In both health and economic terms, prevention of illness is better than cure and Tanzania's expanded programme on immunisation (EPI) is a key part of its national health strategy. Little wonder then that Tanzania has warmly welcomed its inclusion in "The Children's Challenge" campaign launched by the Global Alliance for Vaccines and Immunisations (GAVI) in Davos, Switzerland, on Monday. This is an initiative that holds out the prospect of better and more sustainable vaccination services for Tanzanian children, with significant health gain for the entire population.
"The initiative has just come at the right time for Tanzania, because it's addressing a number of questions that are priorities for us," Chief Medical Officer Dr Gabriel Upunda told journalists on a UNICEF fact-finding mission to Tanzania.
GAVI - comprising business leaders, philanthropic organisations, UN agencies, development banks and national governments - on Monday urged the world's economic power brokers to view children as the key to sustainable human development, and to help save millions of young lives each year by immunising all the world's children. "Every child deserves access to these vaccines, and millions of lives can be saved. We can, and should, do this together," said Microsoft billionaire Bill Gates, whose contribution late last year of US $750 million to establish the Global Fund for Children's Vaccines paved the way for the new campaign.
The vaccine industry - one of the partner groups in GAVI - has also promised to accelerate the delivery of available but underused vaccines for yellow fever, Hepatitis B and Haemophilus influenzae type b (Hib).
In Tanzania, the campaign promises "a renewed focus on the importance of childhood immunisation". The government's efforts to tackle the most significant health problems are severely hampered by debt service payments which are triple the size of its US $210 million health budget. The GAVI funding will offer Tanzania an opportunity to revitalise its immunisation programme by expanding the use of existing cost-effective vaccines, improving the rate of vaccine coverage in the population and accelerating the introduction of new vaccines - such as potential malaria and HIV/AIDS vaccines.
Tanzania has for years enjoyed a reputation for having a well-functioning immunisation programme, incorporating intensive community mobilisation, and it reached the goal of universal child immunisation in 1988, two years ahead of target. In the 1990s, however, due to complacency, institutional change, increased poverty and a donor funding slippage in 1997 and 1998 (among other factors), the country's immunisation coverage fell to its 1998 level of about 74 percent.
A key aim of the GAVI initiative is to make available, more readily and at a cheaper price, the existing hepatitis B vaccine. Tanzania has been planning to introduce it since 1992 but has not been able to afford it because, as a relatively new vaccine, it is much more expensive than those for measles, polio and so on. Once Hep-B has been successfully incorporated, other vaccines like yellow fever and Hib may also be considered, according to a UNICEF briefing. "In addition, as newer vaccines are developed, Tanzania will remain an active partner in the process and will adopt cost-effective approaches as they are proven and documented." Thus, for instance, Tanzania could be among so-called "fast-track countries" for the introduction of any malaria or HIV/AIDS vaccines developed.
"Malaria is the number one health problem in Tanzania, and the major cause of child death. If you control malaria effectively, you can reduce child deaths by at least a quarter and maybe up to a half," said Joanna Armstrong-Schellenberg, a researcher at Ifakara Health Research and Development Centre, Morogoro Region. "Bring us the [malaria] vaccine ... When there are vaccine candidates, we're ideally suited to test them out," she told journalists.
In dispensaries, health centres and hospitals, medical staff repeatedly told IRIN how malaria, anaemia and diarrhoea (often linked with and complicated by malaria), and pneumonia account for a great proportion of the cases they see. Malaria accounts for over 30 percent of all hospital attendances and is the biggest killer of children in Tanzania. It is also a major cause of low birth weight, anaemia and still births.
Health workers in Kibaha and Kilombero districts consistently also spoke of the rising impact of AIDS. "There's an increasing rate of HIV infection in children over the last three or four years, through mothers infecting them in the womb," said Dr John Nkony, a paediatrician at St Francis district hospital in Ifakara, Kilombero. "In the past we saw adults mostly, but now it's the children."
"We're one of the poorest countries in the world and we're trying to do our best," said Tanzania's Chief Medical Officer Dr Upunda. "GAVI gives developing countries a chance to complement whatever the governments are doing with their own resources."
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