Thursday, July 18, 2024

The hope and challenge of immunization: What Bazezuru community fail to understand

Vaccines have had made a major contribution to public health, including the eradication of one deadly disease, small pox, and the near eradication of another, poliomyelitis. Through the introduction of new vaccines, such as those against rotavirus and pneumococcal diseases, and with further improvements in coverage, vaccination can significantly contribute to the achievement of the health-related United Nations Millennium Development Goals.

The Global Immunization Vision and Strategy (GIVS) was developed by WHO and UNICEF as a framework for strengthening national immunization programmes and protect as many people as possible against more diseases by expanding the reach of immunization, including new vaccines, to every eligible person. It is estimated that between two and three million child deaths are averted annually through vaccination against diphtheria, tetanus, pertussis and measles and many more future deaths averted in older groups (e.g. 600,000 future deaths prevented annually through hepatitis B vaccination). However, vaccine-preventable diseases are still responsible for about 25% of the 10 million deaths occurring annually among children under five years of age. 

This is partly related to the fact that an increasing number of infectious diseases can now be classified as vaccine-preventable. With the availability of new vaccines, such as those against rotavirus and pneumococcal diseases, and further improvements in vaccination coverage, a much larger proportion of children can now be protected against a broader range of infectious diseases.

In 2005, the 58th World Health Assembly, recognizing the role that vaccines and immunization can play in reducing under-five mortality, welcomed the Global Immunization Vision and Strategy (GIVS) 2006-2015 developed by WHO and UNICEF as a framework for strengthening national immunization programmes. Its goal is to protect as many people as possible against more diseases by expanding the reach of immunization to every eligible person and ensuring that immunization is high on every health agenda. The strategy aims to increase, or at least sustain very high levels of vaccine coverage, not just for infants but for all age groups, introduce new vaccines and link immunization with the delivery of other health interventions. This strategy was drawn up against a background of increasing demand for vaccines, rapid progress in developing new vaccines and technologies, continuing health-sector development, increasing vulnerability to pandemics and other health emergencies and more potential opportunities for partnerships.

Thus vaccines have the potential to make a significant contribution to the achievement of the health-related United Nations Millennium Development Goals (MDG), especially MDG4 that calls for a two third reduction in the under-five mortality rate by 2015 compared to 1990 levels. However, if the trend in mortality reduction observed between 1990 and 2005 continues, the goal will not be achieved. In 2003, the World Health Assembly urged full implementation of the WHO-UNICEF strategic plan for measles mortality reduction 2001-2005, and, at the end of 2005, the major public health goal of reducing global measles mortality by 50% compared with the 1999 level had been surpassed, with a reduction of 60%. In 2005 the World Health Assembly endorsed a revised goal to reduce global measles deaths by 90% by 2010 (or earlier) compared with 2000 as one of the GIVS goals. Global mortality due to measles was reduced by 74% from an estimated 750,000 deaths in 2000 to 197,000 in 2007.

The largest percentage reduction in estimated measles mortality during this period occurred in the Eastern Mediterranean (90%) and African regions (89%), accounting for 79% of the global reduction in measles mortality. Immunization coverage estimates produced annually by WHO and UNICEF, based on official data reported by member states and other published data, showed that in 2007, global coverage with the scheduled dose of a measles-containing vaccine reached 82%, increasing from 72% in 2000 .

The decrease in measles mortality was the result of both improved routine coverage and the implementation of mass vaccination campaigns. These public health accomplishments helped to prevent nearly 11 million measles deaths between 2000 and 2007, with vaccination campaigns in which more than 578 million children aged nine months to 15 years were vaccinated against measles between 2000 and 2007 in 47 high priority countries accounting for 3.6 million of these deaths averted.  They were made possible by the enormous efforts made by the national governments of the targeted priority countries with the highest disease burden and the concentrated focus of immunization partners on the most effective strategies to control measles rapidly, supported by predictable financing of the programme

In Botswana, Pediatric providers currently face numerous challenges in improving rates of immunization among children and adolescents of the Bazezuru community, mainly emanating from religious and cultural believes. Promoting coverage through the vaccines, counseling parents with clear information about the risks and benefits of vaccines, and taking advantage of non preventive visits for immunization  have been met with a lot of resistance from the Bazezuru community  who prefer to do without modern health technology. All they believe in is prayer. 

Even the children have no medical cards and never go to clinics.┬á They are born at home and none of them is allowed to go to the clinic. One of the leading Zezuru tribesmen Farai Panaganai has previously been quoted in Mmegi in 2004 stating that “it was true the Bazezuru were religious people who are not affected by the virus. He said prophets in their church had long ago predicted the coming of the poliovirus and the affected age group has received befitting prayers. He went on further stating that, “It is not that they are against what the government has said, but their custom in church does not allow this. They felt that they take care of their children on their own and nothing can harm them.”

Panganai also pointed out that according to their custom none of them should seek medical attention elsewhere except in church. He said none of them have medical cards and never visit clinics or hospitals. “We don’t go to clinics. Our wives give birth at home and never experience any problems. It’s our custom and it is working well for us,” he said.┬á

Immunization enormous strength is not just that it prevents death and is one of the most cost effective ways to do so, but that it also prevents disease and disability. Vaccines help healthy people remain healthy, and in doing so, they remove a major obstacle of human development. In a world protected by immunization, parents can concentrate on productive work while their children go to school and live up to their full potential. 

Although, in some cases, parents might have a legitimate reason not to vaccinate, however, the refusal by Bazezuru community not to vaccinate is a bit selfish. Kids are disease factories. Vaccines are never 100 percent. The bottom line is that people who don’t get their kids vaccinated put the rest of the community at risk.
 
Thabo Lucas Seleke is a researcher in Health Policy and Health Systems Strengthening

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