KHOPOTSO: Many infants could be saved from illness and death from pneumonia if they were given a vaccine that could prevent them from acquiring the pneumococcal infection. Prevenar, a pneumococcal conjugate vaccine that prevents the bacteria that causes pneumonia and meningitis in children, was launched in South Africa more than two years ago. But due to its high cost, it remains a luxury to many South African children who need it. Dr Anne von Gottberg is the co-director of the Respiratory and Meningeal Pathogens Research Unit at the National Institute for Communicable Diseases.

Dr ANNE VON GOTTBERG: Vaccines aren’€™t always covered by medical aids, so even though it’€™s available in the private sector I don’€™t think it reaches all infants in the private sector’€¦ So, the vaccine does not reach the majority of infants in South Africa.    

KHOPOTSO: But those at a greater disadvantage are infants from poorer families that exclusively rely on the public sector for health care, says Dr von Gottberg’€™s colleague, Professor Shabir Madhi.    

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 a dose and you need to give, at least, about three doses, which works out to about R1 800.

KHOPOTSO: Several studies, including one conducted in South Africa over a period of four years, have shown the huge benefits children could derive from the vaccine, especially those with HIV.

Prof. SHABIR MADHI: We were involved in a huge study done in Soweto. In fact, it involved over 40 000 children. It was a study which was started in 1998 and was completed in 2001’€¦ What we found in that context is that a vaccine prevented 13% of pneumonia in HIV-infected children ‘€“ about one 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.

KHOPOTSO: The World Health Organisation recommends that countries with a mortality rate of more than 50 out of every 1000 children, or, where more than 50 000 kids die annually, should incorporate the vaccine into their national immunisation programmes.    

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: With our high prevalence of HIV infection, the risk of pneumonia is exponentially increased in infants. But because of lack of money, many will get sick and most probably die. Johan van den Heever is the Department of Health’€™s National Immunisation Programme manager.

JOHAN 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 is quite considerable because you don’€™t only get one dose. Every child needs to get three jabs.

KHOPOTSO: Price negotiations between the Health Department and pharmaceutical company, Wyeth, that manufactures the vaccine, as well as child health specialists started more than a year ago. But the Department says there are a whole lot of factors over and above the cost to consider before it can add the vaccine to the National Immunisation Programme.

JOHAN VAN DEN HEEVER: There are 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: In the meantime, the threat of pneumonia infection continues to hang over the heads of South African children – unless something drastic happens.

Dr ANNE VON GOTTBERG: There is scope for a lot more social mobilisation and lobbying both with the government and vaccine producers to make these vaccines affordable for all children in South Africa.