Routine child immunisation vaccine shortage hits Ghana health facilities
The situation has the potential to increase the vulnerability of children to the diseases the vaccines seek to protect them against.
Under the routine vaccination programme, Bacille Calmette-Guérin (BCG), a vaccine for tuberculosis (TB) disease; oral polio vaccine 0 (OPV); Measles-Rubella; Meningitis and Diphtheria, tetanus, pertussis (whooping cough) are administered.
Vaccines against polio, hepatitis B and Haemophilus influenza type B (DPT/Hep B/ Hib 1) and six infectious diseases that are particularly dangerous to babies are also among those administered.
Daily Graphic checks with health facilities in the capitals of the Greater Accra, Western, Central, Upper West, Bono, Eastern and Upper East regions confirmed the situation.
Our correspondents who checked on the situation include Shirley Asiedu Addo (Central Region); Dotsey Koblah Aklorbortu (Western Region; Doreen Andoh & Jemima Okang Addae (Accra), Emmanuel Modey (Upper West Region); Gilbert Mawuli Agbey (Upper East Region), Biiya Mukasah Ali (Bono Region) and Haruna Wumpini (Eastern Region).
The Daily Graphic investigation followed a report about a month ago of erratic supply of vaccines to the regions of the north since the middle of last year.
The Central Hospital in Tamale closed down its Paediatric Unit last year due to an outbreak of measles.
The Regional Directorate of the Ghana Health Service recorded 15 suspected cases in that region alone, but with no deaths.
The Regional Health Director, Dr Braimah Baba Abubakari, however, insisted that there were enough vaccines to fight the disease.
However, checks at the time in the region prior to the arrival of those vaccines showed that out of the 13 vaccines for routine immunisation, only two – tetanus and tuberculosis – were in stock.
Managers of some of the health facilities that are popular for their child welfare and public health services, confirmed the shortage but declined to give details.
When pressed, some of them for fear of victimisation, blurted out: “Madam, please I love my job”, “Please, I don’t want to be transferred”, among others.
Some of the managers kept pushing the responsibility to speak to the next person, saying “I am not the right person to speak on the issue”.
When the Director of Public Health of the Ghana Health Service, Dr Franklin Asiedu-Bekoe, was contacted on the interventions put in place, he said he was collecting update on the situation and would revert.
As of the time of going to press, there was no such update.
The Medical Director at the Eastern Regional Hospital, Dr Arko Akoto-Ampaw, confirmed the shortage of some vaccines at the hospital to the Daily Graphic.
The vaccines in short supply included those for Measles - Rubella, penta and Rota and Oral Poliomyelitis, he said.
However, Dr Akoto-Ampaw said BCG vaccine, which is administered at birth, was available.
He said some of the vaccines could not be obtained as far back as the beginning of the year, especially vaccines for poliomyelitis, measles, pertussis, tetanus, diphtheria and tuberculosis.
He, however, indicated that the only vaccines available at the hospital were for tuberculosis.
Dr Akoto-Ampaw explained that the shortage of vaccines had been periodic but if the situation was allowed to last for a month there could be community spread should a child contract any of the diseases.
When the Daily Graphic contacted the Eastern Regional Deputy Director of Public Health, Dr John Otoo, he said the directorate took delivery of some of the vaccines a fortnight ago.
He said although babies were to be vaccinated at birth that could also be done in five months without any medical implications.
Dr Otoo, therefore, dispelled suggestions that if the shortage of the vaccines persisted for some time it could pose a serious problem for the children, saying they could be vaccinated at a later date and remain safe.
A nursing mother, Hajia Samira Mohammed, whose child had not been vaccinated for BCG and other diseases, told the Daily Graphic that she was concerned about the shortage of the vaccines.
Hajia Samira appealed to the government to make available the vaccines to enable their children to be vaccinated against the six childhood diseases at the various health facilities in the region.
The shortage of routine immunisation vaccines has caused a lot of frustration among health workers and nursing mothers in the Upper East Region.
Vaccines such as Bacillus Calmette-Guerin, OPV Polio, measles, yellow fever, Men A, for the vaccination of children have been in short supply in the region for the past two months.
Due to the shortage of the vaccines, only a few children are sometimes vaccinated on either Tuesdays or Thursdays, with the rest of the mothers being asked to go home since the vaccines could not cater for them.
The Daily Graphic gathered from the Coronation Health Centre and Dagweo CHPS compound, both in the Bolgatanga municipality, and other health facilities in the region, that due to the shortage, nursing mothers are turned away when they visit the facilities to vaccinate their new babies.
A nurse, who spoke on condition of anonymity, said: “Sometimes, about 40 children are brought to our facility to be vaccinated but due to the shortage only 10 children get immunised, with the rest turned away to come back later when new ones are received”.
The source said “since January this year, there had been shortage of BCG and instead of opening two vials a day, only one vial was opened, especially on Thursdays, to vaccinate 20 children.”
"Unfortunately, the shortage of the vaccines has interrupted the vaccine cycle for the children,” the source said.
The nurse called on the government to take immediate steps towards the provision of the vaccines to prevent mortality among children under five years.
Four of the vaccines for the prevention of childhood diseases are in short supply at many hospitals in the Upper West Region.
A number of District Disease Control Officers in charge of the Expanded Programme on Immunisation who spoke to the Daily Graphic on condition of anonymity, confirmed it.
They mentioned some of the vaccines as BCG and those for measles, oral polio and Rotavirus, which had not been received regularly since November last year.
“We have all the other routine childhood vaccines, including Penta, yellow fever, Men-A and PCV,” one of the officers said.
They said their first monthly supply for the year came without the four vaccines mentioned.
The shortage, the officer contended, was holding back their regular immunisation coverage since none of the children born from last November to date had received those vaccines.
The Ashanti Regional Public Health Department has been experiencing shortage of supply of some vaccines for a while now.
Some of the vaccines currently out of stock include Oral poliovirus (OPV), polio, measles, yellow fever, rotavirus, BCG, meningitis and Vitamin A 1000 and 2000.
Hospitals such as the Maternal and Child Health Hospital (MCHH), popularly known as Children’s Hospital, the Manhyia Government Hospital and the Suntreso Government Hospital had all run out of some vaccines.
Some of the facilities said the phenomenon was not new as it had happened before.
“Usually when this happens, we reschedule the babies for another day and the most important thing is that they get vaccinated,” a health worker told the Daily Graphic.
For instance, at the Manhyia Government Hospital, the staff said the facility had been experiencing shortages since January this year.
The source was unable to tell the source of the challenge and when the vaccines would be restocked.
Some nursing mothers at Benue Nkwanta, a farming community in the Sunyani municipality in the Bono Region, expressed frustration about the frequent shortage of immunisation vaccines for their babies at the Benue Nkwanta CHPS compound.
Some of the mothers said they had to wait for weeks before having their babies vaccinated against the six childhood diseases which were usually meant to be taken in the first week of birth.
A nursing mother in the community, Sarah Yaa Pomaa, told the Daily Graphic that she had managed to administer some of the vaccines to her 16-month-old child, but could not remember the type and number of vaccines.
She explained that on some occasions when she visited the facility, she was told the vaccines were not available.
“The nurse in charge asked me to wait till the next week when I visited the facility a number of times in December last year,” Ms Pomaa stated.
The Daily Graphic gathered from the facility that there was a frequent shortage of routine immunisation vaccines and that nursing mothers from the community who visited the facility were unable to get the vaccines for their babies.
A source, who pleaded anonymity, said the facility sometimes relied on other health facilities such as the Antwikrom Clinic for vaccines and logistics to administer to babies in the area.
At the Watchman CHPS compound also in the Sunyani Municipality, the Midwife In charge, Doris Asirifi, told the Daily Graphic that there were enough vaccines at the facility for the vaccination of babies against the six childhood diseases.
She said the immunisation teams were on the field on a daily basis to administer vaccines to children at designated points in the facility's catchment communities.
A source at the Central Regional Health Directorate told the Daily Graphic that while there were shortages at some of the facilities, the situation was not widespread.
However, the Central Regional Director of Health, Dr Akosua Sarpong, said the issues relating to the shortages were reported last year but had since been generally resolved in the region.
She said the recent issues the directorate picked up were not about dire shortages but challenges with the effective redistribution of the vaccines at the district level.
Dr Sarpong indicated that sometimes the vaccines had to be redistributed for facilities that needed them to have them rather than stocking them at one facility.
“On that, we are constantly communicating to ensure effective and proper redistribution of all vaccines,” she said.
The Public Relations Officer of the Cape Coast Teaching Hospital, Fred Nyankah, told the Daily Graphic that the hospital did not have the oral polio vaccine and rotavirus vaccine.
No BCG syringes
“We do have all the other routine childhood vaccines, including BCG. However, we do not have BCG syringes which are short in supply nationwide, but we have improvised with insulin syringes, he noted.
He said for proper checks and balances, there was a national protocol for stocking up on vaccines.
“As a facility, we can have in storage at the maximum a month’s stock, (this number is based on the average number of people we vaccinate in a month) not more. This is to prevent vaccines expiring in a facility when others are in need,” Mr Nyankah explained.
He said the vaccines were also not available for private purchase, so once the government did not supply them, the facility itself could not procure them.
Similar reports of routine immunisation vaccine shortages were confirmed in some health facilities in Takoradi, the Western Regional capital, where managers of some of the health facilities visited said they did not have the full complement of the vaccines.
Vaccines in short supply include those covering diphtheria; pertussis, Tetanus, Hepatitis B and haemophilus influenza type B.
Some parents who spoke to the Daily Graphic said they were yet to receive BCG, OPV and Hepatitis B at birth and six weeks, 10 weeks, 14 weeks and Vitamin A at sixth month but the rest are yet to.
One of the parents who gave her name as Akosua Agyapomaa, said the last time she visited the Effia-Nkwanta Regional Hospital was last month and the nurses told her they did not have OPV for the third and final doses.
She expressed the hope that her child would be able to access vaccines for Measles-Rubella 1 and Yellow Fever in her ninth to 12 months.
However, the Western Regional Health Directorate debunked the finding and said the region received vaccines just last Friday and the vaccines were currently at the regional medical stores.
The Deputy Director of Public Health, Dr Gifty Amugi, said facility managers telling clients that the vaccines were not there did not mean it had run out completely.
“Vaccines are kept under a particular temperature in negative numbers and they are released to a health facility. When they come out of the cold-room at a plus number it results in shortening the time,” she said.
Dr Amugi added that: “We keep the bulk at the storage, therefore if clients visit the facilities and the managers say they are out of vaccines, it means they did not reorder.”
“Let me say that every region has one big store where we store everything, and we at the regional level are saying we have the vaccines – we are not saying it cannot run out of resources, but let me tell you we have a stock.
“We are not saying resources cannot run out, yes it can but at the regional level in the Western Region – we have and if the facilities are ready they would call for them due to their inability to store, compared to regional offices,” the deputy director said.
Stakeholders in the health sector have expressed the fear that the shortage would cause the country to derail life-saving gains made with the introduction of immunisation in the country in 1978.
The source said with donor funding, which had been the spine of the country’s immunisation success story expected to dry up by 2026, the country would face a real challenge in sustaining the immunisation.
The Executive Director of Hope for Future Generation (HFFG), Cecilia Senoo, said the country continued to have challenges with meeting its co-funding obligations to the Global Alliance for Vaccine and Immunisation (GAVI) over the years.
Citing instances the country defaulted, Mrs Senoo said in 2018, it paid 30 per cent out of the 69 per cent the country was expected to contribute to routine immunisation expenditure.
Gains made in immunisation coverage and outcomes may not be sustainable if domestic funding for immunisation remains limited.
The country initiated the EPI in the year 1978. It made it countrywide in 1985, targeted at expanding immunisation coverage among children under the age of one from six per cent to 80 per cent against six diseases: tetanus, pertussis, tuberculosis, diphtheria, poliomyelitis, and measles (now measles rubella).
Data available to the GHS indicate that there has been a significant fall in morbidity rates of vaccine-preventable diseases such as measles and poliomyelitis.
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