Vaccines for refugee children remains a challenge
Immunisation helps avert millions of child deaths each year, as well as millions more bouts of illness and disability. Poor countries as well as rich have benefited, although developing countries almost always benefit only after long delays. Basic childhood immunisation is one of the few health interventions to which most of the world’s poor have access, free of charge and through the public sector. In fact, immunisation is one of the most equitable health interventions, protecting girls and boys alike, and reaching the poor within countries at higher rates relative to the wealthy than other services.
Despite their impact, vaccines have generally received less attention than drugs. But the vaccine landscape is shifting, and new opportunities, challenges, and debates have pushed vaccines to the centre of global health discussions.
However, there are multiple factors that make delivering vaccines to children in developing countries difficult. These include – among others – high prices of newer vaccines, the lack of research and development (R&D) for better-adapted and needed vaccines, as well as weak health systems with corresponding health worker shortages.
In developing countries, refugee children are incredibly the most vulnerable to developing diseases which can be prevented by vaccines. For example, the situation in Yida refugee camp in South Sudan last year was excruciating, with children dying of diseases that vaccines could have protected them against.
Sudanese refugees began streaming across the border into South Sudan in June 2011 when conflict erupted between the Khartoum government and the rebels of the Sudan People’s Liberation Movement-North (SPLM-N) in Sudan’s South Kordofan State. At the height of the crisis in Yida camp last summer, high mortality rates were reported among young children admitted in MSF’s hospital with respiratory tract infections, such as pneumonia, one of the leading causes of death. Refugee camp conditions make children particularly vulnerable to pneumococcus, the most common bacteria causing pneumonia, as crowding and exposure to multiple different strains of the bacteria lead to increased risk.
While planning to immunize children against pneumococcal diseases in Yida camp MSF faced multiple barriers trying to purchase newer vaccines at an affordable price and were left struggling to navigate bureaucratic policies that exclude the needs of conflict-affected populations.
Newer vaccines have primarily been introduced in poor countries with support from the Global Alliance for Vaccines and Immunization (GAVI Alliance), but GAVI does not cover vaccination in refugee and crisis-affected populations, leaving major unmet needs. Moreover, discounted prices that GAVI is able to negotiate are not systematically available to humanitarian actors working in crisis contexts. Despite requests to the actors involved, including pharmaceutical companies Pfizer and GlaxoSmithKline (GSK) that produce these new vaccines, and GAVI, a low global price for humanitarian organisations such as MSF has not been established.
MSF determined that vaccinating with the pneumococcal conjugate vaccine (PCV) could result in a substantial mortality reduction in Yida. This is one of the first times that PCV is being used in a refugee camp, and the first time in South Sudan.
Since September 2012, MSF has been working to procure PCV for use in Yida camp but has faced significant delays because of lengthy negotiations and international legal procurement constraints. The companies making the vaccines made an ad hoc donation offer, but MSF tries to avoid donations because it seeks a sustainable solution to this problem so it can act swiftly in similar contexts. MSF was eventually able to obtain the vaccine from GSK at a reduced price, but delays have now pushed the planned vaccination into the logistically-challenging rainy season.
We’ve been trying for more than four years to find a solution for regular and affordable access to newer vaccines so we can act fast when we need to, but we still have no solution for refugees. We need pharmaceutical companies and GAVI to offer humanitarian organisations the lowest global price for newer vaccines. We can help to save young lives in crisis, just let us do it.
