjugate Vaccine (PCV), which debuts in the Uganda public health system for free. Due to the high disease rates of the killer invasive pneumococcal disease (pneumonia, septicaemia and meningitis), a major cause of illness and death, now Government is set to introduce PCV as part of the routine immunization schedule.

This will see at least 1,425,995 children including Mary’s baby getting the recommended three doses of PCV by the end of 2013 while 1,509,628 are being targeted in the year 2014. Vaccination of the children will be possible following the GAVI Alliance’s approval of a Uganda Government funding request to the organization last year. The vaccine will be given at 6, 10 and 14 weeks of age.

Introduction of PCV comes at a time when the recently released 2011 Uganda Demographic and Health Survey (UDHS) shows that although improvements have been registered, neonatal, infant and under five mortality remain high and way out of reach for the 2015 target of achieving Millennium Development Goal No. 4 of reducing child mortality. The UDHS shows that one in every 19 Ugandan children dies before the first birthday, and one in every 11 children dies before the fifth birthday.

It further shows that: “Infant mortality declined from 88 deaths to 54 deaths per 1,000 live births between the 2000-01 UDHS and the 2011 UDHS. Under-5 mortality from 152 deaths per 1,000 live births to 90 deaths per 1,000 live births between the two survey periods. Childhood mortality is higher in rural areas than in urban areas. The mortality rates were lowest in Kampala. The neonatal and post neonatal mortality rates were 27 deaths per 1,000 live births, each.”

Ministry of Health records show that Pneumonia, which annually kills 39,000 children under 5 years (representing 21 percent of mortality), occupies top slot among pneumococcal disease. A total 1.8 million episodes of Pneumonia are estimated to occur every year, out of which a proportion of only 47 percent (846,000) receive treatment.

In the new initiative, “Government co-financing will involve contribution of US$ 0.20 per dose, per year. This translates in US $1,980,000 for 2013 and US$ 1,014,000 for 2014. In 2013 GAVI will contribute US$ 21,235,500 and US$ 17,971,000 in 2014.”

If the anticipated 92 percent coverage of the pneumococcal vaccination programme is achieved by the end of 2014, Shs 2.6 billion would be saved in direct medical costs. Similarly, nearly 11,000 lives of children under 5 years would be saved with this kind of intervention.

But not all lives can be saved due to the presence of non-vaccine pneumococcal serotypes, and as commemoration of World Pneumonia Day takes place today (November 12) and the Lung Week (12-17 November), the International Union against Tuberculosis and Lung Disease (The Union), said in a statement released Friday that more needs to be done beyond vaccination.

“Pneumococcal vaccine is an important intervention that is already in use and highly effective in resource-rich settings - and it has great potential in high child-mortality settings too. However, tackling pneumonia is a complex issue that requires a more comprehensive approach than a single vaccine,” so says Dr Stephen Graham of The Union’s Child Lung Health Division, to Citizen News Service - CNS. Dr Graham is also the Chair of the Childhood TB sub-group of the DOTS Expansion Working Group of the Stop TB Partnership.

In order to fully address child pneumonia in all settings, The Union recommends a balanced and comprehensive approach that accentuates other preventive strategies, as well as vaccine. Listed is good nutrition and breastfeeding, reduction in indoor air pollution, hand washing and improved case management.

“Curative interventions include addressing the rising rates of bacterial resistance; models of community care; the role of zinc; focus on the needs of high-risk patients, such as those who are malnourished or HIV-infected and infants; as well as wider availability of oxygen therapy and other methods of respiratory support.”

Uganda and other resource limited countries, as observed by Dr Graham, still have a challenge of addressing other drivers of Child Pneumonia. Again, looking at Uganda’s Demographic and Health Survey, all is not well. Thirty three percent of the children are stunted due to poor nutrition. It (UDHS) further shows that most fatal cases are happening in rural areas where almost 100 percent of lighting and cooking activities cause indoor air pollution and health services are severely underfunded.

Management of cases has been an uphill task in Uganda where the surveillance system has demonstrated intermediate resistance of some vaccine serotypes to the cheaper penicillin but susceptible to cefotaxime, a more expensive antibiotic, which is way out of reach for many families. Yet funding to the health sector has remained at an average 9 percent of the GDP for several years making it hard for many impoverished families to access vital medicines.

To this, while administration PCV is anticipated to be successful, it remains to be seen if Government, not known to easily take up donor supported projects when funding winds up, will continue with the programme after 2014.