News

    Vaccine to Save a Generation of South African Children

    South Africa's Dr. Petro Basson says the pneumococcal vaccine will save thousands of lives... but she hasn't seen it in the Free State province, where she works.
    South Africa's Dr. Petro Basson says the pneumococcal vaccine will save thousands of lives... but she hasn't seen it in the Free State province, where she works.
    Darren Taylor

    A swirling gale raises red dust in the crumbling streets of Dithlake, an impoverished township in the west of South Africa’s central Free State province. The same warm wind flattens nearby wheat fields, almost iridescently golden, and seemingly endless pastures of bright yellow sunflowers.

    But Dithlake is far from a rural idyll.

    Many of the area’s children get pneumonia. Some die, their bodies buried under simple slabs of concrete in the local graveyard. Public health facilities in the district are scarce.

    Three-year-old Daniel Petrus lives with his parents in a small shack in Dithlake. The two-roomed building is made out of corrugated iron and soggy wooden panels. Daniel’s father has placed old tires on top of the rusty roof to prevent it from blowing off.

    A doctor immunizes a baby
    A doctor immunizes a baby
     

    The Petrus family is poor. Daniel’s only toy is a bald, graying tennis ball, which he rolls across a dirty makeshift floor of loose bricks. But the child appears happy, laughing as his sticky fingers once again collect his ball.

    Yet just a month ago, his mother says, Daniel was almost dead. “He couldn’t breathe,” she whispers.

    Fortunately, a relative was able to rush Daniel to hospital in the nearest large city, Bloemfontein. He was diagnosed with pneumonia, but he survived after treatment.

    Prof. Shabir Madhi, a top South African pediatrician, says Daniel’s a “very lucky” boy. He could easily have become one of the estimated 300,000 African youngsters killed by pneumococcal disease every year.

    Youngsters on the continent die in particularly tragic circumstances, since these illnesses are completely preventable. Due to medical advances, deaths from pneumococcal disease have become rare in the developed world, but are still common across Africa.

    Leading cause of death

    “Pneumococcal disease is probably the leading cause of death in children from any single pathogen,” says Madhi, the co-director of the University of the Witwatersrand’s respiratory and meningeal pathogens research unit.

    The illnesses are so common, he says, because pneumococcus bacteria are present in six out of every ten people’s mouths. But while most healthy adults are strong enough to resist adverse effects, babies and very young children – and HIV-infected people with weak immune systems - aren’t.

    “It’s a bacteria which can cause serious ear infections (sometimes leading to deafness), and infections of the chest or the lungs – which we call pneumonia – as well as infections around the brain, which is known as meningitis,” Madhi explains.

    He says when a child first falls ill with pneumonia it often seems as if it just has a mild cold, with a runny nose and a fever. “But quite a few of those children eventually end up developing a superimposed pneumococcal infection. And when they develop this, over and above the underlying viral infection, that’s when they become really ill,” Madhi says.

    Prof. Shabir Madhi, South African expert on early childhood diseases, has tested a vaccine against pneumococcal sicknesses and delivered "astounding" findings.
    Prof. Shabir Madhi, South African expert on early childhood diseases, has tested a vaccine against pneumococcal sicknesses and delivered "astounding" findings.

    The infected child has a bad cough, battles to breathe, and grunts. Eventually, the lips of a baby that’s severely affected will turn blue, because it can’t get enough oxygen.

    “The problem with pneumococcal pneumonia is that if there’s not good access to health care, it’s a disease which can be extremely fatal,” Madhi tells VOA. “In rural areas in South Africa or in other settings in Africa….children that can’t get to health care facilities (soon after) they develop pneumonia, there’s a very high mortality rate.”

    The scientist also specializes in meningitis. Again, in the case of this illness, an infected child will experience a fever, but also accompanied by a headache, blurred vision, vomiting, and neck stiffness. Even with access to good care, says Madhi, three out of every ten people who get pneumococcal meningitis, die.

    Over the past two decades, the professor explains, it’s become especially difficult to treat pneumococcal disease in South Africa, as the pneumococcus bacteria has developed resistance to antibiotics that were once successful in fighting it.

    This “major obstacle,” says Madhi, spurred him on to do intensive research to prevent the disease from occurring, rather than relying on antibiotics to actually treat it. International health experts consider the work completed by the South African professor and his team in this regard as groundbreaking.

    The Soweto trials and the HIV link

    Madhi’s unit is at the Chris Hani – Baragwanath Hospital, the largest hospital in the southern hemisphere, in Soweto on the outskirts of South Africa’s biggest city, Johannesburg. About two million people reside in the area where poverty is rife. Every day, more than 2,000 patients check into the facility…. with almost a quarter of them being HIV-positive.

    About 22, 000 of the 30,000 children born annually in Soweto are delivered at the hospital locals call ‘Bara,’ which has made it an ideal setting for Madhi’s life-saving mission.

    A Rwandan nurse prepares a dose of Prevenar, a pneumococcal vaccine. The South African government has also made the vaccine part of its national immunization program.
    A Rwandan nurse prepares a dose of Prevenar, a pneumococcal vaccine. The South African government has also made the vaccine part of its national immunization program.
     

    Over the past few years, the researcher has evaluated the efficacy of medicine designed to prevent pneumonia and meningitis. Madhi has given the pneumococcal conjugate vaccine (PCV) - which included the ingredients of the commercially available drug, Prevenar - to 40,000 babies, of whom 2,500 were HIV-positive.

    In South Africa - at 5.5 million, the country with the highest number of HIV-infected people in the world – Madhi says it’s “impossible” to separate pneumococcal disease from HIV. “Largely because of the HIV pandemic, there’s a huge child and infant mortality rate in Soweto. But the real reasons why these children die are complications because of HIV and AIDS. And one of the major complications of HIV and AIDS is in fact death due to pneumonia,” he explains.

    Because their immune systems are so weak, HIV-infected children are particularly susceptible to pneumococcal illnesses, with three-quarters of all cases in South Africa occurring in youngsters with HIV.

    Madhi’s work in Soweto has yielded tremendously positive results.

    “By vaccinating children we were able to reduce severe invasive pneumococcal disease due to those strains included in the vaccine by 85 percent in HIV-uninfected kids, and by 65 percent in HIV-infected kids,” the professor enthuses.

    South Africa's Dr. Petro Basson says the pneumococcal vaccine will save thousands of lives... but she hasn't seen it in the Free State province, where she works.
    South Africa's Dr. Petro Basson says the pneumococcal vaccine will save thousands of lives... but she hasn't seen it in the Free State province, where she works.

    In April 2009, largely as a result of Madhi’s team’s efforts, the South African government became the first in Africa to introduce the pneumococcal vaccine – trade-name, Prevenar - into the country’s public immunization program.

    The scientist says South African babies are now receiving the inoculation in three doses, injected at six and 14 weeks of age, and finally when the child is nine months old.

    Vaccine is ‘invisible’ in some poor areas

    Even South Africa’s notoriously anti-government health activists have praised the state for budgeting millions of dollars to save children’s lives. But challenges remain. In isolated, under-resourced areas of the country – such as Dithlake - Prevenar is invisible.

    “I must say, working in the rural communities of the Free State….the communities that really need this vaccine are ignorant about its existence,” says Dr. Petro Basson, a highly-qualified nurse who regularly visits health facilities to care for children with “life-limiting” conditions, including HIV.

    Madhi, who’s also a member of a government task team on immunization, acknowledges that there were initially “some hurdles” in terms of introducing the vaccine throughout South Africa. But he says these have largely been overcome and that “full national coverage” will soon be achieved.

    Basson maintains, though, that it’s “hard” for people in particularly the nation’s isolated rural areas to immunize their children, especially in light of the fact that three separate injections at different stages of a baby’s early life have to be administered for the vaccine to be effective.

    “They stay 20 kilometers from the nearest clinic. So this makes it very, very difficult. It’s hard for them to visit a clinic even once. There isn’t an ambulance that can pick the child up because it isn’t an emergency situation (to get a booster injection),” the nurse laments.

    The only solution, Basson insists, is for the South African government to build more clinics. But some health economists say the authorities are already short of cash, with the state’s pneumococcal immunization program costing at least 600 million rand (US $ 85 million) a year.

    Extreme expense of Prevenar

    However, South Africa is fortunate. Without donor funding, the vaccine remains out of reach for most African countries.

    Babies awaiting immunization that could save their lives
    Babies awaiting immunization that could save their lives

    “It’s extremely expensive,” says Madhi. In the private sector in South Africa, the cost of one dose of Prevenar is almost US$ 200, with each child needing three doses.

    Madhi adds ruefully, “That’s basically more than the income of families in many African countries, for an entire year or even two.”

    But the Global Alliance for Vaccines and Immunization – or GAVI – is coming to the rescue of some of the extremely resource-poor countries that are in dire need of Prevenar. GAVI has provided support to Rwanda, for example, to introduce pneumococcal vaccine into its national immunization program. GAVI is partly funded by a number of industrialized countries, and South Africa itself contributes to the initiative, as does the Bill Gates Foundation.

    South Africa, explains Madhi, doesn’t qualify for GAVI assistance, since its per capita income is more than $1,000 a year – hence its state support for pneumococcal immunization.

    GAVI aims to introduce Prevenar into at least 45 eligible countries within the next five years.

    “That’s a very ambitious program. And if that does happen, it would save close on four to five hundred thousand children dying each year,” Madhi states. But he adds that it’ll be a “major challenge for these countries to sustain these immunization programs when the donor money dries up.”

    At the moment though, Madhi is choosing to reflect on the positive aspects of South Africa’s initiative. “By preventing children from dying today, what we’re basically investing in is allowing those children to actually develop their potential and hopefully to be productive members of society into the future,” he says.
     

    This is part 15 of our 15 part series, A Healthy Start: On the Frontlines of Maternal and Infant Care in Africa

    « Prev: Fetal Alcohol Syndrome Series Index Back to Beginning »
    This forum has been closed.
    Comments
         
    There are no comments in this forum. Be first and add one

    Featured Videos

    Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
    Brexit Vote Plunges Global Markets Into Uncharted Territoryi
    X
    June 24, 2016 9:38 PM
    British voters plunged global markets into unknown territory after they voted Thursday to leave the European Union. The results of the Brexit vote, the term coined to describe the referendum, caught many off guard. Analysts say the resulting volatility could last for weeks, perhaps longer. Mil Arcega reports.
    Video

    Video Brexit Vote Plunges Global Markets Into Uncharted Territory

    British voters plunged global markets into unknown territory after they voted Thursday to leave the European Union. The results of the Brexit vote, the term coined to describe the referendum, caught many off guard. Analysts say the resulting volatility could last for weeks, perhaps longer. Mil Arcega reports.
    Video

    Video Orlando Shooting Changes Debate on Gun Control

    It’s been nearly two weeks since the largest mass shooting ever in the United States. Despite public calls for tighter gun control laws, Congress is at an impasse. Democratic lawmakers resorted to a 1960s civil rights tactic to portray their frustration. VOA’s Carolyn Presutti explains how the Orlando, Florida shooting is changing the debate.
    Video

    Video Tunisian Fishing Town Searches for Jobs, Local Development Solutions

    As the European Union tries to come to grips with its migrant crisis, some newcomers are leaving voluntarily. But those returning to their home countries face an uncertain future.  Five years after Tunisia's revolution, the tiny North African country is struggling with unrest, soaring unemployment and plummeting growth. From the southern Tunisian fishing town of Zarzis, Lisa Bryant takes a look for VOA at a search for local solutions.
    Video

    Video 'American Troops' in Russia Despite Tensions

    Historic battle re-enactment is a niche hobby with a fair number of adherents in Russia where past military victories are played-up by the Kremlin as a show of national strength. But, one group of World War II re-enactors in Moscow has the rare distinction of choosing to play western ally troops. VOA's Daniel Schearf explains.
    Video

    Video Experts: Very Few Killed in US Gun Violence Are Victims of Mass Shootings

    The deadly shooting at a Florida nightclub has reignited the debate in the U.S. over gun control. Although Congress doesn't provide government health agencies funds to study gun violence, public health experts say private research has helped them learn some things about the issue. VOA's Carol Pearson reports.
    Video

    Video Trump Unleashes Broadside Against Clinton to Try to Ease GOP Doubts

    Recent public opinion polls show Republican Donald Trump slipping behind Democrat Hillary Clinton in the presidential election matchup for November. Trump trails her both in fundraising and campaign organization, but he's intensifying his attacks on the former secretary of state. VOA National Correspondent Jim Malone reports.
    Video

    Video Muslim American Mayor Calls for Tolerance

    Syrian-born Mohamed Khairullah describes himself as "an American mayor who happens to be Muslim." As the three-term mayor of Prospect Park, New Jersey, he believes his town of 6,000 is an example of how ethnicity and religious beliefs should not determine a community's leadership. Ramon Taylor has this report from Prospect Park.
    Video

    Video Internal Rifts Over Syria Policy Could Be Headache for Next US President

    With the Obama administration showing little outward enthusiasm for adopting a more robust Syria policy, there is a strong likelihood that the internal discontent expressed by State Department employees will roll over to the next administration. VOA State Department correspondent Pam Dockins reports.
    Video

    Video Senegal to Park Colorful ‘Cars Rapide’ Permanently

    Brightly painted cars rapide are a hallmark of Dakar, offering residents a cheap way to get around the capital city since 1976. But the privately owned minibuses are scheduled to be parked for good in late 2018, as Ricci Shryock reports for VOA.
    Video

    Video Florida Gets $1 Million in Emergency Government Funding for Orlando

    The U.S. government has granted $1 million in emergency funding to the state of Florida to cover the costs linked to the June 12 massacre in Orlando. U.S. Attorney General Loretta Lynch announced the grant Tuesday in Orlando, where she met with survivors of the shooting attack that killed 49 people. Zlatica Hoke reports.
    Video

    Video How to Print Impossible Shapes with Metal

    3-D printing with metals is rapidly becoming more advanced. As printers become more affordable, the industry is partnering with universities to refine processes for manufacturing previously impossible things. A new 3-D printing lab aims to bring the new technology closer to everyday use. VOA's George Putic reports.
    Video

    Video Big Somali Community in Minnesota Observes Muslim Religious Feast

    Ramadan is widely observed in the north central US state of Minnesota, which a large Muslim community calls home. VOA Somali service reporter Mohmud Masadde files this report from Minneapolis, the state's biggest city.

    Special Report

    Adrift The Invisible African Diaspora