Thought Leadership

The good news, the bad news…and some hope

Last week I was at the annual conference of the European Society of Pediatric Infectious Disease in Brussels.

There was a buzz in the room as the new tools available in our arsenal to do battle with our microbial competitors in our ecosystem were discussed. In addition to cutting edge new drugs, there were some papers that were amazing not for their science but for their implementation. One of particular interest was by Dr Pettit of the University of Geneva Hospital who showed how through several “simple” but meticulously implemented measures as like hand-washing,are able to push down the rate of hospital acquired infections, saving lives and saving money. I thought back to my time working at the University of Nigeria Teaching Hospital Enugu and our struggle to get running water. I think of the efforts of students pouring water over the surgeons hands from a bucket as he prepared for surgery, to then imagine that this is the premier tertiary health facility in Eastern Nigeria…goose pimples emerge at the thought of what the effects are. Health care associated infections is an area we have not even scratched in Nigeria…so Ill not bore you.

So…guess what are the two biggest vaccine-preventable diseases which together account for more than 35% of all child deaths every year, the majority of which are in the developing world.

….no …not measles, meningitis, diptheria….

….no not TB

The two are “diarrhoeal disease” and “pneumonia

The good news – What I will share with you is the availability of two “new” vaccines. They are not really new, but their impact on the lives of children is just becoming obvious.

1. A vaccine has been included in the routine vaccination schedule against 10 subtypes of the bacteria – pneumococcus, the most common cause of pneumonia in children, but also a cause of meningitis and sepsis in many developed countries. A 7-valent vaccine has been available for some years now. WHO has issued a recommendation for the introduction of pneumococcal vaccines into immunization programs in developing countries to save millions of lives, starting with the currently available 7-valent pneumococcal conjugate vaccine.

One African country has added the pneumococcal vaccine to its schedule: Rwanda. Several others have plans in advanced stages…for details look here….and sorry Nigeria is NOT one of them!

2. A new vaccine against the rotavirus, already widely used in many parts of the world, including most of Latin America has now been shown to work effectively in African settings too following studies conducted in Malawi and South Africa. On the 5th of June during the ESPID conference last week in Brussels, the World Health Organisation recommended the global use of the rota virus vaccine.

These new vaccines bring real hope to millions of children in Africa, sadly not yet ours. The agency responsible for delivering on immunisation in Nigeria as been in the wilderness for years, with neither the will nor the leadership to deliver on its mandate. We have barely been able to deliver the primary vaccines that have been on our schedule for years.

But now with new leadership (more on this in future posts) at National Primary Health Care Development Agency, the agency responsible for immunisation in Nigeria there is renewed hope. The agency is working towards to re-defining itself and to restore some of the legacies of Professor Kuti and protect the lives of the most vulnerable. For now, these kids will continue to die from pneumococcal disease…just because they were born in Nigeria and not Rwanda! What a turn of events!

Meanwhile…see here my means of transport in Brussels….lovely city!

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

By Chikwe Ihekweazu

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

4 replies on “The good news, the bad news…and some hope”

Adding to the points already highlighted, WHO now (common sense philosophy?) says Flu pandemic deaths linked to poor public health. How does Nigeria tackle issues like these in the face of wealth creation as the only forward. Our people still do not get it until the big one. Nobody is wishing ill on Nigeria but it is prudent to take out additional insurance before it is too late. IMO our MGDs on health are not aggressive enough. To be efficient we need to information systems that everyone can contribute to rather than the pen & paper politics that is being played out. Those challenges are so tiny that we could even get them free! Thank you for the excellent reporting and insight.

The evidence of benefit for the pnemococcal vaccine (PCV-7) despite its limited serotype coverage is clear. Yes Rwanda has started giving PCV-7 and The Gambia is next. What do these countries have in common-evidence of the burden of disease which then informed policy making. So I begin to wonder how policy is made or directed in our FMOH and its agencies. The PneumoADIP website shows 4 categories of countries with respect to how close they may be to actual delivery of PCV-7 within their EPI programme. You will note that Nigeria is not even among the larger group of 30countries that have expressed interest to use PCV. So the questions are, do the powers that be at the FMOH and Primary Care development agencies have any real idea of the key causes of morbidity and mortality in Nigerian under five children? Do they spend any funds or budget any funds annually for research for local data collection or do they just depend on whatever data is bandied about? Where are the folks who should be advocates for change in policy with respect to these 2 diseases (paediatrician colleagues and others in primary care and family medicine)? What do they know about the burden of these diseases? I know there is a bit more in published literature about rotavirus diarrhoea (I could not find any study meeting standard requirements for estimating the burden of rotavirus diarrhoea) but there is very little about pneumococcal disease save a recent paper from Ibadan. So where are all our clinical researchers? What does the FMOH do about gathering evidence to inform policy, where are our academics in teaching hospitals and colleges of medicine? The research culture/ethic seems to have suffered near irreparable damage along with the all pervading decay in every sector of Nigeria’s corporate existence. What can we do about this?

Everywhere I turn I hear god news about Rwanda. Good to see they are taking advantage of the new vaccine.

As to Nigeria, considering it took a year to replace a health minister, I am not surprised … But, nonetheless, I hope that this minister and his staff will be able to do some good work which will produce measurable results.

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