There was a controversy in Kenya over the polio vaccination campaign in July, with the Catholic church raising fears about the safety of the vaccine. The WHO Horn of Africa co-ordinator Dr Samuel Okiror for polio eradication spoke to Elizabeth Merab about the controversy.

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How is the immunisation coverage in East Africa?

Coverage varies. While there are countries with very good coverage, others are yet to catch up. Statistics from the independent monitors show that there is 90 per cent immunisation coverage in Uganda, Sudan, Tanzania, Kenya and Eritrea. This goes to show how immunisation has improved over the past seven years.

But there are still immunisation campaigns going on. What indicators do you look out for to determine if a campaign is necessary?

Whenever there is a drive to eliminate or eradicate a disease, a campaign will be conducted. Having not met the year 2000 WHO eradication target, we are compelled to mobilise all available resources to eradicate the disease. That means boosting the number of vaccination being administered to ensure immunity is achieved.

Considering that immunity cannot be achieved with routine vaccination there is a clear need to boost the immunity by having both routine and campaign immunisation.

How do you determine the number of times an immunisation campaign should be conducted?

If there is an outbreak of wild polio virus, we recommend that the affected country plan for five rounds of immunisation immediately to stop transmission. The rounds are then continued as long as new cases are detected.

For a round to be complete, a child must receive two drops of the vaccine. A round can be given after every two weeks or in monthly intervals depending on the type of vaccine used.

When transmission has been contained, you must have three rounds of immunisation. These campaigns target children under the age of five. Therefore, so long as your child is below five, there is no harm in taking them for the vaccine whenever there is a campaign.

What diseases are being prioritised for immunisation?

At the moment immunisation campaigns are being conducted for polio, measles, tetanus and the Human Papilloma Virus (HPV), which has been introduced due to the need to protect girls against cervical cancer.

The main campaign immunisations are for polio and measles. But we do more polio campaigns than measles because of the need to eradicate the disease.

Kenya just completed its polio immunisation. Were there other countries conducting immunisation in the region?

As we speak, Somalia is just completing its immunisation. Nigeria and Uganda have also conducted their campaigns. However, the campaign was not necessary for Tanzania because the country was declared free of polio in 1996 and there have not been any reported cases. Campaigns in Kenya should have taken place early in the year. However, a few controversies delayed the exercise.

Are these controversies well founded?

Anybody who raises questions on the safety of the vaccines should have the scientific ability to substantiate their information. As far as we are concerned, we haven’t seen any concrete evidence presented. Therefore, they have no basis for saying the vaccine is not safe.

How do you react to such controversies when WHO/Unicef is named?

As a body charged with implementing the World Health Assembly resolutions, we do not doubt our products, we are certain of the quality and safety of vaccines procured through WHO/Unicef.

Recently, it was written that whoever tested the polio vaccine [National Quality Control Lab] said it was safe. We were not part of that exercise. To say the least, the response has been very good. Even with the recent controversy, independent monitoring has shown that the response was 93 per cent.

Are there independent bodies that test the vaccines to allay public fears?

Well, governments have a responsibility to their people. Therefore if a government feels there’s a need to retest the vaccines, we will not stop them. Our work is just to remind them that the vaccines are safe. But we cannot stop the government from retesting the vaccines if they wish.

They have a responsibility to reassure the public about the safety of the vaccines. However, like I said, we cannot take part in the retesting since we have confidence in the products.

There are fears that drug manufacturers are behind the controversy; is this a possibility?

No. That does not happen. There are very few prequalified vaccine manufacturers. For instance, there are only four polio manufacturing companies, the and the cost of manufacturing a vaccine is not cheap. It is also a rigorous stage-by-stage exercise of preparing vaccines.

What about questions about safety and efficacy of vaccines?

The vaccines that we procure are safe because they are subjected to rigorous vetting processes before they are put out for public use. In terms of efficacy, they may not be 100 per cent but they are over 90 per cent effective.

Is this controversy unique to Kenya or do other countries also grapple with such issues?

Let us differentiate between controversy, rejection and refusal. These three things are completely different. Kenya’s case is a controversy because the people instigating it are not even the parents of the children.

However, we have had cases of rejection and refusal from parents for different reasons — either the child is sick or religious beliefs that do not allow western medicine.

These are easy to address because it is just about lack of knowledge. But the controversy is not unique to Kenya. The same thing occurred in Nigeria, but the issue was addressed. There are other countries with such minor controversies but in general, vaccination is accepted worldwide.

What are the challenges immunisation campaigns face in the region?

We have to deal with insecurity in countries like Somalia, South Sudan and northeastern parts of Kenya.

We are also grappling with issues of mobile populations. These are population that we have to keep tracking to ensure they are immunised.

Who and what determines the safety of vaccines?

The WHO is a global agency which is mandated to control prequalification process of manufacturers and vaccines. The staff who conduct the prequalification do not have to be from WHO. Besides, there are protocols to follow and every government is a signatory of the World Health Assembly (WHA). WHO only implements the resolutions passed at the WHA.

What can be done at borders to contain polio and other viruses?

It is not easy to contain viruses at the border because of people’s mobility. So, to contain such situations, we conduct synchronised cross-border immunisation campaigns.