Why Liberian parents are shunning immunisations

At a maternity hospital in Freetown's Hill Valley Community. PHOTO | KEMO CHAM 

Ebola’s legacy on immunisation in Sierra Leone is struggling to up its immunization coverage after it fell by 8 per cent as one of the direct consequences of the Ebola outbreak.

At the height of the epidemic, fear of contracting the viral disease at a time healthcare workers were seen as sources of infection caused many to shun hospitals.

For many parents, conspiracies around the safety of vaccines left them reluctant to have their children vaccinated.

Consequently immunisation coverage dropped from 88 per cent to 80 per cent, according to the Ministry of Health and Sanitation (MoHS).

This is a cause for concern, amidst a growing threat of many infectious diseases, said Dr Denise Marke, Director of the Expanded Programme on Immunisation (EPI) at the ministry.

The EPI is a World Health Organisation programme designed to cover children all over the world with life saving vaccines. Established in 1974 with an initial list of four vaccines, the EPI has since been expanded to include vaccines for diseases like Hepatitis B, Yellow Fever and Meningitis.

The original goals of the EPI include: to ensure full immunisation of children under one year of age in every district, to globally eradicate Polio to reduce maternal and neonatal tetanus to an incidence rate of less than one case per 1,000 births, to cut in half the number of measles-related deaths, and to extend all new vaccine and preventive health interventions to children in all districts in the world.

Sierra Leone has eleven vaccines on its routine vaccination programme, covering diseases like Polio, TB, neumococus, rotavirus (introduced only last year), and measles. All of these form part of the EPI list.

Late last year the government announced an addition of a second dose for measles, the disease of children which is caused by a virus and is one of the leading causes of deaths in Africa. Children used to be vaccinated for the viral disease at nine month. But they will now be administered with a second dose at month 15. The Health ministry said this was in response to the realization that one dose wasn’t enough.

Part of the problem of the reduction in vaccine coverage is a high defaulter rate. This was one of the targets of the last Maternity Health Week (MHW) conducted in December.

MHW has been set aside to provide door-to-door healthcare services to pregnant women and suckling mothers. It’s one way the government and its global partners have sought to address one of the world highest rates of maternal and infant mortality.

Liberia's President Ellen Sirleaf Johnson on May 9, 2015 in Monrovia after members of the World Health Organization declared Liberia to be free of the Ebola virus. PHOTO | FILE

The MoHS has taken advantage of the rare opportunity offered by the week-long campaign by administering vaccines of all forms on defaulter children.

Sierra Leone invests US$5M annually in immunization, most of which comes from the Global Alliance for Vaccine and Immunisation (GAVI), an alliance established in 1999 with the goal of improving child health in the world’s poorest countries through the expansion of the EPI.

GAVI comprises a grand coalition that includes the UN agencies like WHO and UNICEF, as well as public health institutes, and donor and implementing partners.

The US millionaire and philanthropist Bill Gates, through his Bill and Melinda Gates Foundation, has been a major funder of the Alliance.

The 90 per cent vaccine coverage target is a goal of the Alliance, and it was aimed at 2010.

The Sierra Leone government accounts for 5 per cent of the $5m spent on vaccines and, according to Dr Marke, the local contribution increases yearly.

“GAVI is not going to be funding the programme for ever. Eventually government will take over and it is our tax [money], so we have to use it,” he said at a recent forum, while urging a concerted effort to maximize the acceptability of vaccine.

Of a major concern for the government and its partners is Polio. WHO targets it for eradication by 2018.

The last time Sierra Leone recorded a case of the highly infectious viral disease was in 2010. But threat from neighbouring countries considered by the global health body as hotspots, like Nigeria and Cameroon, leaves Sierra Leone at constant risk.

Diarrhoea accounts for a high per cent of the diseases that lead to infant deaths in Sierra Leone, which was why in 2014 the government introduced the Rotavirus vaccine.

Pentavalent vaccine, a five in one vaccine, takes care of Yellow Fever and hepatitis, a disease doctors say is becoming a major health problem for the country.

Even before Ebola struck, the rate of paediatric tuberculosis was at an alarming stage, hence the TB vaccine has become paramount for the government.

Like in Nigeria, religion and culture have served as a stumbling block to the successful implementation of immunization programmes. One ethnic group in particular, the Fullani, has been singled out for their opposition, mainly due to religious beliefs.

Liberian Health Minister Burnice Dahn washes her hands as the director of the World Health Organization (WHO) for the Africa region, Matshidiso Moeti (R) waits for her turn during a visit to the Redemption Hospital in New Kru Town on the outskirts of the capital Monrovia, on April 22, 2015. PHOTO | FILE

Predominantly Muslims, some communities in the group have refused to cooperate because of the widely held view that the vaccine causes infertility, said Hamid Turay of Hellen Keller International, at an end of year presentation to a coalition of health civil society groups in Freetown.

But official corruption and maladministration had also been known for frustrating the effort of the government and discouraging donors.

In 2014, the Inspector General of the Global Fund, the investigative arm of the health funding body, found massive corruption within the Health Ministry, in the form of procurement irregularities. It found “evidence of fake invoices and fictitious vendors in the procurement of office equipment for the Sierra Leone Ministry of Health and Sanitation.”
The MoHS was given an ultimatum to refund the money or face sanctions.

GAVI in 2013 also froze crucial funding to the ministry after about $1m meant for the procurement of vaccines went missing.

Over $5 million was held back for months.

An Anti Corruption Commission investigation indicted over a dozen people, from permanent secretaries to directors, alleged to have diverted the funds meant to immunize children into personal accounts.

Subsequent trials of the indictees ended with almost all of them, including the topmost officials, acquitted and discharged.

Because of these experiences, GAVI is now considering the involvement of civil society as a monitoring mechanism, said John Kamara from the Catholic Relief Services (CRS), one of the disbursement and monitoring partners of GAVI and other donors involved in the health sector.

To address apathy influenced by negative beliefs, the government is also considering legislating to force parents to immunise their children.

Sierra Leone is one of a few countries that have no legislation on vaccination.

“The government is not here to do any harm, but rather to save lives,” said Turay of Hellen Keller International.

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