African immunization year, 1986 / by L. A. Arevshatian

Expanded Programme on Immunization Alrican Immunization Year, 1986 By declaring 1986 as African Immunization Year, the African Regional Committee has chal- lenged member countries to ensure the protec- tion of their children against six killer diseases by Dr L. A. Arevshatian Regional Officer for the Expanded Programme on Immunization, WHO Regional Office for Africa Y he African Region is the true homeland of WHO's Expanded Pro-gramme on Immunization (EPI), which held its very first seminar in Kumasi, Ghana, in 1974. lt is not perhaps something of which we should be proud, since it was born out of suffering. Yet we are proud, and rightly so, because EPI is directed towards reducing that suffering . However, the struggle in Africa is a hard and complex one because of widespread malnu- trition, poor resources and enormous logistical problems. Without immunization, one million African children south of the Sahara will die before their first birthday from dis- eases that could have been prevented . A further half-million will be disabled each year. And this is not all: hundreds of thousands of African mothers and fathers will spend several days taking care of 32 million episodes of sickness in their babies every year, due to measles, tuberculosis, pertussis, teta- nus, diphtheria and poliomyelitis - all of which diseases are covered by EPI. The severity and huge toll of these diseases in Africa is the result of a vicious cycle of infection and malnu- trition . Immunization services are effec- tive in preventing specific diseases which might otherwise precipitate mal- nutrition. They therefore contribute sig- nificantly to reducing childhood mortal- ity and disability. For example, the pre- 22 sent immunization coverage of 20 per cent of the target population of children aged under one year will prevent six million cases in the Region, thereby saving 200,000 lives and 100,000 cases of disability. That in itself is already a significant achievement. Yet it is as nothing com- pared to the 32 million cases expected A Kenyan baby receives its protecting dose of oral vaccine against polio. Photo WHO/Jorgen Schytte to occur each year . Even with the present coverage, 2,200 African chil- dren still die every day because they are not protected by immunization . lt is against this background that the African Regional Committee, at its thirty-fifth meeting in Lusaka, Zambia, last September, adopted a special resolution proclaiming 1986 as African Immunization Year. lt invited member states to step up their EPI activities with a view to achieving the pro- gramme's objective by 1990. This calls for the provision of immunization to all children and all women of child- bearing age . There are many constraints in the way of achieving that objective. Tropical temperatures can diminish the potency of vaccines even in the space of a single vaccination session; there may be a lack of electric power, inadequate trans- portation facilities and equipment, man- power shortage and so on. These all pose special challenges for many na- tional programmes, especially in West Africa where the per capita income is much lower than elsewhere in the continent. At a time when health services in Africa are striving to administer three, or at the minimum two, injections to children, their counterparts in the de- veloped world have little difficulty in giving 1 0 or 12 such injections to pro- tect children throughout their lives not only against all six EPI target diseases but also against mumps and rubella. Since the inauguration of EPI in the Region in 1977, progress has been made in establishing immunization as an essential component of primary health care (PHC). The programme was received throughout the Region with remarkable enthusiasm and determi- nation. In 1983, the latest year for which comprehensive country data are available, 31 per cent of children aged under one year received the first dose of diphtheria/pertussis/tetanus vaccine (DPT-1 ), which is an indicator of access to immunization services, while 20 per cent received DPT-3, an indicator of full immunization. The tragedy is that vacci- nation, one of most powerful and effec- tive tools in preventive medicine, is not yet available to most children in Africa . The objective of African Immuniz- ation Year is to substantially increase immunization coverage among the target population and build up a mechanism for permanent services. While the proposed objectives are com- mon to the countries of the Region, the targets actually set and the strategies adopted differ according to existing EPI coverage and the degree of integration of the programme into PHC. Some of the most successful strategies and ap- proaches being employed in this crucial year have laid emphasis on intersectoral collaboration, setting-up of national EPI committees, winninq over political and W oRLD HEALTH , Aug./Sept. 1986 religious leaders, providing immuniz- ation at all health contact points, giving priority to large urban areas, concentrat- ing scarce resources on the new-born to 11-month-old age group (the most vulnerable of all), and increasing out- reach vaccination sessions for the most peripheral populations. Arranging per- iodic immunization rounds and national immunization days has proved very ac- ceptable to the populations as well as to the health services . Many favourable factors can contri- bute to the success of EPI in the Region as a whole, and of African Immunization Year in particular. For instance, Africa was the last active participant in the smallpox eradication programme, which resulted in the health services accumulating valuable experience and created a pool of skilled national experts in and managers of disease control. There is a strenuous political commit- ment in several countries, where Heads of State and other high-level officials are giving their personal support to immunization. As a result of the procla- mation of African Immunization Year, this commitment is increasing in other countries of the Region. Immunization, in Africa is not a pro- gramme for individuals; rather it is a family and community one. Experience in several countries shows that. if prop- erly managed, the community can par- ticipate actively ·at all stages of pro- gramme activities, including planning and evaluation. African Immunization Year has won maximum recognition from the international community, alongside UNICEF's outstanding support to the universal child immunization ap- proach. International and bilateral agen- cies and non-governmental organiz- ations (NGOs), such as UNDP, Save the Children Fund, Rotary International and some international development agen- cies, have contributed funds, technical staff, vaccines and cold chain equip- ment. W HO and UNICEF are committed to achieving the goal of making immuniz- ation available to all children by 1990. Their collaboration is complementary. While UNICEF is increasing its financial, material and manpower support to na- tional immunization programmes, W HO in the African Region is introducing new and more flexible organizational struc- tures which will permit closer contacts with the countries at subregional and country levels . This will considerably increase the flow of technical expertise from WHO to each country, thereby improving the managerial capabilities of W oRLD HEALTH , Aug ./Sept. 1986 Immunizations are part of primary health care activities and reqUire a strong involve- ment of the community. Photo WHO/H.Anenden national programme personnel at all levels . We intend to focus on the district level as the main operational support to immunization programmes. This sup- port will not be limited to the delivery of immunization alone but will include oral rehydration for diarrhoea! diseases, malaria treatment and prophylaxis, ad- vising on breastfeeding and weaning, clean water and sanitation and other elements of primary health care. So African Immunization Year will become one of the innovative mechanisms which strengthens the existing health infrastructure and promotes the primary health care approach to Health for all by the year 2000. The concept of African Immunization Year calls for careful thought and plan- ning . lt is viewed in the context of the regional medium-term programme, so planning for a single year is not enough. Plans have been drawn up in many countries to cover at least four or five years , with 1986 as the key year of the overall plan. The most successful programmes are those for which all national and external resources - human, financial and material-can be listed sector by sector or agency by agency. Accord- ingly, all the participants in the pro- gramme are aware of their responsibil- ities, and of the precise amount and type of support expected of them . Posters, booklets, slide sets, films and other health education materials have been prepared to inform the population about immunization and motivate them . A number of countries have issued such materials in local languages, thereby considerably increasing com- munity involvement. District level operation support teams have been created which will carry out immunizations in conjunction with other PHC activities, and not as a "vertical" and isolated activity. EPI has often proved to be an effective entry point for other primary health care activities, especially those related to child survival as defined in the Declaration of Alma-Ata. Training is regarded as crucial for African Immunization Year. Many Afri- can countries are running training courses and seminars for middle-level management and peripheral-level per- sonnel. WHO Headquarters in Geneva and the African Regional Office in Braz- zaville provide course materials and staff to strengthen the technological aspects of national training pro- grammes. Working with national auth- orities, UNICEF is making tremendous efforts to provide not only vaccines but also cold chain and immunization equip- ment. WHO and other agencies also collaborate with nationals in supplying vacc1nes and equipment, as well as technical advice on the selection of vaccines and materials. National EPI programme managers' meetings are being arranged in English-speaking and French-speaking Africa . African Immunization Year, will put the spotlight on the Expanded Pro- gramme on Immunization. But that pro- gramme will not end in December nor even next year. lt will continue as long as children are being born, so the activities of EPI must be considered as being of a permanent nature. • 23