WHO Expert Addresses Vaccination Achievements and Challenges in Africa

by Deborah Bender, PhD, MPH

Dr. Rose Jallah Macauley, WHO Coordinator of Routine Vaccinations and New Vaccine for the Africa Region, visited Cape Town to share her expertise with UNC Honors Students this past week. Dr. Macauley, an alum of the UNC School of Public Health, received her MD from the University of Liberia and an MPH from the Department of Maternal and Child Health in 1987.

The focus of her remarks was on the Global immunization Vision and Strategy (GIVS) developed by WHO and UNICEF for 2006-2015. The GIVS sets a number of goals to be achieved by 2010 and another set by 2015. The immunization coverage goal for 2010 is that all countries will attain 90% DPT3 coverage at national level and 80% in all districts.

For the past 4 years African countries have be implementing the Reaching Every District (RED) approach to improve and maintain high immunization coverage. The 5 operational components of the RED approach (Re-establishing outreach services, Supportive supervision, Linking with the community, Monitoring and use of data for action, and Planning and management of resources) were chosen to re-energize immunization delivery in the Africa region and to provide management infrastructure sufficient to enable local districts to reach their targets.

Dr. Macauley reminded her audience that measles mortality reduction remains very important in Africa. The GIVS Measles Mortality Reduction Goal which challenges countries to reduce mortality attributable to measles by 90% by 2010 as compared with 2000 levels. The strategies being used to attain this goal are: Catch-Up campaign, Follow-Up Campaign and Keep-Up Campaign. The Catch-Up Campaign which targets infants and youth up to 15 years of age is unique in global health strategy because of its extended the age limits.

In addition to the measles mortality reduction, Dr. Macauley also spoke about other accelerated disease control initiative, including polio eradication initiative, yellow fever control and maternal and neonatal tetanus elimination.

The polio eradication initiative has 4 strategic areas: strong routine immunization achieving >90% OPV3; supplemental immunization activities (NIDs, SIDs, Mop ups). WHO and it partners have focused major efforts in Nigeria, the only polio endemic country in Africa, to interrupt the transmission of wide polio virus. While great progress has been make in reducing the number of wide polio virus cases, there still have been isolated reports of the occurrence of vaccine derived polio virus (VDPV) cases reported in Nigeria. Risk factors associated with the VDPV in Nigeria are said to include: Low routine immunization coverage, poor sanitation, over crowding and the tropical condition.

With regards to the introduction of new vaccines, over 80% of African countries have introduced Hepatitis B vaccine while about 50% have introduced Haemophilus influenzae type b vaccine.

Dr. Macauley reminded the audience that childhood immunization is one of the most successful and cost-effective health interventions ever. During the 1980s, under John Grant’s leadership at UNICEF, vaccination rates reached new high levels. However, during the 90s, during the years when the global funding shifted priorities (e.g. combating of the emerging HIV/AIDS crisis), vaccinating the world’s children took a back seat. Immunization coverage either stagnated or decline in most countries in Africa. Estimates are that 2.5 million children under five years of age die every year as a result of diseases that can be prevented by vaccination using currently available or new vaccines. Dr. Macauley expressed confidence that the innovative integrated approach of the GIVS Strategy will achieve its 2010 and 2015 targeted goals.