Is Uganda losing the immunisation fight?

Traditionally, there are six known immunisable killer diseases. They include polio, measles, tuberculosis, diphtheria, whooping cough and tetanus. But Ugandans were ignorant about the illnesses and as a result, many children died.

The diseases had strange symptoms, which left many confused, with some mistaking them for witchcraft.  There is no data on how many of the seven million Ugandans were victims of the six killer diseases by independence in 1962. 

But vaccines like Sabin’s polio vaccine which, was discovered in 1957 and licensed in 1962 in the US had been discovered. 

Following the arrival of a study team from the World Health Organisation (WHO) in 1969, the Uganda Virus Research Institute (UVRI) received enhanced status as a fully-fledged virus research laboratory capable of handling viral diseases like polio and measles that were of public concern. 

In the subsequent years, extensive and valuable data on entero and respiratory viruses and the efficacy of vaccination with oral polio virus and measles vaccines were accumulated. 

The collapse of the East African Community in 1977 marked the end of the “golden years” of research for UVRI, which deteriorated as it stopped receving international support. 

Many international and national staff left the country as civil strife raged in the country from the late 1970s untill 1986. This also interrupted immunisation. 

Although all the diseases kill, measles was much more feared and patients were isolated whenever it would strike. 

Measles is an acute viral respiratory illness associated with high fever, rashes and vomiting. It is considered one of the most deadly vaccine-preventable diseases, accounting for an estimated 777,000 childhood deaths per year worldwide, with more than half of these occurring in Africa.

Apart from death, children who are affected by measles may suffer from life-long disability including brain damage, blindness and deafness. It was feared to the extent that people in different parts of the country even came up with euphemisms for it. 

In Buganda it was named mulangira; it is called adeka na ekwam in Teso, while the Luo speakers call it two-koyo. When a child would get measles, they would smear him/her with cassava flour besides putting them on a salt-less diet with the source usually being a certain species of silver fish (Nkejje). This was a form of treatment and injections were discouraged. 

“In the 1970s and 80s, some medics would inject children suffering from measles and many died. But after some time, people realised that measles did not require an injection once it has attacked a child,” said Deborah Kyeyune, a resident of Wakiso district, who was one of the first volunteers during the first immunisation campaigns by the NRM government.

Another disease that was common by the time President Yoweri Museveni took over power in 1986 was polio. Polio is a viral disease spread through taking food or drinks that are contaminated by faeces of an infected person. 

The polio virus spreads from one child to another and an infected child may not show any signs. The common signs and symptoms for polio are weakness and paralysis of the limbs, respiratory failure and even death. Globally since 1988, there has been a 99% reduction in polio cases due to this vaccine.

During the NRM government, the health ministry formed the Uganda National Expanded Programme on Immunisation (UNEPI) targeting infants and women of child-bearing age. Measles and polio were UNEPI’s priority for eradication.

In the early 1980s, hardly 50% of the children would get immunised due to the insecurity that interrupted several activities. But upon coming into power, Museveni supported by WHO, UNICEF and the United States Agency for International Development (USAID) campaigned and raised the vacination levels throughout the country. 

A number of campaigns such as Kick Measles and Polio out of Uganda were integrated in social activities like drama and sports to sensitise the masses about the advantages of immunising children. 

This was in addition to supporting the budgets of mission hospitals, which were rendering a significant service in terms of provision of healthcare. 

The President managed to allay fears amongst Ugandans against negative talk that polio vaccines instead cripple children. Besides Museveni, a number of public figures including, Buganda’s Kabaka Ronald Mutebi and religious leaders, have on several occasions boosted immunisation campaigns by taking part in the exercises. 

In 2002, the health ministry and WHO increased the number of immunisable diseases in Uganda from the traditional six to eight. 

In addition to polio, measles, tuberculosis, diphtheria, whooping cough and tetanus, the ministry included hepatitis B and influenza B. 

But Dr. Jackson Orem of National Cancer Institute suggests that besides the gazetted immunisable diseases, cervical cancer should be included in the routine programme as it impacts greatly on women’s health. 

Due to sensitisation, immunisation coverage has over the years greatly improved. According to WHO statistics, the percentage steadily rose throughout the 1990s to an average of over 70% for immunisable diseases and the percentage reached 83 in 2008. 

But something seems to have gone wrong thereafter, as the health ministry reported a drop in vaccination coverage from 83% in 2008/9 to 76% in 2009/10.

According to the Economic Policy Research Centre policy brief, only 52% of Ugandan children were immunised in 2011, an indication, which shows that Uganda is on a downward trend as far as immunisation is concerned.

Uganda’s population is estimated at about 34.5 million people of whom 6.6 million are infants below the immunisable age of five years. But since not all children are covered, this could perhaps be the reason why there have been fresh outbreaks of polio, hepatitis and measles of late.

In October 2011, Uganda was announced as one of the first African countries to contain measles, having not recorded a single death in the previous two years. 

Dr. Jacinta Sabiiti, a senior medical officer in the health ministry and leader of UNEPI, said the last measles death reported in Uganda occurred in 2009 and that measles deaths reduced from 6,000 to 300 between 1996 and 2006 and none was reported in 2011.

The same was said of polio in 1996 until the 2009 outbreak in Amuru, Moyo and Pader districts. In August 2010, WHO again declared Uganda polio-free. But in October in the same year, a polio case was detected in Bugiri district. 

Fresh polio, measles and river blindness (onchocerciasis) cases were again reported in 46 districts in different parts of the country, prompting President Museveni to launch a three-day immunisation campaign in Pader in May this year. 

It is for this reason that Dr. Asuman Lukwago, the health ministry’s permanent secretary, called on Ugandans to take children for immunisation to eliminate the immunisable diseases. The health ministry recommends immunisation as one of the key strategies for the attainment of the millennium development goals four and five; that is the reduction of child mortality by two thirds and the reduction of maternal mortality rate.