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How economic growth could threaten vaccination efforts in Africa

Economic growth in Africa could threaten immunization programmes and the introduction of new vaccines, a research paper has warned.

The authors from South Africa analysed World Health Organization data to produce snapshots of African countries’ vaccination programmes in 2000, 2010, and 2017. Their paper appeared in Vaccine on 7 May.

The researchers argue that much of Africa’s ability to introduce novel or make better use of underutilised vaccines is dependent on funding by the vaccine alliance, Gavi. But many countries are poised to become ineligible for support over the next few years.

To qualify for Gavi support, a country must have a per capita gross national income of US$1,580 or lower. Of the 47 African countries, 37 are eligible and 10 self-finance their vaccination programmes.

While moving from Gavi support indicates economic growth, this does not necessarily mean graduating countries will have enough funds to sustain or start immunization programmes, the authors say.

“The introduction of new vaccines overwhelms the vaccine supply chains; subsequently immunization coverage drops and this hinders further introduction of new vaccines,” they write. Ghana, a country that according to the paper will soon be cut off from Gavi funding, funded only 18 per cent of its national immunization needs itself in 2015.

The paper suggests that African countries should work together to purchase affordable vaccines to maintain and boost coverage and should plan to produce vaccines locally. This will ensure a stable supply and cut the time taken to introduce new vaccines. Only South Africa and Senegal now manufacture vaccines on the continent. Cold chain storage and transport also require more funding to deal with new vaccines, the paper states.  

“Countries migrating from Gavi to self-financing need concerted efforts to ensure a step-wise progressive transfer of ownership of the whole immunization programs to local governments to ensure that systems and finances are not just committed on paper,” the authors say.

Vaccine rollout on the continent grew rapidly between 2010 and 2017. All African countries now have vaccine programmes in place against hepatitis B and haemophilus influenzae type B. While the paper admits that this is a promising sign, the authors are worried by how long it took to occur.

“Compared to well-developed countries, this is a lag period of over 30 years for many countries, between the time the [vaccines were] introduced in a developed country to the time it was introduced to some of [the African countries],” they say.

African countries’ access to other vaccines also grew in 2010-2017:  pneumococcal conjugate vaccines increased from 3 to 39; rotavirus from one to 34; and inactivated polio vaccine from 1 to 37.