Vaccines

Meet Ghana’s vaccine king

Apr 22nd, 2013 1:33 PM UTC
By Guest Blogger

This is a guest post from the Bill and Melinda Gates Foundation, originally published on their Impatient Optimists blog.

Dr. K.O. Antwi-Agyei manages the Expanded Programme on Immunisation in Ghana, where he oversees the day-to-day work to ensure vaccines reach children across the country.

Ghana’s health care system has put a lot of its resources into vaccines. Why?
We can see a lot of achievements in reducing child deaths by investing in delivering vaccines. The returns are high, so the politicians and policy makers are convinced that it’s worth investing in vaccines. That is why at least every year within our budget we ensure that we pay for all our traditional vaccines.

Our communities have also been great because they embrace vaccination. They even testify that “Oh, our children used to die from measles. Now with vaccination, we don’t see measles.” And of course, they allow our staff into their homes. There is trust. We can now return to the communities with other vaccination campaigns. It’s marvelous.

What impact have vaccines had on the health of Ghana’s population?
Around 1974, immunisation coverage was around 1.6 percent. Today, well over 90 percent of our population is covered by immunisation services, reducing the burden of disease.

For example, measles used to be the number two killer of children. Now it’s no longer a cause of death for the past 10 years in Ghana. So a lot has been achieved through immunisations.

Last year, you were the first immunisation chief in Africa to simultaneously roll out two vaccines, one protecting children against pneumonia and the other against rotavirus. Why did you decide to do that and, and what was the result?

Our desire to reach the Millennium Development Goal to reduce childhood death was a very big motivating factor. Apart from malaria, pneumonia and diarrhea are the two highest killing diseases. So we thought, if there is no vaccine against malaria now, and there are vaccines against pneumonia and diarrhea, then it’s worth fighting. So we decided to fight the two together. We thought it would be difficult, but not an impossibility. And with careful planning, we could succeed.

How important are Ghana’s community health workers in delivering the vaccines?
They are very important. The front line health workers, they are in touch with the communities. They help improve our public health services, not only through vaccinations but also by treating minor illnesses offering family planning and providing other health-related services.

How does Ghana use data collection to improve immunisation coverage?
Data is used for making decisions. If your data is not good, then of course your decisions will also be faulty, and you won’t be able to achieve your objectives. So a lot of effort has gone into data reporting. We developed tally and register books for the basic level so that they are able to pick the necessary data on children vaccinated, and also on what vaccines have been used. We firmly believe that if you won’t use the data, then don’t collect it. So once we collect the data, we use it. If a region’s coverage is low, we immediately ask, “What is happening there?” We go and investigate and then give us feedback. Then, whatever the error is, we discuss it and correct it.

What is your long term goal for Ghana’s immunisation program?
To reach the top is difficult, but to remain at the top is even more difficult. For Ghana, our goal is to remain as a leader in the area of immunisation and to show our commitment and to develop initiatives which can spread to other areas. Whatever is happening in other countries has a bearing on us. We want to have success stories which can be shared so that together we can get rid of diseases which are killing our children and mothers.

This week is World Immunisation Week. Find out more about how ONE is supporting access to vaccinations. 

But how will it get there?

Dec 6th, 2012 1:39 PM UTC
By Malaka Gharib

Malaka Gharib is currently at the GAVI Partners Forum in Dar es Salaam, Tanzania, where global health and government leaders are gathering to explore ways to accelerate results, innovation, sustainability and equity in the field of immunization.

What do you think one of the biggest issues in vaccines and immunizations is? That’s an easy one, right? Making sure that every country in the world has access to vaccines, of course!

Baby receiving the pneumococcal vaccine

Well, actually, we achieved universal child immunization – way back in 1990. Thanks to collaboration between WHO, UNICEF, countries and suppliers, a system was put in place to bring immunization coverage to nearly 80 percent of the global birth cohort. And it’s a system that’s worked well for a long time.

But now, that system is breaking down. The GAVI Alliance reports that 9 of the 24 countries in which they operate have poor vaccine stock management and vaccine distribution. And more than 20 percent of the GAVI countries’ vaccines go to waste above the expected rate.

It’s not hard to see why. The introduction of new vaccines and increased coverage targets is putting “business as usual” at risk. Since the 1980s, kids need 3 times more vaccine doses per child and there are 2.5 times more diseases to vaccinate against. Looking into the future, experts believe that we’ll need 4 times more fridges (vaccines need to stay cold) between 2001 and 2020.

Preparing the pneumococcal vaccine

The conversation now is about how to make the system better, how to make transport of vaccines more reliable, and how to protect and preserve vaccines. The solution that experts are proposing is a clear one: countries need to take ownership of their vaccine supply chain (also called the “cold chain,” since vaccines are temperature-controlled). And they need to be super creative about it, because every country has its own situation and infrastructure – it can’t be a one-size-fits all strategy.

Transportation of vaccines in Nicaragua: By horseback!

I had the wonderful opportunity to listen to supply chain experts like Michel Zaffran from the World Health Organization, Dmitri Davydov from UNICEF and Dr. Bruce Lee from the University of Pittsburgh, and country health officials from Benin, Tanzania and Uganda discuss this issue at the GAVI Partners Forum yesterday. I was particularly interested in listening to some of the innovative ways that countries were tackling some of the challenges with their vaccine supply chain.

- Hon. Huda Oleru from Uganda’s Parliamentary Forum for Immunization, says that they’re using an SMS tool called U-Report to crowdsource problems with the vaccines distribution system from Ugandan citizens. She says that her team is using the feedback to learn about some of the holes in the Ugandan supply chain – and fix them.

- Dr. Bruce Lee leads the team that developed a software called HERMES, a computational tool to design, plan and manage vaccine supply chains. What’s neat about it is that it can even predict estimated future needs, which will help in reducing vaccine wastage, stock outs and problems with storage. Currently, it’s being tested in Benin, Thailand and Niger.

Fridges are an important part of the vaccine cold chain.

- The World Health Organization, GAVI, UNICEF and the Bill and Melinda Gates Foundation are finding that the cold chain itself is a barrier to routine immunizations – and it’s not getting the funding it needs. The world needs to invest more in cold chain hardware, like fridges and packaging. And there’s some cool stuff that they’re looking at on the horizon, including solar-powered fridges and vacuum insulation that lasts for up to 30 days.

ONE members fought hard last year to make sure that world leaders gave GAVI the funding it needed for their pneumococcal and rotavirus vaccines – and we succeeded. But now, it’s up to countries to ensure that these much-needed vaccines actually get to the people who need it most. There will be more vaccines to distribute and more people to immunize in the future – and if countries can find the holes now, strengthen their supply chain and invest in technologies, we can achieve GAVI Board Chair Dagfinn Hoybraten’s one wish for the world: “that the children may live.”

Follow @ONEinAfrica and #GAVIPartners for live tweets from the GAVI Partners Forum.

Angélique Kidjo supports World Immunization Week

Apr 25th, 2012 2:07 PM UTC
By Wangui Muchiri

As part of World Immunization Week ONE Africa Policy Advisory Board member and UNICEF Goodwill Ambassador Angélique Kidjo has recorded a short video on why vaccination efforts are so important.

Immunization is one of the most successful and cost-effective health interventions and prevents debilitating illness, disability and death from vaccine-preventable diseases such as diphtheria, hepatitis A and B, measles, mumps, pneumococcal disease, polio, rotavirus diarrhoea, tetanus and yellow fever. But whilst many of us take vaccines for granted, millions of parents around the world are not able to access vaccines for their children, with devastating consequences.

Please share Angélique Kidjo’s video and find out more about World Immunization Week on the ONE Blog.

Interview: GAVI’s Mercy Ahun talks Ghana’s upcoming vaccine milestone

Mar 28th, 2012 4:04 PM UTC
By Erin Hohlfelder

Last week I had the opportunity to sit down with Mercy Ahun from the GAVI Alliance Secretariat. When I first met her two years ago, she was GAVI’s Director of Program Delivery, but recently she was named GAVI’s Special Representative to GAVI-Eligible Countries. In this role, she serves as a bridge between GAVI, countries receiving GAVI support, and donors, and she works to develop customized approaches that deliver even more effective results on the ground.

ONE is really excited that in less than 1 month, Ghana will become the first country to roll out pneumococcal and rotavirus vaccines at the same time. Especially as a Ghanaian, what does this milestone mean to you?

It’s been exciting! I remember the first time I was talking to Ghana’s EPI (Extended Program on Immunization) Manager about this, and I said, are you sure you want to do this? And he said yes—we are close to achieving MDG 5 (reducing child deaths); doing this allows us to hit two birds with one stone. And when I started looking at their vaccine programs, and saw that they already had achieved high coverage levels of other vaccines, I said yes, I think the system is strong enough to do this. And I think it is important to document the process in Ghana so then others can learn from it.

I go to Ghana about six times in a year, and we have an excellent relationship not just with the EPI Manager but with other groups in the Ministry of Health and with the partners. When we’re in Ghana, you can catch the excitement. I remember that one person said to me, “It feels like the whole world is looking at us”, and to that I just think: wow.

What does a country like Ghana need to do to prepare itself for a vaccines roll out?

I think one of the most important parts is having the needed cold chain equipment for the new vaccines. Giving out two vaccines at once requires a major expansion, and Ghana planed it so that the major 10 regions in Ghana will each have the right fridges and storage units.

The Ghana Health Service also partners with WHO, UNICEF and others; together with community groups, they have developed 8 committees that are planning for this launch. There are groups focused on logistics, training, and communication which meet separately, and they also brought in a professional advertising company from the private sector to guide them. They have done a survey of local knowledge, attitudes, and practices, and they are using the findings to design appropriate messages for communities. So much is on the line that needs to be done, but things are on track.

How have you seen African leaders respond to GAVI’s work? What do they say about vaccines, and their own governments’ role in supporting them?

I think African leaders recognize the importance of immunization. President Kibaki of Kenya launched a new vaccine himself in Kenya last year. I was in Cameroon and it was the First Lady’s office which led the charge there. Ghana is expecting the President to do the launch in April.

But we also know that it’s about more than just the launch, and more than just about Presidential leadership. We know that when countries apply for GAVI support, all the ministers of health and finance need to sign the application too, because GAVI support is not for free. They need to make a commitment of their own. Since we introduced a co-financing policy in 2008, almost all countries have provided financial support for vaccines, which shows their own commitment. Come 2016, we expect that 16 countries will have a ceremony because they will be off of GAVI’s support and increasing their own contributions to immunization financing. I think it’s fantastic.

In your time working for GAVI, what have you found to be the most rewarding?

I think the most rewarding thing has been working with others. We are an alliance. We bring together the strengths of organizations from the public sector (like WHO or UNICEF), from the private sector, from foundations, and from other partners to develop immunization plans with countries. I have found that most rewarding because I think when you involve your recipient countries in the policy-development process, it is more likely to be sustainable because they feel ownership over the programs.

You and your colleagues carry a lot of responsibility at GAVI, ensuring that the world’s poorest children receive life-saving vaccinations. What do you like to do on your days off?

I have three kids—two are teenagers who are still home with me—so I like chatting with them. We are Ghanaians in Switzerland, so sometimes there are cultural challenges, and we discuss these things with each other. I like singing, dancing, attending church services. Really I try not to look at my blackberry, especially on the weekends, and enjoy myself.

Getting the ‘last hair’ in Nigeria

May 16th, 2011 3:20 PM UTC
By ONE

Dr. Muhammad Pate, executive director of Nigeria’s National Primary Healthcare Development Agency, says the country’s polio program has provided the momentum to combat other vaccine-preventable diseases. Read the original post on the Gates Foundation’s Foundation Notes blog.

In Nigeria we have made remarkable progress in the fight against polio, with intense campaigns that drove polio down from 388 cases in 2009 to 21 in 2010 — a 95 percent reduction. We are extremely hopeful that these gains continue, although much hard work remains.

This progress is largely due to the immense momentum of our polio campaign, which has demonstrated that immunizations are safe, cost-effective tools to prevent infectious diseases and ultimately save children’s lives. We have seen non-compliance rates for immunizations fall because parents and traditional leaders have witnessed the effectiveness of oral polio vaccines to protect their children from paralysis and death.

The polio program has provided the momentum to combat other vaccine-preventable diseases, such as measles, that are costing lives of young children. In January, Nigeria launched a major campaign to administer both measles and polio vaccines to 31 million children under five — protecting children from two diseases. And during an upcoming national campaign later this month, health workers at fixed posts around the country will offer children doses of oral polio vaccines — along with an integrated package of other health interventions, including Vitamin A, deworming tablets and other routine immunizations.

From this broad perspective, conquering polio has an impact far beyond the immediate benefits of eradication. Perhaps polio eradication’s most enduring legacy will be that it lays the groundwork for countries like Nigeria to defeat other childhood diseases.

Still, there is significant work to be done. As long as polio exists in Nigeria, it can exist anywhere. To finally finish the job, we must keep up the momentum for mass immunization campaigns. Once Nigeria and the world win the fight against polio, it will inspire us to continue our intense efforts to tackle other pressing health challenges.

The Hausa people, who live in northern Nigeria, have a saying: When you shave a man’s head, it is getting the last hair that is the most difficult. Similarly, the final chapter of polio eradication -– in Nigeria and globally — will require even more effort than the previous ones. We must continue to work tirelessly to ensure that our momentum is sustained — so that we finish the job on polio and build upon that success to protect children from other deadly diseases.

-Dr. Muhammad Pate, executive director of Nigeria’s National Primary Healthcare Development Agency

African health ministers go ‘on the record’ about vaccines

May 13th, 2011 10:21 AM UTC
By Erin Hohlfelder

At ONE we’ve been doing a lot of talking about vaccines this spring, but until now, we haven’t shared the perspectives of those who perhaps most clearly understand the value of vaccines: the ministers of health from Africa who run immunization campaigns in their countries and whose countries benefit from GAVI directly. Our senior Africa Outreach Manager Edith Jibunoh and Africa director Dr. Sipho Moyo recently met up with a number of ministers of health in Togo and Namibia, and they documented the ministers’ on-the-record accounts of just how important vaccines are.

Ghana
“It is unacceptable and against the principles of fundamental human rights that children who are the future generations continue to die of diseases for which there are known cost effective interventions. The introduction of vaccines for the prevention of childhood killer disease has indeed made tremendous positive impact on the health of our children.

Ghana is currently implementing a program of vaccination against nine childhood killer diseases. Three additional vaccines namely, pneumococcal, rotavirus and conjugate meningococcal A vaccines are expected to be introduced in the very near future. Ghana appreciates the support and would continue to strengthen partnerships with GAVI to deliver these essential services to our children”
Joseph Yieleh Chireh (MP)
Minister for Health, Ghana

Nigeria
“The absolute and surest means of disease prevention remains the effective and efficient deployment of vaccines. Key to the reduction of child mortality is an expanded immunization programme. Nigeria needs the continued support of GAVI to impact positively on the health of her children”
Professor C.O. Onyebuchi Chukwu
Hon. Minister of Health, Federal Republic of Nigeria

Rwanda
“The whole of GAVI deserves to be supported for making vaccines accessible and preventing diseases. Prevention is a worthwhile investment because as we know it is cheaper than curing diseases, prevents suffering, avoids the cost of treatment and disrupting families. GAVI’s replenishment therefore deserves to be supported.”
Dr. Agnes Binagwaho
Minister of Health, Rwanda

Sierra Leone
“Vaccination supported by GAVI is an effective and efficient process towards diseases prevention in Sierra Leone. We are very grateful to be in partnership with GAVI, an organization that is making a difference in the lives of a special population, including adolescents and young people. GAVI is a vital organ in promoting health; it needs continued support to strengthen the related health MDGs.”
Hon. Borbor Sawyer
Deputy Minister of Health and Sanitation

The Gambia
“Immunization Campaigns have saved many lives in the Gambia which holds a record 86% coverage. The government of The Gambia is committed to expanding further immunization programs in order to maintain and complete our outreach to meet our nation’s visionary goals. If GAVI is successfully supported in June, we will be on our way to achieving MDG 4.”
Hon. Fatim Badjie
Hon. Minister of Health and Social Welfare

Togo
“Immunization campaigns save lives in Togo and for us to achieve our MDG Goal 4, GAVI must be successfully supported in June. All children have a right to be vaccinated. We commit to doing our part to prioritize immunization programs in our health budgets”
S.E. Komlan Mally
Minister of Health, Togo

Thanks to the French NGO Agence de Medecine and to the leadership at the West African Health Organization for facilitating our access to these inspiring leaders in Togo.

Photo: A toddler and her mom wait at a community vaccination day clinic in Narena, Mali, Credit: 2008 Adrian Brooks/Imagewise, Courtesy of IVAC at Johns Hopkins School of Public Health