Rebecca Coombes: Soaring rents but Ghana gets it right on vaccinations

It’s boom time in Ghana right now. The country’s economy soared by 14% in 2011 thanks to new oil receipts—earning it a listing as the world’s fastest growing economy. This prosperity is a mixed blessing say the locals. Rents in the capital city Accra are approaching London levels—$2000 a month for an apartment in a decent area—fuel prices have rocketed, and food is expensive. But in the baking heat of the capital city’s Independence Square yesterday I witness a bit of African history made possible by Ghana’s emerging confidence.

It became the first African country to introduce pneumococcal and rotavirus vaccines at the same time, simultaneously tackling the leading causes of the world’s two biggest childhood killers, pneumonia and diarrhoea.

This is a big deal for a small country like Ghana—hence this official ceremony in the square at which the first lady was invited to witness the first doses of the vaccines be delivered to a row of smartly dressed babies.

In advance of this double launch, the health service has gone into overdrive to get the vaccines in place. New cold rooms were built in most regions—essential in this tropical climate where boxes of the new vaccines take up lots of space—health workers trained, new systems for evaluation and monitoring the programme set up, and—in a country with more than 200 radio stations—a communications drive was launched to encourage parents to vaccinate their childen.

For a country on the up, Ghana still has a way to go on child mortality, currently at 74 deaths per 1000 live births. Diarrhoea and pneumonia account for 20% of deaths in children aged under five. But it does have a fairly well organised health service, with community health zones all over the country reaching the parts that its troubled neighbour Nigeria, with its inter-ethnic tensions and daily suicide bombs, cannot hope to reach. And its vaccination programme works: most recent figures show 94% of children had three courses of the DTP (diptheria, tetanus, and polio) vaccine.
The consequences of not being vaccinated against preventable diarrhoea and pneumonia diseases are all too evident. We drove out to meet Emma Agbeshie, a 25 year old batik maker in Dodowa, a village an hour’s drive outside of Accra, past banana trees and tropical fruit stalls on the red dirt roads.

Two years ago, her five month old son fell ill with a fever and breathing difficulties. She managed to take him to hospital in a taxi but he died of severe pneumonia. “He’d already had polio and BCG injections, said Emma, “so I thought he was protected from the worse diseases.”

Later at Accra’s Princess Marie Louise Children’s Hospital, medical superintendent Eric Sifah tells how 75% of children who died in the hospital last month did so from diarrhoea and respiratory conditions. Treating rotavirus diarrhoea alone in Ghana costs an estimated $3.2m a year. Most Ghanaians live more than 8km from their nearest health care provider and, according to the WHO, only 54% of children with pneumonia in developing countries will see a doctor. Just 19% of children under 5 will receive antibiotics.

No wonder vaccinations are a best buy.

Even though Ghana co-finances these vaccines the lion’s share of the cost is met by GAVI (Global Alliance for Vaccines and Immunisations), the group which fund vaccines for more than 70 of the world’s poorest countries, and brokers bargain rates from leading manufacturers. Its biggest donor is the UK; to date it has given $2557.8 m—a third of total donor contributions to GAVI.

The new vaccinations—orally-administered rotavirus vaccines by GlaxoSmithKline and Merck, and pneumoccocal vaccines by Pfizer and GSK—all cost less than $3.50 a shot.

The rotavirus vaccine alone will save Ghana $1.7 million in treatment costs and save 1,554 children’s lives per year.

GAVI is occasionally criticised for focusing on non-fragile states like Ghana where vaccine programmes have the greatest chance of success. Even this week two “GAVI” countries experienced political coups, Mali and Guinea Bissau. But Ghana is an important testbed for the rest of Africa. If it can pioneer the rolling out of these two complex vaccines—and it is still an “if”—then it writes a new rulebook for less orderly nations to follow.

Rebecca Coombes is the features editor, BMJ.

Competing interest: Rebecca Coombes is in Ghana on a GAVI – sponsored trip.