A mug and a mission—preventing pneumonia from the first child to the last

A mug and a mission—preventing pneumonia from the first child to the last

Article originally posted on the PATH blog on November 11th, 2017.

Perspectives from The Gambia’s immunization program manager

By Lauren Newhouse, Senior Communications Officer, PATH’s Center for Vaccine Innovation and Access

Photo by PATH/Lauren Newhouse

Among the odds and ends in his office, Dawda Sowe stores an unlikely treasure. A mug.

In and of itself, it’s just a piece of ceramic. But upon closer examination, it becomes clear that the mug is special—a relic from a time when The Gambia was blazing a trail among low-resource countries to introduce a vaccine against the most common cause of severe childhood pneumonia, the pneumococcus.

On the mug is a photograph of the first Gambian child receiving the pneumococcal conjugate vaccine (PCV).

The person delivering the vaccine—Mr. Sowe.

At the forefront of history

Photo: PATH/Lauren Newhouse
This gift mug, distributed around the time that The Gambia was introducing PCV in 2009, shows Dawda Sowe administering pneumococcal vaccine to the very first Gambian child on opening day.

Mr. Sowe has spent his career on the front lines of immunization in The Gambia, and of pneumococcal vaccine history for that matter. Through achievements and setbacks, he’s been there—acquiring a unique vantage point along the way.

Today, he manages The Gambia’s Expanded Program on Immunization (EPI) within the Ministry of Health and Social Welfare. His office hums with energy as staff go about the complex work of coordinating the nation’s immunization program. Their goal—to ensure that every child receives their routine vaccinations.

“I work with a team of technical staff responsible for different immunization components,” Mr. Sowe explains. “As program manager, I coordinate across these staff so that the different building blocks work out as expected. I also advocate for immunization program support and propose vaccine introductions.”

Some of the components he’s talking about include logistics around vaccine availability and distribution; data management to identify immunization trends and drop outs; communications to address barriers to services and improve coverage; and surveillance to monitor disease trends.

A day to remember

“The two vaccines we always say are reducing the most infant mortality are rotavirus and pneumococcal vaccines,” he explains. “I was part of the EPI team when The Gambia introduced pneumococcal vaccine in 2009. We were the second country supported by Gavi, the Vaccine Alliance to introduce after Rwanda. Back then, I was a communications officer focused on advocacy so that people would accept the vaccine. Our theme was, ‘Immunize your child to save lives.’”

The opening day ceremony in Serekunda, The Gambia was a big deal—launched with a speech by the then Vice President. It was there that Mr. Sowe made history by vaccinating the first Gambian child against pneumococcal disease.

“Pneumococcal disease was the leading cause of childhood deaths back then,” Mr. Sowe recalls. “Now, it no longer holds that top spot. We’ve seen infant deaths and illness from pneumonia and other pneumococcal diseases fall significantly with the contributions of pneumococcal vaccine and other treatment and prevention measures.”

In fact, pneumococcal pneumonia cases have since declined in The Gambia by more than 60% among children younger than 5 years old. Other invasive pneumococcal diseases like meningitis and sepsis (blood infection) have also dropped, by more than 50%.

Why should cost be a barrier to saving lives?

Photo: PATH/Mark Alderson
Children await their routine vaccinations at a national immunization clinic in The Gambia, including vaccinations against pneumococcal disease.

Today, it’s clear how much Gambians value this lifesaving vaccine. Uptake is a laudable 95% among children nationwide. But, the job is not done. Enduring hurdles include reaching the last remaining children, resolving storage and cold chain issues, and maintaining the man power to do the work.

And then there’s the cost.

Current pneumococcal conjugate vaccines are one of the most complex and expensive kinds of vaccines to manufacture. At regular price, they’re entirely unaffordable for low-resource countries. A financing mechanism called the Advance Market Commitment (AMC) helps bring the price into more feasible territory for these countries.

For The Gambia, the AMC price is currently $3.11 USD per dose. Each child needs three doses, however, which adds up to more than $9 per child. Additionally, Gavi then pays 95% of the AMC price and The Gambia picks up the remainder under a co-financing policy. When all is said and done, pneumococcal vaccines make up around a third of Gavi’s global funding portfolio. To be sure, making all of this work is no simple undertaking.

“Even with the discount, it’s still a substantial sum for us to pay as a low-resource nation if you factor in the other vaccines in our portfolio,” explains Mr. Sowe. “We’ve never defaulted on our co-financing obligations, but if that were to happen, all that we’ve achieved would go down the drain. For countries graduating from Gavi support, funding their vaccine portfolio is getting even more difficult. This is a high-impact intervention. Why should cost be a barrier to saving lives when the market is there?”

At PATH, we concur. Which is why we’re collaborating, in The Gambia and beyond, to advance the development of more affordable pneumococcal vaccines. Success would free up valuable country and donor funds for other health priorities and lessen the risk of countries ceasing to use the vaccine for affordability reasons.

A journey for the ages

Photo: MRC Unit The Gambia/Aisha Sarr Ya Bajen
A mother discusses her daughter’s immunization card with a health worker at an immunization clinic in The Gambia.

In the effort to immunize The Gambia’s children against pneumococcal disease, from the first to the last, Mr. Sowe’s journey has put him at pivotal moments in his country’s history. On traversing that terrain, he says that the philosophy has been as ever-present as the work itself. “Saving even a single life is important because you don’t know what that life could be in the future.”

Surely the child on the mug, who was given a better chance at survival and good health, would agree with that.

Want to learn more about vaccines against pneumococcal disease and how PATH’s work fits in? Read the National Geographic article “Here’s Why Vaccines Are So Crucial.”

Recommended Reading