Four more African countries will be introducing pneumococcal conjugate vaccine (PCV) into their routine immunization schedules – as other countries across Africa said they would ramp up and revitalize childhood vaccination programmes that were hit hard by the COVID pandemic. 

In commitments announced this week at the 2nd Global Forum on Childhood Pneumonia in Madrid Spain, officials of Chad, Guinea, Somalia and South Sudan announced their readiness to start administering the vaccines routinely by 2024. They said that they would apply for support to Gavi, The Vaccine Alliance to support rollout. 

Burkina Faso, the Democratic Republic of Congo (DRC), Ethiopia, Mozambique and Nigeria also pledged to increase the coverage of PCV and other vaccines to pre-pandemic levels. Specifically, health authorities in Burkina Faso said they would restore PCV coverage to above 90% by working with the Zero-Dose Immunization Programme (ZIP) while also reaching zero-children with vaccines against measles, rotavirus, ​​diphtheria, tetanus and pertussis (DTP).

‘Zero dose children’ are those who have not vaccinated at all – reaching those pockets of children is critical to the ambition to end preventable deaths of newborns and children under 5 years of age by 2030, a health  target of the Sustainable Development Goals (SDG 3.2).

‘Unjust burden’ on Sub-Saharan Africa and South Asia 

Every day, pneumonia kills 2,000 children globally – one of the leading causes of deaths of under-fives. Nearly all of those deaths are preventable, however, with vaccination, equitable access to quality primary health care, and a reduction of other key risk factors such as undernutrition, household air pollution, and a lack of access to safe water, sanitation and hygiene. 

Sub-Saharan Africa and Southern Asia are the worst affected, accounting for four of every five child pneumonia deaths worldwide Partners at the forum declared the childhood pneumonia indices as an unjust burden requiring attention, prioritization, and urgent action.

“This is an unjust burden requiring our attention, prioritization, and urgent action… Fast action to reduce child pneumonia deaths can make the difference and will impact overall child mortality by strengthening health systems to deliver integrated child health services,” the forum’s official declaration stated.

In addition to the pneumococcal vaccine which is used to protect infants, young children and adults against pneumonia caused by the bacterium Streptococcus pneumoniae, health authorities in Guinea and South Sudan also want to introduce the rotavirus vaccine while Somalia is also adding rotavirus and measles-rubella vaccines into routine childhood vaccination in 2023.

Strengthening access to oxygen therapies 

A number of countries also pledged to strengthen access to pulse oximetry and oxygen therapies – critical to diagnosing and treating children hospitalized with pneumonia.

“The Ministry will ensure all relevant child health policies, guidelines, and essential medicines lists include pulse oximetry and oxygen and that health facilities and pediatric wards are equipped with pulse oximeters and oxygen and trained staff to diagnose and treat sick children,” the Burkina Faso Health Ministry declared. 

To help finance these efforts, the government said it is seeking support to acquire and train health workers in using pulse oximetry and oxygen support, as well as better access to doses of  child-friendly amoxicillin from The Global Fund; it is also aiming to co-invest in strengthening the community health workforce by working with the Global Financing Facility and the Community Health Roadmap Catalytic Fund.

Tackling child mortality by targeting zero-dose children

While progress is being recorded in many countries, 54 are not on track to achieve the SDG target 3.2 for child survival by 2030 – whose indicator is less than 25 deaths among children under five per 1,000 live births. 

At the conference, experts argued that fast action to reduce child pneumonia deaths can make the difference and will also reduce overall child mortality by strengthening health systems to deliver more integrated child health services.

On the sidelines of the forum, Dr Keith Klugman, Director, Pneumonia and Pandemic Preparedness at the Bill & Melinda Gates Foundation told Health Policy Watch that targeting zero-dose children to tackle child mortality is a smart goal for African countries but they need to have adequate knowledge regarding vaccination in their countries in other to effectively reach groups of children who have not been vaccinated at all.

“In my view, it’s quite clear. The first is to develop the process to have a clearer idea of who’s being vaccinated and who isn’t. And then to set targets and then to make it a term of national pride, that they’re able to meet those targets. We know how to do this. This is not rocket science,” Klugman told Health Policy Watch.

Commitments by DRC, Ethiopia, Guinea and Mozambique

The DRC pledged to rapidly accelerate the decline in child mortality and progress towards SDG 3.2 by reducing the number of zero-dose children by 30% in 11 provinces by 2025. 

Ethiopia’s “ambitious plan” entails targeting the country’s estimated 1.1 million zero-dose children and reaching those living far from health services to address the currently very low rates of care seeking for children with pneumonia symptoms. This it said will address the currently very low rates of care seeking for children with pneumonia symptoms.

The ministry noted that child pneumonia and other deaths can be reduced by restoring PCV, pentavalent, rotavirus, and measles coverage to pre-pandemic levels of above 90%; by increasing the supply of vaccines and antibiotics through more local medicines manufacturing, and by increasing access to pulse oximetry and oxygen therapies for newborns and children. 

“The Ministry will ensure that COVID-19 pulse oximetry and oxygen supplies are redeployed to benefit sick children,” it added.

In Guinea where there are an estimated 192,000 zero-dose children, the country’s ministry of health committed to reducing the figure by 50% with key roles being played by the finalization of the country’s National Immunization Strategy and strengthening the capacity of health care workers to diagnose pneumonia, especially in remote areas. “Special efforts will also be made to ensure that mothers understand the risks of pneumonia and can seek quality healthcare quickly for a sick child,” the ministry declared.

Mozambique also made a similar pledge to target the country’s estimated 330,000 zero-dose children. In addition, it also pledged to prioritize increasing coverage of routine vaccines to over 90% by 2030 as a way to accelerate progress towards SDG 3.2. 

“Mozambique will [also] continue to implement actions to sensitize and raise awareness in communities about the dangers of pneumonia in children in parallel with other causes of child morbidity and mortality, especially malaria and HIV/AIDS,” the ministry announced.