03 Feb Introducing PCV in Somalia, Guinea, South Sudan and Chad
“We are ready to act… I hope the donors will be with us and support us and all of the fragile countries. Don’t leave us alone. Be with us.”
George Legge, Expanded Program on Immunization, Ministry of Health, South Sudan
On 2 December 2021, the Every Breath Counts Coalition hosted a dialogue on the introduction of the pneumococcal conjugate vaccine (PCV) in Somalia, Guinea, South Sudan and Chad, on behalf of the Steering Committee of the Global Forum on Childhood Pneumonia.
That historic forum took place in Barcelona at the end of January 2020 just as the pandemic was emerging. It brought together countries losing large numbers of children to pneumonia and renewed their commitment to reducing these deaths, including by increasing coverage of the PCV.
But two years later, there are still countries that have yet to introduce the PCV. Among them are Somalia, Guinea, South Sudan and Chad where more than 40,000 children died from pneumonia, and an additional 10,000 from meningitis and sepsis, in 2019, according to the Global Burden of Disease (GBD).
Studies in other African countries show that cases, hospitalizations, and deaths from all of these conditions fall significantly following PCV introduction – including in Rwanda, South Africa, Kenya, Cameroon, Burkina Faso and Zambia. Adult populations are also protected when children get the PCV.
Since Gavi, the Vaccine Alliance offered support for eligible countries to introduce the PCV in 2009, most African nations have done so. By 2021 there were only nine that had not, including Somalia, Guinea, South Sudan and Chad (all Gavi-eligible) and Cabo Verde, Comoros, Equatorial Guinea, Gabon and Egypt.
The high prices of the PCV products available in the market have been a major barrier to introduction in these countries. But in 2020 a third, 30% more affordable, PCV product became available – PNEUMOSIL® from the Serum Institute of India (SII). In 2021 the Government of India announced national PCV introduction with the new SII vaccine and Indonesia, Tajikistan, Timor-Leste and Ukraine have all made progress on PCV introduction during the pandemic.
It is critical that the remaining African countries can both introduce the PCV by 2025 and sustain the high rates of coverage needed to deliver health benefits for children and adults. A recent study found that one-third of the African countries that introduced the PCV have struggled to achieve 80% coverage in two years. The reasons cited include lack of adequate preparation prior to introduction, insufficient supply chain capacity and management, poor communication between organizations and with the public, and data collection systems that are insufficient to meet information needs.
The wide adoption of the PCV, and other vaccines that prevent pneumonia, are especially important in Africa where care seeking rates for children with pneumonia symptoms are low (46%). Rates are even lower in Somalia and Chad, where only 23% and 26% of children with pneumonia symptoms are taken for care, respectively. In this context it is even more critical to prevent infection with vaccination.
Studies also show that widespread use of the PCV could reduce antimicrobial resistance by lowering the number of days children with pneumonia receive antibiotics each year by half.
Further, the need to protect children – indeed all populations – from respiratory infections is becoming more important in an era of global respiratory infection pandemics. COVID-19 is the first, but most likely not the worst, global respiratory pandemic that will be experienced this century.
At the same time, climate change is increasing the major risk factors for childhood pneumonia – notably, air pollution and poor diet. Rapid urbanization is contributing to overcrowding in cities and towns, which also increases the transmission of respiratory infections.
In the face of all of these rising threats, we need to fully activate every vaccine that we have to protect children from pneumonia, and develop new ones to target vaccine-preventable pathogens.
This report offers 10 actions to accelerate introduction of the PCV in Somalia, Guinea, South Sudan and Chad in 2022 and achieve 90% coverage by 2025, as required by the Global Action Plan for Pneumonia and Diarrhea (GAPPD) and Immunisation Agenda 2030.
In the spirit of the Global Declaration that was signed at the Global Pneumonia Forum, we call on all stakeholders to join forces to implement these 10 actions. Our ultimate goal is the achievement of Sustainable Development Goal (SDG 3.2) by 2030 and in the nine years remaining we need to work more effectively with the countries that need the most support to reduce child deaths to less than 25 per 1,000 births.
This is how we keep our precious promise to the world’s children – a fifth birthday for all.
4 February 2022