KHOPOTSO: Up until recently there hasn’t been any effective vaccine to prevent pneumococcus, the bacteria that cause pneumonia in children. But studies conducted in several countries in the late ‘90s have demonstrated that pneumonia can be prevented. The successful testing of the Pneumococcal Conjugate Vaccine (PCV) in South African children between 1998 and 2001 contributed to its licensure two years ago. However, the high cost of the vaccine has made it impossible for the majority of South African children to access it. Only those whose parents or guardians can afford private health care can get it. Professor Shabir Madhi is the
Co-Director of Wits University’s Respiratory and Meningeal Pathogens Research Unit (RMPRU).
Prof. SHABIR MADHI: The costs are phenomenal. As an example, the current cost of the vaccine in the private sector in South Africa is round about R600.
KHOPOTSO: With this vaccine, each child needs to get three vaccinations. That works out to R1 800 for every child.
Prof. SHABIR MADHI: How does that compare to our current immunisation programme? The complete costs of the current vaccination programme, that is, to vaccinate a child with seven different vaccines, at the moment, costs round about R100. So, we’re looking at R100 and adding another R1 800 onto that.
KHOPOTSO: Professor Madhi recognises the fact that the cost is prohibitive. However, he says just like in the case of antiretrovirals, it is possible to mobilise to get the manufacturer, Wyeth Vaccines, to slash the price.
Prof. SHABIR MADHI: There was obviously, lots of advocacy in terms of antiretrovirals and making it available to people from developing countries that required it the most. And a similar sort of initiative needs to be started now with these new vaccines, which are really targeted and meant to assist children from the least developed countries’¦ It’s important for the Health Ministry to engage with the pharmaceutical company to look at what possibilities exist in terms of getting the vaccine at an affordable price’¦ Currently, certainly, at $50, it’s unlikely that the Pneumococcal Conjugate Vaccine would be affordable or even cost-effective in South Africa.
KHOPOTSO: Over the last two months, the Ministerial-appointed National Advisory Group on Immunisation (NAGI) recommended to the Department of Health to introduce the Pneumococcal Conjugate Vaccine into the national immunisation programme. Johann van den Heever is the manager of the Immunisation Programme in the Health Department. A range of issues need to be considered, he says.
JOHANN VAN DEN HEEVER: It’s an extremely expensive vaccine, so one needs to negotiate on a price. Of course, the number of vaccines that you’re going to order are quite considerable because you don’t only get one dose’¦ Every child needs to get three jabs. There’s needles and syringes involved, there’s training of people that are going to implement this’¦ you need to change the Road to Health cards, which the children carry to include that particular new vaccine’¦ And then you need to negotiate with Treasury ‘ a submission be written to the Minister of Health, suggesting that we introduce it, that these are the financial implications.
KHOPOTSO: Because of the country’s relatively high per capita income compared to many developing nations, South Africa cannot qualify for assistance from the Global Alliance for Vaccine Initiatives, an organisation that sponsors vaccines to poor countries. Van den Heever added that the National Advisory Group on Immunisation is currently doing a preliminary study to determine the costs of adding the Pneumococcal Conjugate Vaccine on to the list of the seven routine vaccinations that children receive. However, he couldn’t provide a timeline for the possible introduction of the vaccine.
JOHAN VAN DEN HEEVER: We believe it’s in the interest of good public health and, of course, in reaching the Millenium Development Goals in diminishing death and disease amongst children’¦ It’s longer than a two-year project to get it fully introduced. It’s not on the cards for this year. At least, I can say that with confidence.
KHOPOTSO: Recently, the World Health Organisation issued out a recommendation that governments in the developing world where the mortality rate of children under five is greater than 50 out of every 1000 kids or where there are more than 50 000 child deaths annually, must incorporate the Pneumococcal Conjugate Vaccine into their national immunisation programmes. Professor Madhi, again:
Prof. SHABIR MADHI: Each year in South Africa, about 100 000 children would die’¦ South Africa is one of the countries that have got one of the highest burden of invasive pneumococcal disease.
KHOPOTSO: Madhi added that South Africa’s high HIV prevalence rate increases the risk of pneumonia in children. But in trials conducted in the past, the Pneumococcal Conjugate Vaccine has shown that it can also cut the rate of pneumonia infections in HIV-positive children.
Prof. SHABIR MADHI: We were involved in a huge study done in Soweto. In fact, it involved 40 000 children. It’s a study which was started in 1998 and it was completed in 2001’¦ What we found in that context is that a vaccine prevented 13% of pneumonia in HIV-infected children ‘ about 1 in every 10/15 cases of pneumonia that would have occurred, otherwise in HIV-infected children. In HIV-uninfected children, the vaccine prevented about 25% of all pneumonia. In terms of absolute numbers, the benefit of vaccine in HIV-infected children was about nine times greater than in HIV-uninfected children. HIV-infected children clearly benefit much more with this Pneumococcal Conjugate Vaccine.