Posts or Comments 17 June 2024

Archive for "Vaccine"



Vaccine Bill Brieger | 16 May 2024

Expanding Access of Malaria Vaccinations in Vihiga County Benefits All of Kenya

The class blog for Social and Behavioral Foundations of PHC features a posting by Alice Calhoun on the importance of pilot implementation of the new malaria vaccine in Kenya. Her comments are found below.

Since 2019, significant improvements in death rates and hospitalizations from malaria in young children have been made in Kenya after initiating the pilot malaria vaccine trial, Malaria Vaccine Implementation Programme (MVIP) involving children under 2 years old. Under the leadership and support from WHO, GAVI, and PATH and many other stakeholders, Kenya was able to benefit from the RTS,S vaccine that was developed for over 35 years by GlaxoSmithKline Pharmaceuticals. As the vaccination program continues in Western Kenya, parents in Vihiga County have noted that their children who have been vaccinated are less sick than their older siblings. The 4 part vaccination series typically begins at age 6 months with its completion at 24 months.

Malaria prevention must have a multi-faceted approach to be successful in eradicating this terrible disease from the community. This includes using insecticide treated bednets, indoor spraying, rapid diagnosis and treatment of active malaria, and malaria prevention during pregnancy. By using education and collaboration with groups such as the Kenya Malaria Youth Army, community health workers (CHW) are the key to disseminating information to the villages and encouraging mothers to complete the series for their children. CHW are also providing catch up vaccinations for other diseases while supporting the malaria campaign in Kenya by handing out bednets.

Now is the time for the Ministry of Health (MOH) to expand the vaccine program to all children under 5 years of age, some of whom missed out on the initial set of vaccines due to vaccine hesitancy during the COVID pandemic. The benefits have been seen by the community in Vihiga County and the attitudes of the mothers are now overwhelmingly positive. Due to the dedication of the CHW and the Immunization Coordinator, nurse Edith Anjere, Vihiga County has the highest rate of childhood immunization coverage in Kenya: up to 96% of children as surveyed in 2022.

Vihiga County is the perfect community to capture more children in the vaccination program since the health infrastructure is already in place as well as an openness in the community to continue vaccinating our children. The MOH can support this nationwide campaign against malaria by allowing other vulnerable children access to RTS,S in Vihiga County, serving as a model program for other counties. Kenya has been at the forefront of the malaria vaccination program and will continue to inspire other countries in Africa to work toward this goal of keeping our most vulnerable citizens healthier.

 

Vaccine Bill Brieger | 13 May 2024

Vaccine Hesitancy and Malaria

The term “vaccine hesitancy” is relatively new jargon that is defined in Wikipedia as, “… a delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence.” The World Health Organization considers Vaccine Hesitancy among the top 10 threats to global public health. Vaccine hesitancy is primarily a matter of trust in institutions, technology, government, and health workers among others, according to Unfried and Priebe. Thus, hesitancy has social and political dimensions. This public health concern now extends into the realm of malaria control and elimination.

After many years of testing for efficacy and implementability, we now have two malaria vaccines. Therefore, it is not surprising that the issue of hesitancy has been identified as a potential challenge. Hussein et al. studied parents in Ghana and found that “About one-third (34.5%) of the parents were hesitant to give their children the R21/Matrix-M malaria vaccine,” even though “showed a high safety and efficacy level, and Ghana is the first country to approve this new vaccine.” It seems that parents who had not been getting routine vaccinations for their children were among those who were more hesitant.

The experience with door-to-door oral polio vaccine outreach campaigns from twenty plus years ago, shows that the general problem of avoidance or reluctance is nothing new,  but often rooted in political and cultural factors, according to Jegede. Covid-19 has shed new light on the problem as explained in the Lancet: “COVID-19 vaccines to low-income and middle-income countries (LMICs) is threatened by vaccine hesitancy. In Africa in particular, the low vaccine coverage and the ubiquitous vaccine hesitancy in a concerning proportion of the population undermine efforts to fight the COVID-19 pandemic.”

It should be noted that the term ‘hesitancy’ puts the blame for not vaccinating children and others on community members and health care consumers. When the expanded program on immunization started 50 years ago, there was recognition that reasons for seeking or not obtaining vaccines were multifaceted and included much more than consumer knowledge and attitudes. Health system factors and economic barriers were of equal concern. We need to return to those days when we took a holistic view on how to promote vaccine uptake.

Low levels of vaccine overage go beyond trust. When the Wikipedia definition mentions “despite the availability” there is the assumption that in fact vaccines are available, which is a major logistics, economics, and systems challenge. Fortunately, Mutombo et al. in the Lancet stress the other factors for low vaccine coverage including “historical, structural, and other systemic dynamics that underpin vaccine hesitancy.” They address serious supply problems wherein the global community has not made a “firm commitment to expedite vaccine deployment to the African continent.” It is not surprising that Nigeria has the highest level of unmet demand for COVID-19 vaccines in the world. Wollburg et al. also note that “Many who are willing to get vaccinated are deterred by a lack of easy access to vaccines at the local level.”

Concerning the two malaria vaccines, UNICEF notes that “It is clear that the demand is very high and far surpasses the supply that is expected to become available.” Concerns revolve around production capacity, supply chain management, integration within the health system’s existing immunization programs, pricing, and partnerships. While it is useful to plan ways to counteract hesitancy, such efforts will not be relevant is there is inadequate supply to meet current and projected demand and needs. As Gavi explains, “partners will also work with countries to provide orientation and technical assistance to ensure quality planning and country readiness.”

Vaccine Bill Brieger | 14 May 2023

Tanzania needs malaria vaccines to reduce malaria burden

David Kanamugire has published a blog on the need to add the malaria vaccine to Tanzania’s arsenal of malaria elimination strategies. The original posting is found in the class blog for the Social & Cultural Basis for Community and Primary Health Programs class at the Johns Hopkins Bloomberg School of Public Health. Below is his perspectives on the issue.

Malaria is still a major public health problem. In 2021, malaria killed an estimated 619,000 people – 95 percent of them in Africa. Children under the age of 5 accounted for 80 percent of Africa malaria deaths. Tanzania is among 4 countries that account for just over half of all global malaria deaths.

The country has significantly reduced malaria cases, from a prevalence of 18% in 2008 to 8.1% in 2022. This reduction is attributed to intervention such as Insecticide Treated bed Nets, Indoor Residual Spray, effective drugs and Malaria Rapid Diagnostic tests.

But recently the global progress on malaria has stalled and this could be due to emerging drug resistance, insecticide resistance and the spreading of invasive species Anopheles stephensi. For the past 3 years, the global malaria death remains above 600,000. Therefore there is need for new approaches to help in efforts to prevent and control malaria.

Photo: Gavi, the Vaccine Alliance

Vaccines are safe and cost-effective way combat communicable diseases and improve health outcomes. One of malaria vaccine that have been approved by the WHO is R21. It was developed by Oxford and is produced at a large scale by the Serum Institute of India.

The R21 vaccine is cheap and can be easily produced thus making it ideal for Africa countries. The R21 is also effective against malaria as three initial doses followed by a booster give up to 80 percent protection against malaria.

Innovation &Invest in Malaria Control &Vaccine &World Malaria Day &Zero Malaria Bill Brieger | 25 Apr 2023

World Malaria Day: Investing in Malaria Vaccines

World Malaria Day 2023 is focusing on three key themes, Investment, Innovation, and Implementation, the 3 I’s. The recently approved malaria vaccines and those still under development embody these themes fully.  They all represent decades of investment in innovation, research, and now implementation.

After extensive several decades of clinical research and three years of field implementation in Ghana, Malawi, and Kenya by the World Health Organization and National Malaria and Immunization Programs, the RTS,S/AS01 malaria vaccine is being rolled out with assistance of GAVI, the Global Vaccine Alliance. During the malaria vaccine implementation program (MVIP) and also based on GAVI’s philosophy for vaccine programs generally, a key strategy was to provide RTS,S as routine immunization services alongside other essential services including a comprehensive package of malaria control and elimination interventions. RTS,S is not only being made available to the three MVIP countries, but as supplies come on board, other falciparum malaria endemic countries have started to apply for supplies and funding through GAVI.

It was well known from the beginning that although RTS,s might be first out the gate, other vaccines would be following closely on its heels. The benefits as well as the efficacy limitations of RTS,S were well known.  Therefore, talk was common for new products being available by 2026. Now in 2023, countries have started to move ahead on another vaccine candidate.

BBC reported that “Ghana is the first country to approve a(nother) new malaria vaccine that has been described as a ‘world-changer’ by the scientists who developed it.” R21 appears to be more effective than its predecessor, so Ghana’s drug regulators moved ahead quickly using final trial data on the vaccine’s safety and effectiveness, which is not even public, to approve it. Interestingly, this move is in parallel to the World Health Organization’s consideration of approving the vaccine.  Shortly thereafter, Nigerian medicine regulators also approved R21. Reuters noted that these “approvals are unusual as they have come before the publication of final-stage trial data for the vaccine.” The actual roll out will ultimately depend on official publication of the safety data and sourcing of funds.

As mentioned above, these malaria vaccines represented considerable investment of time and resources, embody the kind of innovation that is needed to tackle malaria as drug and insecticide resistance threaten progress toward elimination, and require detailed planning right down to the grassroots levels to ensure that a malaria vaccine delivery is part of a comprehensive package of malaria and child health services.

We need to return to the theme of investment. While international organizations, universities, ministries of health, and of course pharmaceutical companies have been investing in developing a safe, effective, and feasible product, these innovative products will not save lives until funds are invested for both purchase and service delivery are guaranteed. GAVI and Partners have put together over $200 million in support for RTS,S implementation for three years. The first window was open in September 2022 for the initial three MVIP countries, and a second window for others, depending on available supplies was open in December 2022.

Investment FOR implementation is a challenging subject because GAVI and collaborating agencies are not a bottomless well of money. What level of national investment by a country to protect its own children is feasible? Is there the national political will to contribute and invest in children in endemic countries, and not continue depending heavily on donors?

Malaria vaccines are a perfect example of what the 3 I’s can achieve. But beyond celebrating this addition to the malaria elimination toolkit, will we also be celebrating commitments by endemic countries of local funds to make zero malaria a reality?

HPV &Vaccine Bill Brieger | 15 Mar 2023

Malawi Experiences HPV vaccination Shortages as Registration Increases Among Adolescents Girls

By Jordan Kerr and originally posted in the Social and Behavioral Foundations of Primary Health Care Blog.

Malawi is making strides in increasing HPV vaccinations among adolescent girls across the nation. Since the official implementation of the HPV vaccine program in 2019, 20 out of the 29 districts in Malawi have begun administering the vaccine to adolescent girls between the age of 9 and 14. Despite this success, Malawi continues to be one of the leading countries worldwide in cervical cancer-related mortality. New cases of cervical cancer in Malawi are reported at a rate five times higher than the global average.

This highly preventable disease places a more significant burden on low-income countries like Malawi due to poor access to healthcare services and resources. International agencies are improving their outreach efforts to reach girls not enrolled in school and address vaccine hesitancy in districts with higher vaccine refusal rates. Due to this outreach vaccine registration is improving however healthcare facilities are experiencing stockouts. In some districts, healthcare facilities are reporting that the main reason individuals are not receiving vaccinations is that they are running out of vaccine stocks.

The World Health Organization (WHO) set a goal in 2018 to eliminate cervical cancer by increasing HPV vaccination uptake globally. This initiative has shown to be successful in addressing disparities in low- and middle-income countries however, in 2020 an HPV vaccination shortage began and is expected to continue through 2025.

The Center for Strategic and International Studies (CSIS) presents several strategies that can be used to address this shortage to keep on track with the goal to eliminate cervical cancer. Efforts must be taken to support facilities developing the HPV vaccine to ensure stockouts do not continue. We need policymakers to lobby for policies that increase funding for vaccination development and establish priority vaccination allocations to countries like Malawi that are experiencing high mortality rates from cervical cancer

Children &Mortality &Vaccine Bill Brieger | 14 Mar 2023

THE RTS,S MALARIA VACCINE: A Solution to Nigeria’s Constant Public Health Crisis

By Blessing George & Chino Nduaka and originally posted in the Social and Behavioral Foundations of Primary Health Care Blog.

https://www.everydayhealth.com/malaria/world-health-organization-approves-first-malaria-vaccine/

More than 50% of deaths from malaria are from four African countries, and Nigeria heads the list, contributing a significant part at more than 30%. Nigeria faces a major public health burden, with an estimated 65 million cases and over 100,000 deaths in 2021, representing over 50% of malaria cases in West Africa. With most outpatient visits in Nigeria being caused by malaria, this disease has taken a toll on the economy. Malaria is among the top five causes of under-five mortality in Nigeria. Over the years, various organizations have joined hands in the fight against this deadly disease. However, Nigeria remains at the top of the list contributing significantly to the mortality rate. Insecticide-treated nets (ITNs), indoor residual spraying, and free sharing of anti-malaria drugs for prophylaxis and treatment constitute ways the country has tackled the disease burden. With the funding allocation repeatedly given by international organizations such as the WHO, the World Bank, and the Global Fund channeled to these interventions that have proved somewhat ineffective, we are at crossroads that begs the question, what next? In 2016, the world’s pioneer malaria vaccine, RTS, S, sold with the brand name, Mosquirix, was introduced for pilot implementation in three malaria-endemic countries. It has been administered to over a million children with positive results on its effectiveness. In 2022, the Nigerian government officially applied to receive the vaccine through GAVI but was hit back with the response that currently, there is an insufficient supply of vaccines. Nigeria tops the list of the global malaria mortality rate and should be prioritized. The Nigerian Ministry of Health, in collaboration with the Nigerian Primary Healthcare agency, needs to fight for the health of its citizens, respond to GAVI, and state the concrete reasons why the country should be prioritized. The goal is to ensure that these vaccines are made available for the under-5 population in Nigeria by 2025 such that in the malaria world report of 2030, Nigeria should not be named a major contributing country to malaria mortality.

coronavirus &COVID-19 &Vaccine Bill Brieger | 25 Aug 2022

COVID-19 Vaccine Hesitancy Is Rising In Ghana: Time To Take Action

Andaratu Wuni has contributed this posting to the Blog site for the JHU site for the course Social and Behavioral Foundations of Primary Health Care.

This image has an empty alt attribute; its file name is vaccine-hesitancy-word-cloud800.jpg(Graphic source: https://www.aafp.org/news/health-of-the-public/20210429vacchesitancy.html)

Covid 19 has unarguably wrecked devastating consequences globally since its emergence and has proven to to be a ubiquitous public health health problem. Vaccination against the virus has been shown to be the most effective way of limiting severe disease and mortality. However the spate of vaccine hesitancy in Ghana has continued to rise in the last year. The World Health Organization defines vaccine hesitancy as the delay in acceptance or refusal of vaccination despite availability of vaccination services. This public health problem has far reaching consequences not only in Ghana but globally. Currently the vaccine hesitancy rate in Ghana is about 30% and counting! with people 25 years and under leading the hesitancy core.

This image has an empty alt attribute; its file name is file-20210719-23-1f9cp4p.png

(Graph Source: https://figshare.com/articles/thesis/Examining_drivers_of_COVID-19_vaccine_hesitancy_in_Ghana/14494851)

Since Ghana rolled out vaccines to the general public over one year ago, only 25.9% of the population have been fully vaccinated as of August 19,2022.Ghana has a target of vaccinating 22.9million eligible Ghanaians; that is about 60% of the population in order to achieve herd immunity, however only 8.2 million Ghanaians have been fully vaccinated to date.

Many reasons account for the rise in covid 19 vaccine hesitancy in Ghana; from the depletion of rigorous and continuous education and the consequent lack of community engagement, relaxation of covid 19 protocols, to vaccine misinformation and conspiracy theories as well as political influence. It is time for a policy that will mitigate this crucial problem, which the WHO(before the covid pandemic) described as one of the top ten greatest threats to global health.

The truth is, a single policy may not totally solve the problem as the issue of vaccine hesitancy is a complex one. The best approach will be for policymakers to enact policies to make vaccination a condition for other essential services in Ghana.

Intensify mandatory vaccination especially in high risk individuals and high risk locations, eliminate vaccine exemptions based on all but health related reasons, commit to structured community engagements and outreaches using the key stakeholders like the Ghana Medical Association and the Public Health association of Ghana, use stakeholders like UNICEF Ghana and the Ghana Health Service to disseminate accurate and scientifically proven vaccine information and last but not least introduce incentives for citizens who take the vaccine.

Dengue &Vaccine Bill Brieger | 23 Aug 2022

Dengue vaccines in Singapore – a luxury or a necessity?

Edwin Chng has contributed this posting to the Blog site for the JHU site for the course Social and Behavioral Foundations of Primary Health Care.

This image has an empty alt attribute; its file name is mosquito.jpgDengue has been endemic in Singapore for many decades, with all four dengue serotypes (DENV-1-4) in active circulation. It presents a significant impact on the economy, with the financial burden of dengue estimated to be US$1.04 billion from 2010 to 2020. (Mosquito Photo credit: http://bitly.ws/twG2)

Despite aggressive conventional vector control measures such as fogging and breeding site elimination, Singapore continues to have persistent outbreaks annually. The number of cases in recent years have also surged. From January to July 2022, 9 deaths and 22,468 cases have been reported thus far – the latter number is more than 4 times the number of cases reported in the whole of 2021. Dengue cases is likely to continue to increase, as the traditional peak dengue season in the country is from June to October each year. (Dengue Cases Graph Photo credit: NEA)

This image has an empty alt attribute; its file name is nea.jpg

 

Singapore’s dengue crisis can be attributed to climate change and a recent change in the prevailing serotype. In the past, the dominant strains in Singapore were DENV-1 and DENV-2, hence the Singapore population has lower immunity to the other two strains. As a result, a large proportion of the population remains susceptible to DENV-3, which is emerging as the dominant strain in Singapore.

As such, as per the World Health Organization, dengue vaccination remains an integral part of dengue prevention and control strategy. The vaccine has an efficacy of about 80% against the outcomes of infection, hospitalization and severe infection which is potentially lethal. Unfortunately, the Singapore government has decided not to include it in the national immunization program, hence it is not eligible for government subsidy. As a result, the vaccine which costs a hefty USD450 remains inaccessible to the This image has an empty alt attribute; its file name is denguevaccine.jpgaverage Singaporean. (Vaccine Photo credit: http://bitly.ws/twGk).

Various stakeholders including the National Center for Infectious Diseases, primary care physicians and pharmaceutical companies can rally and work together in awareness campaigns and clinical studies. Health economics data from such collaborations can confirm the cost-effectiveness of dengue vaccines and positively influence the government to consider a change in its existing policy to provide subsidies. Increasing its accessibility and affordability to more Singaporeans will definitely contribute significantly to the fight against dengue in Singapore.

 

Cancer &Community &HPV &Vaccine Bill Brieger | 23 Aug 2022

Stop Cervical Cancer: Promote HPV Vaccination in Kenya

Lisa Marie Clark has contributed this posting to the Blog site for the JHU site for the course Social and Behavioral Foundations of Primary Health Care.

Cervical cancer is among the leading causes of death for Kenyan women. Every day, 9 women die from cervical cancer alone in Kenya. HPV vaccination reduces the risk dramatically, particularly for HPV types 16 and 18, which may be responsible for up to 70% of cervical cancers.

Optimal vaccination is in early adolescence starting at age 10, before sexual activity begins. In 2020, uptake of the HPV vaccine in Kenya was low, with only 33% of the target population receiving the first dose and only 16% percent receiving a second dose.  Low uptake may be due to a variety of factors including misinformation, lack of access, and low supply of vaccines.

In 2019, the Kenyan Ministry of Health began including the HPV vaccine in the routine vaccination schedule. The vaccine, with support from GAVI, the vaccine alliance, is offered free of charge. However, the Catholic Church and medical professional groups influenced by religious ideology have been a major opponent to vaccine uptake. The Kenya Catholic Doctors’ Association has been vocal about urging parents to promote abstinence over vaccination, equating HPV vaccination with permission to engage in sexual activities. See vaccination from Republic of Kenya’s Ministry of Health in photo.

This image has an empty alt attribute; its file name is hD-33n0HRIC3nk5MFEAGMj8-5yoZOZB010xICtXA0I369kfz70j7dkNDxeUms3y96gGDjlHNZHdTrUA3B0Zb6HtrqvGIITz4WBlaXzXpWO-cwnw0I8rmmtOxZh_n3WqHwwmMO6Jw-d9Xf4YJdaVUCj0In the face of such obstacles to vaccine uptake, more funding is needed to strengthen Kenya’s vaccination campaign, with a focus on building trust and strengthening partnerships with faith leaders to improve vaccine uptake. With more funding from GAVI and improved community engagement vaccination rates would improve, HPV infection rates would decrease, and lives would be saved as a result.

coronavirus &Ebola &Vaccine Bill Brieger | 13 Jul 2022

Malaria and Tropical Health Update for 6-13 July 2022

Please see some excerpts from recent news/media reports on COVID-19, Malaria, Marburg Virus, Ebola, Microplastics and more. Follow links for full articles.

Channels TV reports that Nigeria has confirmed 357 new cases of COVID-19 amid the wave of fresh infections resurging in parts of the country. The number of new cases has continued to rise as authorities have yet to restore the relaxed measures initially put in place to curb the spread of the disease. In a tweet on Tuesday, the Nigeria Centre for Disease Control (NCDC) explained that the fresh infections were confirmed between July 9 and 11. These cases, it stated, were reported in five states and the Federal Capital Territory (FCT).

BioNTech to take malaria vaccine into clinical trials later this year as reported on 12-Jul-2022 By Rachel Arthur. BioNTech is readying to take its mRNA malaria vaccine candidates into clinical trials later this year.

Mzuzah Webinar on “The Effects of Microplastics on Human Health” on Tuesday, July 26, 2022 from 10:00 AM to 12:00 PM CDT. Mzuzah Africa is a multidimensional platform, which connects stakeholders from key sectors in the sustainability discourse. These dialogues are essential to ensure the development of Sustainable Leadership with highly skilled, right-thinking individuals leading the transformational movement in Africa.

Faced with COVID and monkeypox, new USAID leader draws strength from African proverb. From NPR July 11, 2022. Dr. Atul Gawande began a challenging new job this year. The surgeon, former New Yorker staff writer and bestselling author of books like Being Mortal: Medicine and What Matters in the End, is now the head of global health for the U.S. Agency for International Development, which provides foreign and humanitarian aid around the world. So far it’s been quite a daunting year. The pandemic has of course continued and cases are now surging in many countries. Then there’s the worldwide monkeypox outbreak, the potential global repercussions of the U.S. Supreme Court’s decision to overturn Roe v. Wade, and other health crises that have arisen in the wake of the pandemic. Gawande spoke to NPR about the agency’s top health priorities in low-income countries.

On July 11, 2022 Jessica Nye wrote that Ebola Reduces Visual Quality of Life in Pediatric Patients. Survivors of EVD and their close contacts were found to have poor health- and vision-related quality of life, especially among children with one or more ocular complications. Shantha JG, Canady D, Hartley C, et al. Ophthalmic sequelae and psychosocial impact in pediatric ebola survivors. EClinicalMedicine. 2022;49:101483. doi:10.1016/j.eclinm.2022.101483

The Express (UK) reported that Marburg Virus, an Ebola-like virus with 88% death rate has hit Ghana as fever sparks ‘serious concern’ AN OUTBREAK of a deadly virus similar to Ebola, called Marburg, has been identified in Ghana, as two people were diagnosed with the highly contagious disease after they had died. Vassia Barba wrote on Jul 8, 2022. The World Health Organization (WHO) said on Thursday “preparations for a possible outbreak response are being set up swiftly as further investigations are underway”. In a statement, the WHO said preliminary assessment of samples from the two patients indicate the cases were positive for Marburg. However, it clarified those results must be confirmed by a laboratory in Senegal.

FutureLearn is offering an online course, The Resistant Mosquito: Staying Ahead of the Game in the Fight against Malaria. Discover how we can keep the upper hand in our fight against the malaria mosquito by managing insecticide resistance development. This course will be available on FutureLearn from 25 July 2022. The link to the course will follow on July 25th.

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