By Elizabeth Merab

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Immunisation coverage in Africa has stagnated at 74 per cent in recent years despite significant increases in access, a principal advisory group to the World Health Organisation has warned.

At the current pace, the Regional Immunisation Technical Advisory Group said that the continent will not achieve the Global Vaccine Action Plan and the Africa Regional Strategic Plan for Immunisation target of 90 per cent national immunisation coverage by 2020.

“We have made great strides in recent years, but there is much work to be done to ensure that all children have access to the life-saving vaccines. Even one child still losing its life to a preventable disease is one child too many,” said Dr Matshidiso Moeti, the WHO regional director for Africa.

Immunisation coverage is measured by percentage of children receiving the third dose of the diphtheria-tetanus-pertussis vaccine, which helps children younger than seven years to develop immunity to three deadly diseases caused by bacteria: diphtheria, tetanus, and whooping cough (pertussis).

Risks

According to the Global Vaccine Action Plan 2017 report, vaccine-preventable diseases kill more than 500,000 children under five years of age every year in Africa – representing approximately 56 per cent of global deaths.

In Kenya, data from the Ministry of Health shows that national coverage has dropped from 85 to 68 per cent.

The statistics also indicate that the number of children without compulsory vaccination rose from 157,584 to 265,523 between January and July, exposing the country to the risk of diseases such as polio, pneumonia, and tuberculosis.

The drop in immunisation coverage has been attributed largely, to this year’s nurses’ strike which saw public health facilities across the country paralysed for almost three months.

Another factor raised by the advisory group was the decline in funding for immunisation in the continent as countries like Kenya transition into middle-income status.

Life-saving vaccines

For example, they said that as Africa nears polio eradication, funding to countries through the Global Polio Eradication Initiative for immunisation is expected to reduce by 50 per cent between 2017 and 2019. This funding supports disease surveillance, laboratory networks, staffing and routine immunisation programmes.

Yet, 28 African countries, including Kenya, fund less than 50 per cent of their national immunisation programmes.

“Increased funding will be needed from national governments to ensure that the phase-out of polio funding does not reverse immunisation progress. The meeting was an important opportunity to assess what we need to do to reach every child in Africa with life-saving vaccines,” said Prof Helen Rees, the advisory group’s chairperson.

Finance

As it transitions into a middle-income country, Kenya must look for new and long-term ways of financing immunisations to plug the gaps as donor support shrinks over the next seven years.

Currently, Gavi, the Vaccine Alliance, helps Kenya procure its vaccines through a co-financing model, where Kenya pays for 10 per cent of its entire vaccine budget, about Ksh400 million ($3.8 million), while Gavi pays the balance of around Ksh3.97 billion ($38.4 million), every year.

The money is used to purchase pentavalent vaccine (for influenza), pneumococcal vaccine (for pneumonia), rotavirus vaccine (against diarrhoea) and yellow fever vaccine.

But the country’s new, wealthier status means it will go through a step-wise graduation process in which it will increase vaccine spending by more than 15 per cent annually.

A study published last year by the Johns Hopkins University School of Public Health indicates that for every shilling spent on vaccines, a country gains back up to Ksh16 ($0.16) in economic benefits and Ksh44 ($0.44) in indirect benefits.