Two thousand vaccine doses won’t fix the problems in Zambia – but they are a sign of progress
A single shot of the measles vaccine can save lives, especially those of children under five years old. But the vaccine was first made in Scotland in 1956. Since then – with slightly fewer helpings given from the United States in the 1980s and then UK in the 1990s – the global distribution of this and all other vaccines has been slowly growing. In 1980 just over a quarter of the world’s population was vaccinated against disease. In the 1990s it was more than half; since 2010 it has exceeded 60 percent.
Why should Britain care about all this? Good news comes from all over the world, but Zambia is one of a small number of places where this change has not happened very far, and remains very limited. Not for health reasons – there are plenty of potential measles cases already, and the country is the first in Africa to give up polio – but to account for enormous inequalities between rich and poor.
Research conducted by the Sheffield School of Pharmacy, at King’s College London, shows the way the weaknesses in Zambia’s system of vaccination create the very conditions for outbreaks:
There are well known social and health inequities associated with the way that vaccines are delivered in Zambia. Almost two thirds of children in high income countries receive all their immunisation needs. In Zambia, however, this figure is just a quarter, putting the cost of ensuring that all children receive all their immunisation needs at 60% – more than £1.4 billion – in the coming decade. Half of all Zambian children are not vaccinated against vaccine preventable diseases. More than half of Zambian children are malnourished and malnourished children are more likely to get vaccine preventable diseases. Food security is among the highest in Zambia, but it is of little surprise that unsafe drinking water and sanitation and sanitation still represent a major health challenge in the country.
The problem is simple: unlike almost all countries in Africa, a huge percentage of the 1.5 million children who are malnourished – probably around 50 percent of the country’s children – live in rural areas. Simple vaccines, such as diphtheria-tetanus-pertussis (DTP) and measles, cannot be given to that kind of population at small margins of vaccine coverage. All of the above make but one small difference, and in the end the bigger challenge is keeping the vaccines circulating. What doesn’t seem simple is for those basic failures to be corrected: do the poorest get any assistance to become health providers?
Today, the maker of the large greenpox vaccine, Merck, is promoting vaccination of children. But this announcement, about free vaccine for African children, reflects only the tip of the iceberg. Until the children become health workers, who can keep the supply chain going and can correct some of the failures that have made vaccines into a highly visible and vastly expensive privilege, the situation in Zambia will persist.