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Ghana's children given hope by rollout of new rotavirus vaccine

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Nine-month-old Isiah Anane, who has pneumonia, in the intensive care ward of the Princess Marie Louise children's hospital in Accra, Ghana. Photograph: Olivier Asselin/Gavi Alliance/PAGavi and Ghana's government are rolling out vaccines against diarrhoea and pneumonia, a major threat to children under five”

Afua Hirsch, West Africa correspondent

In Accra's Independence Square, a baby cries as a few drops of liquid are squeezed into its mouth, watched closely by a jostling crowd of journalists and officials. The child is the first in Ghana to receive a new rotavirus vaccine – designed to protect children from a major cause of deadly diarrhoea and dehydration. The woman administering the vaccine is not a nurse or health worker, but Ghana's first lady, Ernestina Naadu Mills.

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Mills was keynote speaker at the highly choreographed launch of the latest achievement by Gavi – the Global Alliance for Vaccines and Immunisation – which brings together the World Health Organisation, the UN Children's Fund, the World Bank, civil society, the vaccine industry, research and technical agencies, the Bill & Melinda Gates Foundation and other private-sector philanthropists.

Gavi, which raises funds and stimulates the development of new vaccines for the developing world, has worked with Ghana's government to organise the rollout of the rotavirus vaccine and, to much acclaim, a new vaccine against pneumococcal infections, making Ghana the first country in sub-Saharan African to introduce two new vaccines at the same time.

The two vaccines are expected to save thousands of lives. Rotavirus, which causes gastroenteritis, can lead to severe dehydration and causes the deaths of more than 2,000 Ghanaian children each year, accounting for 40% of all diarrhoea-related deaths. Diarrhoea and pneumonia, the most common form of serious pneumococcal disease, each account for 10% of deaths among Ghana's under-fives.

"Ghana is showing the way. Here we have the capacity, a degree of self-confidence, and locally grown and maintained infrastructure that is needed," said Lord Paul Boateng, a member of the UK House of Lords who was born in Ghana and travelled to the country to witness the vaccine launch.

That Gavi has deemed Ghana able to introduce rotavirus and pneumococcal vaccines together is a vote of confidence in the country's ability to establish a "cold chain". The cold chain is central to the ability to administer vaccines, requiring a seamless system to keep vaccines at a temperature of 2-8C.

In Koforidua, the capital of Ghana's eastern region, the regional vaccine cold storage facility has been upgraded from a room crammed full of fridges to a hi-tech walk-in cold room – a donation from the Japan International Co-operation Agency. Emelia D Okai, the regional disease control officer, who looks after the facility, says all that is missing now is a cold van, so they can deliver the vaccines to sub-district health centres.

But power outages cause problems. "We have outages every week, sometimes twice a week," says Okai. "We have a generator that has a manual switch. So we are always ready – if there is [an outage] there is always someone responsible for switching on the standby generator."

Access to healthcare

Despite the new vaccines, access to healthcare remains a major problem for rural communities, with only about 50% of under-fives who contract pneumonia taken to an appropriate healthcare provider, and only 60% of infants under six months exclusively breastfed.

The Asenema community health planning services unit, in Akuapim North district just outside Accra, has no electricity and has to store its vaccines in fridges powered by gas. A solar panel unit sits on the floor beside the gas cylinders – the nurses explain it was provided by a Dutch company but no one has ever come to connect it.

At nearby Awukugu Nyensi village, where Asenema health unit conducts a monthly vaccination programme, 18-year-old Phyllicia's two-month-old daughter is getting the rotavirus vaccine. "I'm happy – I want my child to be strong and fit. I want her to be a nurse when she grows up," she says.

Women come to the monthly gathering in the village when told a vaccination day is approaching. Rebecca Ahiabu knows only too well the effects of the diseases being vaccinated against. She buries her head in her hands as she describes how she lost her 18-month-old daughter Emmanuella to pneumonia. For Ahiabu, the new immunisation programme means the difference between life and death. But it is far from a catch-all solution to the problems of poverty.

Seth Berkley, the chief executive of Gavi, is quick to dismiss suggestions that persistent problems associated with poverty make vaccination any less meaningful. "If you trace a baby that gets measles, you will see that as it gets sick it gets more malnourished, its growth may be stunted, it may suffer some brain damage," he says. "The family will have spent a lot of money – that could have been spent on school fees – on medical treatment. It is a huge issue for families when kids get sick."

One problem of developing the pneumococcal vaccine has been that the strains prevalent in the developing world were different from those being vaccinated against in richer countries. To develop the vaccine, GlaxoSmithKline and Pfizer got an advanced market commitment (AMC), a method of stimulating the development of vaccines needed in low-income countries. Gavi mobilises donors to make a legally binding commitment to subsidise buying vaccines at predetermined terms, creating an artificial market for the vaccine industry so they increase investment in these products.

But working with the private sector to create artificial markets, forming buying consortiums, and making massive purchase orders from the world's largest pharmaceutical companies has led to accusations that Gavi is encouraging business to profit from the poorest.

"Could the price be cheaper?" Berkley asks. "Probably. But there are children today who are alive because that vaccine was developed. Do you wait for other companies to come, and would the other companies have been interested if it wasn't for those big guys? I would love to use the AMC again."

Source: The Guardian UK, 03 May 2012



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