Vaccinating against their will

The growing number of child deaths from diarrhoea in Cameroon has necessitated the introduction of a new vaccine (RotaTeq) designed to protect babies under five against common types of rotaviruses that cause diarrhoea.

But growing skepticism over new vaccines, and lack of potable water and proper hygiene could thwart such public health efforts, experts say.

"Diarrhoea is one of the top killers of children under five in Cameroon, responsible for more than 5,800 deaths in children under five yearly," Desire Noulna of the Expanded Programme on Immunisation (EPI) told IPS.

There is suspicion and mistrust of vaccines among different communities in Cameroon.

According to GAVI, a public-private alliance to boost immunisation, rotavirus kills more than 600 children every day in Africa, and thousands more are hospitalised or require clinic visits.

Globally, rotavirus is the most usual cause of severe gastroenteritis in children, accounting for an estimated 2.4 million hospital admissions and 527,000 deaths each year. About 85 percent of these deaths occur in developing countries, mainly in South Asia and sub-Saharan Africa.

In June 2009, based in large part on clinical trials in Africa that demonstrated vaccine efficacy in impoverished, high-mortality settings, the World Health Organisation (WHO) recommended that rotavirus vaccines be included in all countries' national immunisation programmes.

Cameroon introduced the rotavirus vaccine last month after ten other countries in Africa: Botswana, The Gambia, Ghana, Malawi, Morocco, Ethiopia, Rwanda, Tanzania, South Africa, and Sudan.

According to WHO, South Africa, the first African country to introduce rotavirus vaccines into its national immunisation programme in 2009, experienced dramatic decreases of 54 to 69 percent in rotavirus hospitalisations in both rural and urban settings within two years.

In Ethiopia, the introduction of rotavirus vaccines is estimated to save 3,700 lives, and 800,000 dollars in household expenditures annually. In Ghana, rotavirus vaccines are predicted to save 1,554 lives annually, and 53 percent of treatment costs.

Cameroon will hold a national immunisation campaign in the coming months. But some experts argue that the sanitation problem in Cameroon presents a major challenge to the effectiveness of this vaccine.

"There are some neighbourhoods in our major cities that for months go without potable water. Even when supplied, the quality is very doubtful," says Obed Fung, health expert at the Foretia Foundation that supports development in Cameroon.

According to the African Development Bank (ADB), only about 45 percent of the rural population has access to drinking water against 77 percent in urban areas. An estimated 13.5 percent of rural people have access to proper hygiene and sanitation compared to 17 percent in urban areas.

Women and girls shoulder the largest burden in collecting water; 15 percent of urban and 18 percent of rural populations have to rely on improved drinking water sources more than 30 minutes walk away. It is mostly girls and women who have to fetch the water.

"Poor access to water and sanitation could hinder the success of this campaign but it is important that we focus on water-borne illnesses especially diarrhoeal diseases and seek ways of curbing outbreaks," Noulna said. "While the country may be facing water scarcity and poor hygiene, there is a need to avoid the worst case scenario of a sudden outbreak."

But there is suspicion and mistrust of vaccines among different communities in Cameroon.

"The national immunisation programme in Cameroon now administers nine different vaccines for children and the public think that this treatment is exaggerated. It is always the case because they do not understand the public health risk of having just one victim with a viral attack," Dr. Paul Onambele at the district hospital in capital Yaounde told IPS.

Rumours have been circulated that public health officials were administering vaccines to sterilise women, Onambele said.

A study by the EPI found that 33 percent of families are opposed to vaccination of children and pregnant women due to religious and traditional beliefs.

"These controversies over the efficacy, safety, and morality of immunisation have continued to impede vaccination efforts in Cameroon, most especially in the northern part of Cameroon which is greatly influenced by beliefs stemming from Nigerian communities against vaccination," Onambele said.

Haman Alima, a nursing mother in a Yaounde neighbourhood says: "I grew up and we never used to be vaccinated but we are all fine. I only vaccinate my child because I cannot refuse while in the hospital."

Such attitudes are dangerous. "Our country is in turbulent times with a drop in immunisation coverage, inequality in coverage among districts and cities, and most importantly, the recent resurgence of polio," Clarisse Loe Loumou from GAVI told IPS.

According to EPI, 62 percent of the health centres do not involve local associations and NGOs in the promotion of vaccination.

However, GAVI and EPI intend to achieve a 90 percent level of involvement by increasing efforts already made by using civil society platforms to reach communities and give local people ownership over vaccination.