The Western Cape and Free State are experiencing severe problems with the distribution of crucial pneumonia and diarrhoea vaccines for children.
The speedy roll-out of pneumonia vaccine Prevenar is critical, as the second swine flu season has started in the northern hemisphere and could rapidly spread to Africa.
Pneumonia is one of the commonest swine flu complications and accounts for almost all deaths of flu victims, with young children being particularly vulnerable. Pneumonia is also a frequent consequence of measles, another killer of children. South Africa is at present in the grip of a measles outbreak.
The Western Cape and Free State introduced the vaccines almost six months later than prescribed by national health department guidelines, and several clinics have reported they regularly run out of supplies.
The Western Cape introduced Prevenar in July and Rotavirus, a diarrhoea vaccine, in November, whereas the Free State health department started ordering the vaccines only in October.
National immunisation programme manager Johann van den Heever said the national department is ”not yet sure whether the Free State has started to distribute the vaccines to health facilities, as many facilities haven’t sufficiently budgeted for Prevenar”.
In September last year, the South African government became the first in Africa to announce the vaccines would be provided free of charge to children under five. Prevenar protects against the most common type of pneumonia, pneumococcal pneumonia and pneumococcal meningitis, both caused by the bacterium Streptococcus pneumoniae.
Pneumonia is the world’s number one killer of children, causing more deaths than Aids, malaria and measles combined. It has become increasingly resistant to antibiotic treatment because of overuse of antibiotics.
Wits University vaccinology professor Shabir Madhi, who led South Africa’s Prevenar trials, said the vaccine reduces severe pneumococcal disease by 85% in HIV-negative children, and by 65% in those who are HIV-infected. It cuts the risk of pneumococcal infections related to the influenza virus, including swine flu, by almost half.
Prevenar, produced by Pfizer, is expensive, costing R258.08 a dose in the public sector and R542,48 in the private sector. Three doses, at six weeks, 14 weeks and nine months, are needed for each child.
”Cold chain capacity has also been a major challenge,” said Van den Heever. ”We had to order 3 000 extra fridges to store the vaccines.”
Western Cape health department spokesperson Faiza Steyn said the province had only managed to secure 249 donated fridges by June this year, delaying the vaccine roll-out.
Steyn denied that provincial clinics are experiencing problems, but several doctors and nurses told the Mail & Guardian that they receive ”only a small percentage” of vaccines they order and ”run out of vaccines before the end of the week or month”.
Heather Zar, director of pulmonology at Cape Town’s Red Cross Children’s Hospital, said the hospital has 2 500 annual cases of pneumonia. ”The department has not provided us with vaccines. We’re buying some with our own funds, but can’t buy nearly what we need,” Zar lamented.
Gauteng has done best with the distribution of Prevenar, reporting that it provides the vaccine to 85% of children in need.