Cholera vaccine will help push back disease

ZIMBABWE is taking the present cholera outbreak, which has hit most of SADC as well as our country, very seriously both in the long-term campaign to make sure people do practice good hygiene and have the resources to do that, and now with the vaccination programme using the tightly rationed doses we have so far been allocated.

On Tuesday, Cabinet approved the procurement of another 6,3 million doses, to add to the little over 1,7 million doses that are already being administered and the final batches of this initial allocation that will soon take it to 2,3 million doses.

But like the rest of the world wanting cholera vaccines, Zimbabwe has to stand in line despite the fact that annual global production of cholera vaccines hit 35 million does last year and this output will be at least maintained this year.

That entire output has been dedicated to fighting existing outbreaks, mainly in Africa and Asia, with none being assigned at the moment to preventative vaccination outside the cholera outbreaks, so the producers are being highly ethical.

So Zimbabwe has been told that additional supplies can only be delivered in April, and even then the full 6,3 million will almost certainly have to be spread out as production is allocated as fairly as possible around the world’s hotspots.

Some of our neighbours have worse outbreaks and there are other outbreaks around the world that are bad. So we are on the list, but not for delivery tomorrow, as Minister of Health and Child Care Dr Douglas Mombeshora put it graphically at the briefing after the Cabinet met.

The initial allocation of 2,3 million doses, both those already here and the doses expected in the immediate future, were allocated to the people living in the hotspots, and more precisely as single doses, which offer six months protection, to those communities.

The results have been excellent, particularly as they are backed by measures to get at least basic levels of clean water to those communities and to clear garbage and other waste.

So a lot of the desired order will be dedicated to giving a second dose to the hotspot residents, taking their protection up to three years.

There seem to be good reasons for this. Since the start of the outbreak a year ago, the number of hotspots increased for around six months, with the very dense populations in south-central and south-west Harare becoming the worst affected, but then infection rates tended to stabilise, although the hotspots remained hot.

Vaccination is not seen as a cure all or even the main response to the outbreak, but it is seen as a critically important way of buying time so action can be taken to deal with the main causes of the outbreak.

Despite the borehole drilling and the efforts to improve Harare water supplies to a basic minimum, and the major effort to get rid of solid waste, the hotspots have remained remarkably sticky, suggesting that the bacteria which cause the disease are still around and that there are infected people within the communities.

So six months is probably a bit on the tight side to block off infection in many hotspots, and the longer period of protection will buy more time for the many efforts, some of which involve infrastructure repair by local authorities, and the track record of Harare suggests that this will need central Government help, as well as more infrastructure, such as the rural borehole programme along with the emergency boreholes in Harare suburbs. Engineering is not instant even with the best intentions.

Public health experts have been very clear that the vaccination programme works but works by buying time, beating back the infection rates and putting in the firebreaks, but the ending of the outbreak requires those measures that we have known about for well over a century: good hygiene, clean water, proper sewage disposal and proper waste disposal.

The rationing and delays in vaccine delivery must also open doors for Zimbabwe to acquire the technology and skills needed to produce vaccines, instead of relying purely on external suppliers.

If we could manufacture vaccines we could at least get the blueprint of a new vaccine from outside, and then start manufacture. This will be far from an instant process, but it is a technological journey we must start embarking on. Much later on we need to be able to do the original research.

To a degree, we already have some capacity. The Department of Veterinary Services now manufactures a handful of veterinary vaccines, and we also import some from Botswana, a country with a smaller technology and industrial base. This means that it is possible.

Of course there is a major difference on safety and other factors between a veterinary vaccine and a human vaccine, but it seems that a lot of that difference is a matter of degree rather than a difference in concept.

The upgrading of our State universities has already seen them embarking on practical technology applications, and it strikes us that the University of Zimbabwe, with the oldest and largest medical school, could at least investigate the requirements for vaccine production, and then see what is practical, perhaps in a joint venture with the Ministry of Health and Child Care and perhaps a private sector pharmaceutical manufacturer, and we are looking at rebuilding that particular branch of our manufacturing industry.

A local capability would help with the routine vaccines that we need all the time, the ones we give every child, so there is a confirmed market, and we could probably tie in the manufacture of advanced veterinary vaccines as well, as we build up the unit.

But until we explore the options and requirements we do not know what is practical, and that is the obvious first step.

Once we know what is needed we can then see what we can provide and what gaps we need to fill.