New hope on the booster dose

Ignorance on the importance of vaccines for children has seen many families in the country and across the world being affected by vaccine-preventable diseases.

Long distances to health care facilities, lack of appreciation for vaccines due to information gaps and lack of trust in the vaccines are a few reasons many children do not receive all recommended vaccines.

Nevertheless, experts argue that vaccination is an effective way of preventing childhood illnesses.

Pneumococcal conjugate vaccine (PCV) is a pneumonia vaccine given to newborn children. It was introduced in Malawi in 2011.

But despite high coverage nationally, studies conducted by Malawi Liverpool Wellcome Trust (MLW) under the Pneumococcal Carriage in Vulnerable Populations in Africa (PCVPA) Study-2015-2019 in urban Blantyre found that it has not had the expected impact of reducing pneumococcal carriage.

Despite indications that the vaccine has reduced disease incidence, there is also evidence of 20 percent carriage of vaccine serotypes (those types of pneumococcus the vaccine should prevent) among vaccinated and unvaccinated populations.

This prevalence is higher than results seen in high-income countries which use the same vaccine, but with a booster dose.

It is suggested that using a booster schedule in Malawi — with the booster at 40 weeks of age — might further improve results.

Consequently, the Ministry of Health and Population (MoH) is working with Unicef and MLW under the Pave Study to implement an alternative World Health Organisation (WHO) approved PCV schedule.

In an emailed response, MLW project manager for the Pave Study Peter Chalusa said the alternative schedule will use the same PCV and the three doses, but offered at six, 14 and 40 weeks of age; replacing the current six, 10 and 14 weeks. The dose at 40 weeks will act as a booster dose.

This will be initially evaluated at 10 randomly selected Blantyre district health facilities and the results will inform MOH policy decision on PCV strategy, including whether to switch to the new schedule that includes a booster dose.

“The major expectation from the Pave Study is to develop evidence as to whether the booster schedule will give Malawi better results compared to the current schedule [no booster] and further contribute to better survival outcomes from pneumococcal illnesses,” he said.

In a written response, Unicef health specialist Steve Macheso corroborated the effectiveness of PCV, which he said protects eight to nine of every 10 children from pneumococcal disease.

He said Unicef is supporting MOH and MLW on the Pave Study to identify the most effective PCV dose schedule.

Macheso added that this will help to protect all children against pneumonia, which is a major cause of deaths in under-five children.

Unicef works with government and other partners to strengthen immunisation programmes and help realise children’s rights to survival and good health.

On his part, MOH spokesperson Joshua Malango agreed that pneumonia is one of the most common causes of death in under-five children in the country, besides Malaria and diarrhoea.

He also reminded the public of the importance of vaccines in preventing childhood vaccine preventable diseases and deaths.

He said: “Prevention is better than cure. PCV protects against pneumococcal infections. The bacteria can lead to serious infections such as pneumonia, blood infections and bacterial meningitis. These infections can in turn lead to loss of lives and costs in treatment for the sick child.”

He highlighted that vaccines are always available in the health facilities across the country, with very minimal stockouts.

The Gavi Alliance website indicates that Malawi saw the birth of 719 240 children in 2019 and 606 279 under one-year survived.

Malawi has since 1979 also operated the Expanded Programme on Immunisation (EPI) to reduce infant morbidity and mortality rates due to vaccine preventable illnesses by providing quality immunisation services.

In an earlier interview, Mchinji EPI coordinator, Edward Jere cited the need to appreciate the importance of immunisation for children.

“Some people get used to the fact that newborn children get immunisation and others choose to ignore it. Parents need to know what immunisation does for the child — boosting their immunity,” he said.

He argued that parents who immunise their children just because others are doing it can easily back down if they do not appreciate the benefits.

WHO ssya PCV protects against severe forms of pneumococcal diseases, such as severe pneumococcal pneumonia, meningitis and bacteraemia.