Immunization: A Major Component Of The Primary Health Care

The practice of immunization dates back hundreds of years. Edward Jenner is considered the founder of vaccinology in the West in 1796 after he inoculated a thirteen-year-old boy with vaccinia virus and demonstrated immunity to small pox. In 1900, the small pox vaccine was the only one administered to children. By the early 1950’s, children routinely received three vaccines for protection against Diphtheria, Pertussis, Tetanus and Small pox and as many as five shots by two years of age. In 1998 the first small pox vaccine was developed.

The expanded programme on immunization is a World Health Organization programme with the goal to make vaccines available to all children. The comprehensive multi-year plan is the medium term plan for the expanded programme on immunization in Ghana. The WHO initiated the expanded programme on immunization in May 1974 with the objective to vaccinate children throughout the world. Ten years later in 1984, the WHO established a standardized vaccination schedule for the original EPI vaccines. Oral polio, measles, bacillus Calmette Guerin, Diphtheria-Tetanus-Pertussis. Increased knowledge of the immunologic factors of disease led to new vaccines being developed and added to the EPI’s list of recommended vaccines, and till date, more vaccines are being added.

In 1999 the Global Alliance for Vaccines and Immunization (GAVI) was created with the sole purpose of improving child health in the poorest countries by extending the reach of the EPI. The creation of the Global Alliance for Vaccines and Immunization has helped to renew interest and maintain the importance of immunization in battling the world’s large burden of infectious diseases. The current goals of the Expanded Programme on Immunization are:

• To ensure full immunization of children under one year of age in every district.
• To globally eradicate poliomyelitis.
• To cut in half the number of measles-related deaths that occurred in 1999.
• To reduce maternal and neonatal tetanus to an incidence rate of less than 1 case per 1000 births by 2005.
• To extend all new vaccines and preventive health interventions to children in all districts in the world.

Immunization is defined by WHO as the process whereby a person is made immune or resistant to an infectious disease typically by administration of a vaccine. In the process of protecting an individual from a disease, a live, dead or partial component of the invading organism in introduced into the individual’s system. This stimulates the body’s own immune system to protect the person against subsequent infections. Among the vaccines include: life attenuated organism, harmless strain of the live microbes, dead microbes and the detoxified toxins. The most common vaccine preventable diseases also include; Poliomyelitis, Tuberculosis, Measles, Yellow fever, Hepatitis B, Haemophilus influenza, Chicken pox, Cerebrospinal Meningitis (CSM), Tetanus, Whooping cough, Diphtheria. Some advantages of immunization observed so far are;

• Immunization has helped to reduce or prevent deformities. Vaccines have reduced and in some cases eliminated many diseases that killed or severally disabled people just a few generations ago. For example, Small pox vaccinations eradicated Small pox disease worldwide. People do not have to get Small Pox shots anymore because the disease no longer exists. Immunization has helped in the eradication of some diseases. The application of Measles-Rubella or Measles-Mumps-Rubella vaccines has helped in the eradication of Rubella. Polio has been regionally eradicated and is expected to be the next globally eradicated infectious viral disease.
• Immunization has contributed enormously to reducing infant and maternal mortality. Innovative approaches to maternal immunization has decreased serious morbidity and mortality not only in the mother but also the foetus, neonate and young infants who are able to immunologically respond to most vaccines. The yellow fever vaccine which makes use of a live-attenuated viral strain is now recommended by WHO for consideration in pregnant women. Vaccines that could be given to pregnant women to prevent disease in their foetus, and those for young infants are also made available. Maternal immunization with trivalent inactivated influenza vaccine has helped in prevention of influenza in infants.
• Immunizing individuals also help to protect the health of our community by slowing down or stopping disease outbreaks. When most people in a community are immunized against an infection it can help to protect even those people who are not immunized. People who are not immunized include those who are too young to take certain vaccines. Example children less than a year old cannot receive the measles vaccine but can be infected by the measles virus, those who cannot be vaccinated for medical reasons such as children with leukaemia, and those who cannot make an adequate response to vaccination. Also protected are people who receive a vaccine but cannot develop immunity.

Immunization is very crucial but it comes with some side effects. All or most vaccines have side effects. Some bodies are delicate and reacts strongly to the weakened virus injected into the body. One can develop an allergy, muscle pain, headache, swelling, shivering, or even mild fever.

Many parents are concerned about letting their infants get too many vaccine shots at a very fragile age. Normally, a baby might get more than 20 shots until it reaches 2 years and often even multiple vaccines shots at one time. Kids are more vulnerable to the side effects of these vaccines.

Ghana has been able to achieve most of its rational for immunization in the country. Polio is being eradicated through a number of interventions such as child health promotion week celebration, integrated maternal health campaigns and most of its routine immunization. A recent study published in the Journal Frontiers in public health reports test conducted on 38,333 children in Ghana indicates that all–cause mortality is significantly lower in children who received measles vaccination after receiving a course of Diphtheria, Tetanus, and Pertussis vaccines. The term “all-cause mortality” is used by epidemiologist to described death from any cause. Tuberculosis, Diphtheria, Tetanus, Measles, Pertussis, and Poliomyelitis as labelled as “killer diseases” by the World Health Organization (WHO). They have been targeted over decades for eradication through mass immunization programmes. Previous study indicates that routine vaccines against these diseases have saved millions of young lives.

The pragmatic goal of routine immunization is to ensure that vaccination services are accessible, available, acceptable and affordable to users in an efficient and effective manner. This is well enveloped into the characteristics of the Primary Health Care System that seeks to make health care universally accessible, socially acceptable, engages full participation rather than prescription, and also affordable to people. Despite the maturity of Expanded Programme on Immunization, immunization systems as part of broader health systems have become fragile as they face new challenges. Some of these challenges are;

• Vaccine, Cold Chain and logistics Management: System requirements have expanded drastically over the years with the introduction of new vaccines and the frequent mass campaigns to control, eliminate or eradicate diseases like measles, rubella, and tetanus. The most visible impact of new vaccine introduction is an increase in the volume of products that need to be stored, transported and distributed as well as need for more storage capacity due to the increased use of single-dose vials. Successful cold chain and logistics management requires attention to many considerations. Adequate fuel and transport are necessary to ensure continuous running of cold chain equipment. In addition, maintaining vaccines at proper temperature has become more complex than in the past as some new vaccines are damaged by exposure to freezing while other vaccines are damaged by heat exposure which in tend can affect the efficacy of the vaccine.
• Generation and use of quality immunization data: the generations of high-quality immunization data is important to informing programmatic decisions. Maintaining and improving the quality of routine immunization data is a consistent challenge. Another problem is the inaccuracy of denominator (population) data, which are often based on outdated census data or inaccurate projections that do not reflect recent growth or population movement. Also double counting of doses given, the mixing of doses given to older children with doses given to infants and the fabrication of reports in order to achieve targets.
• Communication and Community Partnership: Educating and mobilizing the public to support immunization and to use immunization services is central to Expanded Programme on Immunization. Here, health workers and other trusted individuals are required to inform caregivers on where, when and how many times they need to bring children for vaccination. Caregivers consistently cite health workers as their most important source of information on immunization, yet health workers receive limited training on supervision on interpersonal communication skills and its importance knowing about vaccination, although important, does not lead to vaccine acceptance. Locally adapted and appropriate communication strategies are needed to address the sociocultural and political influences that impact immunization behaviour.

Gradually buying into the idea of immunization, parents are now getting to experience good side of the Primary Health Care System. In Ghana, parents who are able to complete the full schedule for the Child Welfare Clinic are rewarded with certificates and. Some mothers attend the clinic with their husbands so the men can be educated on the need for the clinic. Such couples are attended to with priority to motivate all men to attend the clinic and have education on the health care. Interestingly, these services are rendered to the people without charges or payment.

With all these synopsis of measures in place, immunization has now gotten extremely rooted in the country’s Primary Health Care System, and aesthetically changing the face of health needs of the population.

Written by:
Amma Abrafi (Miss)
A Physician Assistant Student, (U.C.C) level 200
abrafiamma8@gmail.com