INTRODUCTION OF HEPATITIS B AND HAEMOPHILUS INFLUENZAE VACCINES IN SOMALIA: THE CHILDREN ARE AT LAST REAPING THE DIVIDENDS OF PEACE
by Khalif Bile M.D.; Ph.D.
Sunday, May 19, 2013
The Somali governmental authorities, civil society organizations, health professionals operating in the country, the Diaspora health groups and the Somali people at large must by no means underestimate the great historical event of launching hepatitis B and Haemophilus Influenzae type b (Hib) vaccination in Somalia, through the introduction of the Pentavalent-vaccine in the country that was launched during April, 2013. The latter is a combination of five vaccines that protect against the childhood diseases of diphtheria, tetanus, whooping cough, hepatitis B and haemophilus influenza type b against severe pneumonia and meningitis, delivered through the national Expanded Programme on Immunization (EPI). Three other vaccines are also provided to the children of Somalia that protect them against polio, tuberculosis and measles. In addition, pregnant women can also access tetanus vaccination to prevent this deadly infection amongst newborn infants. These vaccines are now freely available to children at virtually no cost to the national authorities. However, many of these diseases continue to cause outbreaks resulting in high morbidity and mortality rates, indicating that the required immunization coverage levels have not yet been attained.
What Does Access to Hepatitis B Vaccine Mean?
The launching of the Pentavalent vaccine will enable every infant to access the three doses required to achieve lifelong immunity and administered at 6, 10 and 14 weeks of age. The Pentavalent will ease the logistics of vaccine transportation and administration, whereby all the five vaccines are given together as one single shot during each vaccination session instead of administering them separately. Epidemiologically, chronic liver disease is very common in Somalia and over 30% of these conditions are caused by hepatitis B viral (HBV) infection, mostly acquired during early childhood and evolving later during their adulthood into chronic hepatitis, liver failure and liver cancer, when these individuals are economically most productive and responsible for raising families.
Vaccinating a child against HBV infection is therefore a valuable investment requiring solid national ownership and high levels of political and community support for its successful implementation. The Somali health sector must realize that the World Health Organization (WHO) recognized the importance of hepatitis B vaccination as early as 1992 when the World Health Assembly passed its resolution 45.17 calling upon member states to integrate this vaccine into national immunization programmes by 1995 for countries where 8% of the population or more are affected by HBV infection and by 1997 for all other countries, regardless of their infection rates. Accordingly, Somalia should normally have introduced this vaccination eighteen years ago in 1995, belonging to the category of HBV infection high burden countries.
Introduction of Haemophilus Influenzae Type b (Hib) Vaccine: Preventing Pneumonia and Deadly Brain Infection in Young Somali Children
Hib is the major cause of bacterial meningitis, an inflammation of the membranes that cover and protect the spinal cord and brain and leads to a deadly brain infection in infants and young children. Hib is also responsible for a tangible proportion of the severe pneumonia that affects young children. The Hib vaccine is being introduced for the first time in the country through the Pentavalent vaccine. Hib vaccine provides protection to children against the life-threatening illnesses of pneumonia and meningitis. One major advantage of the Hib vaccine is its ability to generate herd immunity, whereby, if the majority of the target children are immunized, this would reduce the disease risk in the unimmunized children. The positive health impact of this vaccine will therefore be immediate and profound.
The Five-in-one Pentavalent Vaccine as a peace dividend
The nation needs to celebrate this achievement, in which a dream has been turned into a reality, where the launching of this vaccine is a clear and impressive signal of the success of the peace building process that the nation is currently pursuing. A large number of Somali children who for years could not access their basic and essential health care services including vaccination, will now have the opportunity to avail these basic rights through the provision of the five-in-one combined Pentavalent vaccine and three other vaccines at their doorsteps. This reflects the bridging of the peace talks and state building processes with tangible improvements made in the children’s and pregnant women’s access to immunization and skilled delivery services, respectively leading to significant reductions in child and maternal deaths. The children’s access to universal primary education and adults’ right to freely engage in the generation of their means of livelihoods are among the key expected outcomes of the peace dividend that have direct positive correlation with the populations’ health status.
The challenges ahead
The success gained in introducing the Pentavalent vaccine is a clear evidence of the very significant reduction of the impediments caused by the extended conflicts in the country. Accordingly, the health sector authorities should not underestimate the inherent moral and operational obligations to effectively manage the vaccine cold chain system, guarantee vaccine safe transportation and storage and ensure that the target children get regular access at their door steps, irrespective of their geographical location. Currently in many parts of Somalia, less than 50% of the children are accessing the nationally supplied lifesaving vaccines after being delivered to the regions and districts of the country. Another challenge is that many areas of the country still remain out of reach due to insecurity, hence the need to provide protection and safety to vaccination teams. The three international partners i.e. WHO, UNICEF and the Global Alliance for Vaccines and Immunisation (GAVI), who are appreciably supporting the Pentavalent vaccine initiative and other supportive development partners expect the Somali health sector to work closely with the other administrative tiers of the government, civil society organizations and with the community at large to ensure the vaccination of all targeted children. To assume the required leadership role, the health sector must rise to the challenge and take full responsibility for progressing towards the milestone set by WHO, mandating all countries to reach a routine immunization coverage of 90% nationally and of at least 80% coverage in every district by 2010. Considering the present level of performance, these coverage rates would seem a tall order, yet this is the most salient indicator to accomplish, if the children’s health rights are to be fulfilled.
Conclusion
The introduction of hepatitis B and Hib vaccines as integral parts of the routine immunization programme has eliminated the cost barriers for the parents of millions of Somali children and created an opportunity for greater child survival. These are the results of the peace dividend gains that need to be consolidated and sustained. On the other hand, the health authorities have to join hands with civil society organizations and the communities at the grass roots to mobilize a sustained nation-wide action for effective routine child immunization. With the introduction of this vaccine in Somalia, the next generation birth cohorts will be free from the risk of HBV related disease such as acute and chronic hepatitis, liver cirrhosis and liver cancer as well as from the risk of other four major vaccine preventable diseases. Accordingly, let the nation and the health sector in particular regard the Pentavalent vaccination initiative as a health peace-initiative and extend utmost support to the national health workers to move freely in order to access the target child population of every district, where health action spearheads the message of peace. The promotion of health as a bridge for peace will help accelerate the implementation of primary health care services in the country and contribute to the consolidation of peace by pursuing a national holistic approach towards health development and social equity.
Khalif Bile M.D.; Ph.D.
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