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Immunization in Pakistan Resumes During COVID-19

immunization in pakistanDuring the COVID-19 pandemic, 63 polio cases were reported in Pakistan. Four months after the COVID-19 outbreak occurred in Pakistan, more than 50 million children did not receive a polio vaccination, as immunization in Pakistan was delayed. At the end of July 2020, Pakistan was able to complete a round of vaccinations to cover 780,000 children.

Vaccinations and COVID-19

On April 1, 2020, Pakistan went into a nationwide lockdown for a month due to COVID-19. During the lockdown, immunization in Pakistan reduced by more than 50%. This reduction occurred mainly in impoverished regions and areas that were far from service delivery.

Healthcare workers’ contracting COVID-19 led to a halt in immunization services in some areas. More than 150 Expanded Programme on Immunization healthcare workers contracted COVID-19. Additionally, shortages of personal protective equipment (PPE) further reduced immunization, as healthcare workers were concerned about the risk of transmission while providing immunizations without proper PPE.

Transportation Interruptions Delay Immunization

Many immunizations in Pakistan were not delivered due to flight disruptions from COVID-19. Reduced immunization in Pakistan can lead to new outbreaks of other preventable diseases, like measles. The Khyber Pakhtunkhwa Province, an area with a large refugee population and limited healthcare access, has already seen an increase in measles cases.

The lack of public transportation available during the pandemic also made it difficult for many to travel to receive immunizations. People who are at high risk of contracting COVID-19 were often afraid to go out in public and get immunized.

New mothers in particular were not willing to risk the travel to hospitals to get their children vaccinated. One new mother expressed her concern that the absence of vaccinations could lead to contracting preventable diseases, but she was also worried about the coronavirus. Furthermore, multiple private and public hospitals were overwhelmed with COVID-19 and did not allow babies and mothers to receive their immunizations.

WHO’s Restrictions Led to Vaccination Difficulties

After the World Health Organization advised countries to postpone their immunization campaigns, Pakistan halted its door-to-door polio immunization program. The postponement of mass vaccination programs may lead to 117 million children worldwide not receiving a measles vaccine. Countries that have low immunization rates are at the highest risk. Pakistan’s routine vaccination campaign for tuberculosis, for example, reached only 66% of its slated coverage this year, compared to 88% in 2019.

In Karachi, the Health Education and Literacy Programme (HELP) works to support maternal and child health and maximize vaccination coverage. Founder of HELP, Dr. D. S. Akram, said that the delay in immunization could lead to hundreds of thousands of young Pakistanis missing their tuberculosis and polio vaccines. On average, 12,000 to 15,000 children are born in Pakistan every day. Since polio is still endemic in Pakistan, the suspension of the door-to-door polio immunization program may lead to more outbreaks in the future.

Once Pakistan started to come out of its lockdown in May 2020, clinics began to reopen in an effort to continue vaccination campaigns. Pakistan faced two obstacles in attempting to increase routine vaccinations: both opening hospitals and ensuring that parents felt safe to bring their children there. Hospitals had to ensure not only that there were enough vaccinations in supply but also that parents would be willing to get their children immunized.

In Pakistan, children who belong to poor households are affected by vaccination coverage the most. The reduction of immunization in Pakistan has occurred mainly in slum areas, where it is difficult to deliver healthcare products. Despite the delay in immunization caused by COVID-19, Pakistan continues to adapt in its efforts to return to routine vaccination.

– Ann Ciancia
Photo: Flickr

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6 Facts About Vaccines in Developing Countries

Vaccines in Developing Countries
It is estimated that immunization practices save two to three million lives each year. The development of vaccines and mass immunization practices have helped eradicate deadly diseases such as smallpox, while drastically reducing the number of people infected by influenza, hepatitis A and B, rubella, measles, chickenpox, polio, tetanus, mumps and other preventable illnesses. Vaccines also help prevent outbreaks and epidemics by increasing the number of people immune to various diseases within populations. Despite these benefits, global vaccine coverage is inadequate. Developing countries, in particular, often lack access to life-saving vaccines. Here are six facts about vaccines in developing countries.

6 Facts About Vaccines in Developing Countries

  1. An estimated one-quarter of all deaths in low-income countries are attributable to communicable diseases. More than 1.5 million people die annually from diseases that are preventable through vaccination. In 1990, 2.5 million children in developing countries under five died from vaccine-preventable diseases such as rotavirus, measles and pneumococcal disease. No deaths were attributable to these diseases in industrialized nations. Efforts to expand access to vaccines in developing countries reduced the child mortality rate to 750,000 in 2013. Despite this improvement, 19.7 million children under the age of one still lacked access to basic life-saving vaccines as of 2019.
  2. High manufacturing costs for vaccines hinder accessibility in many developing countries. Poverty-stricken nations often rely on vaccines to be imported from developed nations. Inefficient public health infrastructure and a lack of resources for transporting vaccines pose an obstacle to widespread immunization access.
  3. Developing countries continue to lack access to vaccines. Vaccine coverage has remained unchanged throughout the past few years in many developing countries, despite global advances in immunization knowledge and technology. Humanitarian crises caused by conflict and natural disasters threaten to perpetuate this stagnation in vaccine access.
  4. Several preventable diseases are making comebacks. In recent years, an increase in vaccine hesitancy among populations in developing countries has resulted in reductions in already poor immunization rates. The result has been outbreaks and resurgences of vaccine-preventable illnesses such as measles, diphtheria and even polio.
  5. Vaccinations also have significant economic benefits. Expanding access to vaccines in developing countries is a strategic economic investment because the financial and human costs of death and disease outweigh the burden of implementing immunization programs. Between 2001 and 2020, the economic benefit of vaccinations in developing countries was nearly $2.3 trillion.
  6. The World Health Organization has proposed the Immunization Agenda 2030 to address vaccine access. This program plans to address the shortcomings and challenges of immunization globally, including the recent outbreaks of infectious diseases such as Ebola and COVID-19. The Immunization Agenda 2030 envisions “a world where everyone, everywhere, at every age, fully benefits from vaccines to improve health and well-being.” Amidst the current COVID-19 global pandemic, its mission to improve access to life-saving vaccines in developing countries is more important than ever.

These six facts about vaccines in developing countries highlight the work that still needs to be done. Moving forward, it is essential that the World Health Organization and other humanitarian organizations make increasing access to vaccines a priority.

– Alana Castle
Photo: Flickr

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10 Facts About Health Care in Sudan

Health Care in Sudan
Sudan is rich in natural and human resources; however, it is poverty and conflict-stricken. Agriculture is an income provider for 70 percent of the populace. Due to a lack of resources and training availability, the health care sector of the country remains underfunded and understaffed. Here are ten facts about health care in Sudan.

10 Facts About Health Care in Sudan

  1. Approximately 14 percent of Sudanese do not have access to health care. This is largely due to the fact that Sudan has a critical shortage of health care workers. According to the World Health Organization, there are 23 qualified health care workers per 10,000 members of the population.
  2. Sudan’s maternal mortality rate has improved, but it varies by region. In 2015, the maternal mortality rate was 311 per 100,000 live births. This was a significant improvement from 744 per 100,000 live births in 1990. Unfortunately, these rates are not consistent across the country. While more recent data is not available, in 2006, the maternal mortality rate in Southern Kordofan was 503 per 100,000 live births. In the Northern state, however, the rate was only 91 per 100,000 live births.
  3. Approximately 32 percent of Sudan’s population is drinking contaminated water from untreated water sources. This is a result of chemical and bacterial contamination from industrial, domestic and commercial waste that degrades the water quality. There are acts at the state and national levels to help prevent this washing and injection; however, these acts need activation. UNICEF is working with the Sudanese government to increase access to basic treated water supplies for the people of Sudan, with a focus on women and children.
  4. Sudan suffers from outbreaks of cholera, dengue fever, Rift Valley fever (RVF), chikungunya and malaria. Increased outbreaks in 2019 were, in part, a result of heavy rainfall during the rainy season. Consequently, this rainfall left behind stagnant pools which were breeding grounds for mosquitos, contributing to the spread of infection. Government authorities and their humanitarian partners worked to respond to outbreaks across the country. The Kassala and North Darfur Ministries of Health launched weekly response task force meetings and developed state-level plans to mitigate the outbreak.
  5. Sudan has widespread micronutrient deficiencies. This is partially due to insufficient levels of crop growth. Only 14 percent of 208 cultivable acres are being cultivated. Drought, pests and environmental degradation also contribute to widespread malnourishment. However, vitamin A deficiency decreased due to repeated vitamin A supplementation given during National Immunization Day campaigns.
  6. Many Sudanese women and girls lack adequate health care and resources. Women and girls living in the rebel-held areas of Southern Kordofan or the Nuba Mountains of Sudan have very limited or no access to contraception. Human Rights Watch found most of the women interviewed did not know what a condom was and was unfamiliar with other common contraceptive practices. This lack of education and the low availability of condoms are why there are high percentages of women testing positive for hepatitis B. Consequently, gonorrhea and syphilis are on the rise in Sudan.
  7. The National Expanded Program on Immunization in Sudan supports an increase in routine immunization coverage. In addition, the government’s financial investment to EPI and polio eradication program is 15 million USD. Challenges the program faces include poor service delivery and a lack of resources and skilled staff.
  8. Sudan spends 6.5 percent of its gross domestic product and 8.3 percent of government spending on health care. Before the 1990s, receiving care at public health care facilities was mostly free. However, the structural reforms of 1992 introduced user fees. Now, out-of-pocket expenses for patients hover in the 70 percent range.
  9. There are 75 degrees and diploma-granting health institutions in Sudan. About 28 of these institutions offer diplomas and 47 of these schools offer degrees. There are 14 private institutions, while the others belong to agencies such as the Federal Ministry of Health and other government agencies. In 2001, the Federal Ministers of Health and Higher Education signed a Sudan Declaration and Nursing and Allied Health Workers in 2001. The goal of the declaration was to improve nursing and other health care education. The Academy of Health Sciences was established in 2005 to help implement this goal.
  10. The Sudanese government is working to rebuild and reform the health care system. A 25-year plan spanning from 2003 to 2027 was created in the early 2000s. This plan focuses on ensuring health care services are accessible and high quality, particularly for impoverished and vulnerable populations.

These ten facts about health care in Sudan illuminate some of the struggles the nation has faced, as well as improvement efforts by the Sudanese government and other humanitarian organizations. It is imperative that these efforts continue in order for health care to continue to progress in Sudan.

– Robert Forsyth
Photo: Flickr

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How to Bring Medicine to the Poor

How to Bring Medicine to the PoorThere are many diseases plaguing the developing nations of the world. There is also much that can be done to improve the state of health across the globe. This is especially true with regards to measles. Measles is a serious problem, particularly in African nations, including Nigeria. Nigeria desperately needs people to bring medicine to the poor.

The CDC reported 176,785 confirmed cases of measles in Africa between 2013 and 2016. While the frequency of measles cases has been on the decline since 2013, the disease is still too widespread to be considered a solved problem. This is especially true for children between nine and 59 months old; they are the most vulnerable to this disease.

Starting in 2013, Nigeria had 50,585 known cases of measles. By 2016, this number had dropped to 11,499 known measles cases, leaving it still the most highly infected African nation. This seems like an exceptionally great dilemma to members of the developed world who are accustomed to the high cost of vaccines. In the United States, the CDC’s five recommended childhood shots can cost an average of $937 per person. Considering how much these vaccines cost Americans, how could it be possible to combat an epidemic in a nation as poor as Nigeria?

According to the World Health Organization, it is actually quite cost-effective to immunize nations such as Nigeria from measles. While vaccines are quite expensive in nations such as the United States, they are relatively inexpensive to use when manufactured for mass immunization projects. The World Health Organization has estimated that mass immunizations could be performed in countries such as Nigeria for roughly $1 per child vaccine.

What can be done to bring medicine to Nigeria? A simple solution would be to write and call your Congress representatives to encourage them to support immunization projects. Donating to the Borgen Project is also a great way to put forth efforts to increase U.S. spending on global disease prevention. To make a direct impact, it is also possible to contact the World Health Organization to ask how you can contribute to the fight against measles. From these steps, there will be an improved capacity by many organizations to bring medicine to the poor.

– Tim Sherwood

Photo: Flickr

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Federal Budget Fulfills $1 Million Pledge to Vaccine Alliance

Gavi

In his proposed 2017-2018 budget, President Donald Trump has pledged to fulfill the U.S.’s $1 billion commitment to Gavi, the Vaccine Alliance. The program has helped immunize hundreds of millions of children and lowered the cost of vaccinations since its creation in 2000.

Gavi, the Vaccine Alliance is an international organization that “aggregates demand” for vaccines from the countries it supports— 60 percent of the world’s births take place in Gavi-supported countries. This demand sends “a clear signal to manufacturers” that these countries are viable markets for vaccines. Countries supported by Gavi pay for a portion of their vaccine programs, but as “a country’s income grows, its co-financing payments gradually increase to cover the full cost of vaccines.” Gavi relies on large donors to run this business model.

In January 2015, USAID dedicated $1 billion to Gavi in support of the organization’s plan to “immunize 300 million additional children and save at least 5 million lives by 2020.” The Obama administration was vocally supportive of global poverty reduction efforts— Obama addressed extreme poverty in three of his State of the Union addresses— but the Trump administration was not expected to contribute to poverty reduction efforts to the same extent. Trump’s pledge to Gavi is refreshing in the midst of the 32 percent overall cuts to international aid proposed in his budget.

Gavi’s website lists the U.S.’s contribution to the program for the period of 2016-2020 as $800 million. If Trump were to have cut the U.S.’s funding for Gavi, the organization would have lost close to a ninth of its $9.2 billion budget. Reducing aid to Gavi would have further damaged the U.S.’s aid reputation, as it spends the least on foreign aid of all developed countries, especially since other countries fund the majority of Gavi’s budget. Notably, the U.K. has contributed $2,515 million, Norway $922 million, and Germany $676 million for the same 2016-2020 cycle.

It is important that the U.S. continue to support international vaccination programs like Gavi, the Vaccine Alliance as they allow healthier populations to become more stable, self-sustaining and economically stronger. Gavi projects $100 billion in economic gain worldwide as more people are immunized and the world moves closer to global poverty eradication.

– Caroline Meyers

Photo: Flickr

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African Leaders of State Vow to Provide Universal Access to Immunization


Preventable diseases continue to claim thousands of lives each year in Africa, but leaders of state have taken a bold stand against this reality. An official pledge in January affirmed their commitment to realizing the goal of universal access to immunization by the year 2020.

African Union Commission Chairperson Nkosazana Dlamini-Zuma stated in a press release following the Addis Declaration on Immunization (ADI) summit: “With political support at the highest levels, we are closer than ever to ensuring that all children in Africa have an equal shot at a healthy and productive life.”

This announcement marks the continuation of ongoing efforts to provide immunizations to citizens of 40 separate countries by Gavi, the Vaccine Alliance. To date, Gavi has saved more than 4.5 million lives by providing vaccines.

“African leaders are making a sound economic investment in future generations,” Dr. Seth Berkley, the CEO of Gavi, said in response to the announcement.

Berkley’s comment is not figurative. According to a 2016 study by Johns Hopkins University, when factoring in quality of life and reduction in economic disease burdens, every one dollar invested by the U.S. in vaccination among the 94 poorest countries on Earth yields a staggering 44 dollars in returns. In those countries directly supported by Gavi, the figure rises even higher, to 48 dollars.

The extensive list of diseases prevented by such immunizations includes polio, whooping cough, tetanus, yellow fever, diarrhea, cervical cancers and the most deadly of all, measles. Due to its highly contagious nature, measles alone was the cause of nearly 40,000 deaths in Africa in 2013, based on a survey by the World Health Organization.

The African government is not alone in supporting immunization efforts for children. Africa United, a platform for raising awareness of global health issues, has enlisted star football athletes to provide public service adverts during this year’s Total Africa Cup of Nations tournament. “Football unites people from all across Africa and beyond,” stated Issa Hayatou, the President of the Confederation of African Football, the governing body of professional football for Africa. “Together we can help ensure millions of African children are immunized by 2020.”

Though great strides have been made during the past 15 years, approximately one in five young people in Africa still do not have access to vaccines that prevent these life-threatening diseases. This pledge may mark the first step in reducing that number to zero by providing universal access to immunization.

– Dan Krajewski

Photo: Flickr

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The Next Breakthrough in Public Health: Vaccine Stabilizers

Vaccine StabilizersImmunizations are lauded as one of the greatest achievements in public health; the eradication of polio standing as a tremendous accomplishment and testament to this. According to one study, pre-vaccination incidence rates were used to predict polio occurrence and cost between 1970-2050. The program would have saved more than $128 billion in medical costs and more than 800,000 lives. By preventing millions of cases of paralysis, the polio vaccine has also significantly impacted the number of disability-adjusted life years. Unfortunately, success with other preventable diseases has been limited. One of the major barriers to immunization for other diseases has been storage requirements, and that is where vaccine stabilizers come in.

Several major childhood vaccines require strictly regulated storage conditions. One such vaccine is the rotavirus vaccine. Rotaviruses are the most common cause of diarrheal disease in children worldwide. According to the World Health Organization, more than 200,000 children under five die each year from rotavirus infections. One in 70 infected children requires hospitalization. Two vaccines are available and equally recommended for the prevention of rotavirus infection. Though one comes as a lyophilized powder, both must be stored at between two and eight degrees celsius. For resource-limited countries, where most rotavirus-related deaths occur, sustained temperature control is often unfeasible.

Researchers at the Ecole Polytechnique Fédérale de Lausanne are working to break down this barrier to immunization. They experimented with three additives that eliminate the refrigeration requirement. These vaccine stabilizers could prove to be the next breakthrough in public health. The researchers discovered that nanoparticles, polymers and sucrose each have the potential to prolong the stability of viral vector vaccines, by limiting the heat-induced fluctuations that destabilize vaccines.

If these vaccine stabilizers could be successfully applied to more vaccines, the public health benefits would be tremendous. The polio program has already demonstrated the efficiency and effectiveness of vaccination efforts. The returns are well worth the investment. If the onerous refrigeration requirements could be eliminated, several other preventable diseases could potentially be eliminated, or at least be drastically reduced, and the global health benefits would be immense.

– Rebecca Yu

Photo: Flickr

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Vaccination Can Combat Poverty by Saving Lives

Vaccination can Combat Poverty
Vaccination has perpetually been a vital aspect of the fight against poverty. Global health is one of the most imperative causes and immunization is the foundation for global health. Consequently, organizations like GAVI, WHO, MSF and UNICEF have put in their combined efforts into promoting this cause. Their endeavors have also highlighted how vaccination can combat poverty.

The efficient provision of vaccination and immunization schemes has been augmented by the exponential progress that the medical field has experienced over the past few years.

An estimated 2-3 million children, 1.5 million of which are under the age of five, die every year due to diseases that could have been averted by more readily available vaccines.

There are numerous underlying reasons for why vaccination can combat poverty. These mainly revolve around lowering infant mortality rates, dedicating more medical facilities and improving health care services.

Moreover, the rapid yellow fever outbreak that has plagued Angola, along with neighboring Kinhasas and Kwango, is being closely monitored by MSF. As yellow fever can lead to death for 15-50 percent of associated cases, Congolese people in the region are especially threatened.

Fortunately, the entire city of Matadi was successfully vaccinated. This move has culminated in the establishment of more vector-control activities for the people. This will especially be efficacious in improving awareness on household protection.

The inaccessibility of the pneumococcal vaccine has endangered the lives of countless children in developing countries. This malady affects millions of children all over the world.

Despite Pfizer’s advancement in this aspect, MSF has tried to rebuff its patent application as it sees it as a form of monopolistic competition because it restricts the development of the vaccine by other entities.

Furthermore, higher prices for the vaccine will be detrimental as it would not be affordable for people from lower socio-economic backgrounds. Therefore, it is imperative that vaccines of this nature be both affordable and easily accessible.

Vaccination has also played a pivotal role in the U.N. health agency’s emergency response in Nigeria. The polio vaccination programs have been an integral aspect.

Similarly, the Gombe state government of Nigeria approved the polio immunization of 900,000 individuals who have traveled from disputed areas under the control of the Boko Haram militant group. Vaccination can combat poverty by this method as it is a precautionary regulation that can alleviate the pressures of mass influx.

In addition to this, the steady progression that has been made with regards to Zika vaccine trials has accentuated the sense of urgency that is needed to address this crucial issue.

Consequently, the recently proposed approval for the performance of Zika clinical trials on humans will pave the way for a breakthrough that could help thousands of communities in the Americas. The upcoming launch of the leprosy vaccine in India also echoes this resonance of hope.

The GAVI Alliance has invested an exorbitant amount of $800 million for bolstering health care sectors in developing countries. Such maneuvers will hopefully result in stimulating the interests of private and public sectors in the country towards the cause.

– Shivani Ekkanath

Photo: Flickr

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Necklace in India to Track Children’s Immunization History

Khushi Baby
In rural Rajasthan, North India, an innovative necklace has been introduced into the health system to track a child’s vaccination history. It is helping to increase the number of children protected against diseases that can kill them in the first few years of their lives.

Approximately 1.5 million children die every year from diseases that can be prevented by vaccination and India has one of the worst immunization records in the world. Less than 60 percent of children in India are vaccinated, a number far below the World Health Organization’s target of 90 percent.

The necklace is called Khushi Baby (which means ‘happy baby’) and is a small plastic pendant on a black string. A computer chip in the pendant stores vaccination data as well as the mother’s health records.

The chip interfaces with a mobile app for community health workers. The health workers just need to tap the pendant to the back of a tablet, syncing the devices and storing the information in the chip. The Ministry of Health and other health agencies can then easily access the data.

Particularly for families that live far from cities, getting access to vaccinations can be difficult. Rural areas have fewer clinics and parents are not always aware of when or why their child might need a vaccination. “Many mothers don’t understand the importance of vaccines and choose not to take their children to immunization clinics,” says a statement on the Khushi Baby website.

With the help of the necklace, health workers no longer need to carry cumbersome records for every patient. Furthermore, the necklace allows health workers to see which vaccine the child needs and when. “Khushi Baby wants to ensure that all infants have access to informed and timely health care by owning a copy of their medical history,” said Ruchit Nagar, co-founder of Khushi Baby.

According to the BBC, Khushi Baby costs less than US$1 to make. Currently, there are around 1,500 children in the Khushi Baby system. Health workers plan to expand the program to include the 1 million people within Rajasthan’s health system.

– Michelle Simon

Sources: BBC, Antara Foundation, CNN, Daily Mail
Photo: Antara

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One Stop Shop Improves Health Care in Lesotho

Healthcare in LesothoUNICEF and the German Agency for International Cooperation (GIZ) have announced that they will launch four pilot health centers in 2016. As a result, thousands of rural residents may be able to receive basic health care in Lesotho.

The health centers, called One Stop Shops, are an effort to bring HIV, malnutrition, blood pressure screenings, immunizations and infant checkups to the most remote areas of the country. Community members in mountain regions are currently unable to get these services without traveling to district capitals, which is a severe hardship that often deters them from seeking help at all.

“Without easy access to these service providers, they won’t go after these services,” said district council secretary for Maseru, Mamajara Lehloenya. “One wouldn’t take the initiative to go test your high blood pressure (hypertension) unless you are very sick.”

This is a serious problem in a country facing a number of national health burdens. The most recent reports from the World Health Organization indicate that the hypertension prevalence rate is more than 30 percent. HIV affects over 23 percent of the population. At the same time, Lesotho is experiencing an under-five mortality rate of 100/1000 children.

To remedy this lack of accessible health care in Lesotho, which is taking away lives, UNICEF and GIZ are bringing services to the most accessible level of government: community councils.

After the pilot phase is over, agencies hope that One Stop Shop will be a “reliable information hub” where community members can learn what services they can receive near home and how to receive them. One Stop Shop also aims to strengthen the referral network for more technical services offered in the capitals.

Social workers will also be included in the initiative in order to assist residents with government documents, including birth certificates and identification cards, as these are often necessary to receive help outside of local communities.

Empowering rural citizens of Lesotho to take charge of their health is critical to sustainably improving human and economic development in the country.

“By linking them to services that build their human capital – like health and education – a safety net of public assistance programs can help the poor rise out of long-term poverty,” said UNICEF Social Protection Consultant Betina Ramirez.

The efforts will complement those of the United Nations Development Program (UNDP), which has been working to build capacity in the country, especially in the agricultural sector. UNDP urges that, together, improving health and food security will be critical if Lesotho is to get back on track with the Millennium Development Goals.

– Ron Minard

Sources: UNDP, UNICEF, WHO
Photo: Flickr