National Immunisation Programme needs injection

By Shezna Shums

Government health authorities have observed a gradual reduction in infant immunisation converge since 2008 in Sri Lanka.

The problem with the current trend is that it may give rise to the numbers of treatable diseases increasing, causing lifelong hardship for the families concerned, the health system and the economy as well.

In 2009 the immunisation converge percentages stood at about 88-90% when compared with near 100% coverage during the previous years. However it was highlighted that the current routine immunisation coverage data contains immunisations performed mainly at Government hospitals and not from private hospitals; therefore the percentages may vary.

After the temporary suspension of the DTP, Hep B and Hib vaccine in early 2008 and following two adverse events following immunisation (AEFI),  deaths after the rubella vaccine in 2009, a drop of immunisation coverage among infants and in school immunisation programme was observed.

It is highlighted that the vaccination quality used by the Sri Lankan Government are of World Health Organisation (WHO) standards.

The quality of the vaccines used by the Government are of international standards as stringent measures are taken before purchasing the vaccines, when the vaccines arrive in the country, storing the vaccines and when dispersing the vaccines. Sri Lanka boasts one of the strongest immunisation programmes in the region and of the finest in the world where effective control or elimination was achieved towards all traditional childhood vaccine preventable diseases through the national infant immunisation coverage.

Some control was also achieved towards adulthood through the very high coverage and adult immunisation with repeated booster immunisation schedules against Tetanus, Diphtheria, Japanese b Encephalitis and immunisation of women in child bearing ages against rubella. Among the developing countries, Sri Lanka has also pioneered the introduction of non-traditional vaccines in to the Expanded Programme of Immunisation (EPI) national schedule to gradually reach near elimination levels regarding some diseases. Immunisation coverage commenced to rise to significant levels with the commencement of EPI in 1978. The gradual increase of immunisation coverage has resulted in a steady decline in the number of reported disease incidents over the same period of time, studied over three decades done by the Epidemiological Unit show.

Gradual internalisation of the value of immunisation among parents and the healthcare providers is the key factor in the success of immunisation in Sri Lanka.

Field health staff under the direction of divisional, regional and provincial health management with close collaboration with curative, estate and private health sector too is responsible for this success.

Leadership given to the programme by the Epidemiological unit and Family Health Bureau and priority given by the Ministry of Health during resource allocation have immensely contributed to this success as well. Consistent technical and financial support accorded to the programme by the WHO and UNICEF since the inception of the programme was an immense strength.

In most of the developed countries, when the respective immunisation programmes reached the level of maturity as of the Sri Lankan programme today, with high immunisation coverage and with no apparent threat of disease in the community, suddenly immunisation coverage started to drop and disease outbreaks started to appear. This was due to the proportion of clients who stopped being immunised and a small section of the medical community also advocating such stoppages due to the undue fear of the rare Adverse Effects Following Immunisation (AEFI) in the background of low or no diseases. After seeing such a situation arising the Sri Lankan immunisation programme commenced AEFI surveillance as early as 1995, even before most developed countries started their surveillance.

Owing to this system on receipt of AEFI reports, and following investigations, it was able to clearly demonstrate that most of the severe AEFI’s reported were mere coincidence and there was no relationship to immunisations.

This led to the re establishment of confidence in the medical community as well as parents thereby helping to prevent any setbacks in the national immunisation work. Since Sri Lanka has been able to establish such strong AEFI surveillance system, WHO has recognised Sri Lanka as a Global Training Centre for AEFI surveillance and already Sri Lanka has trained immunisation managers from 16 countries sent by WHO.

Another reason some clients keep away from national immunisation campaigns is because of the poor service conditions and facilities as well as an inappropriate clinic hour, overcrowding of clinics and poor physical appearance of the clinics when compared with the private sector health institutes.

This is despite the government continuously providing high quality potent vaccines through cold chain and safe injections.

Over the years Sri Lanka also developed a time tested expertise on purchasing of known quality vaccines directly from the global vaccine market by floating worldwide tenders for a highly competitive price and network under cold chain network.

The evidence indicates the current efficient and mature status of the Sri Lankan immunisation programme and it is well equipped to add or receive new antigens to control more vaccine preventable diseases, which has reasonable disease burden where benefits of such introduction outweigh the costs.

However, in the entire history of the national immunisation programme in Sri Lanka, the years of 2008 and 2009 could be considered as the most testing years.

EPI was undergoing the most difficult period of its history as legations starting inflicting cracks on the EPI foundation. National immunisation programme has been identified as a long term investment by the Sri Lankan government. Its value, over the years has been in the forefront of all parents in the country.

However, suspension of the newly-introduced Hib containing the pentavalent vaccine in early 2008 following a crisis of AEFI and two deaths following rubella vaccination in 2009, caused uncertainty among many people in the Island. Following this the rubella vaccination was suspended and has now been restarted last week.

Two independent investigations were conducted by local experts as well as experts from the WHO. The outcome of the investigation was that the death was not linked to the inferior quality of the vaccine and highlighted the deficiencies in the system for response to such an eventuality in a timely manner.

Furthermore the Epidemiology Unit in collaboration with the National Vaccine Control Lab and Drug Regulatory Authority sent the vaccine vials to be tested to the Therapeutic Goods Administration, which is a centre of excellence in Australia. The report confirmed that the vaccine vials were consistent with globally accepted standards.

Vaccinations are vital for the well being of children and for the development of the foetus when the mother is pregnant as well. National vaccines thereby are provided free of charge by the government and are also of the highest quality available.