Counting the effectiveness of vaccinations.

Sometimes the things that are said in the parliamentary portfolio committees are a bit confusing.

Just a couple of weeks after the 2011 census results were released, the Department of Health acknowledged it did not know how many babies were unvaccinated because it had only a hazy idea of the size of the population it was targeting.

The issue has officials so concerned that they are planning a door-to-door survey next year to get better figures, according to the department’s chief director for child, youth and school health, Nonhlanhla Dlamini.

The Department’s Expanded Programme of Immunisation is one of its most important initiatives for improving child health, and it regularly (and it seems, erroneously) claims high coverage rates. Its most recent annual report, for example, says there is a 95.1% coverage rate.
The figure refers to the benchmark DPT3 vaccine that protects children against diphtheria, whooping cough and tetanus.

However, Médicins Sans Frontières last week drew attention to a discrepancy between the department’s figures and those published by the World Health Organisation (WHO) and United Nations Children’s Fund (Unicef), which were much lower, at 72%.Médicins Sans Frontières’ country manager Daniel Berman said his organisation was concerned that South Africa was paying relatively high prices for its vaccines compared to other developing countries, and could not measure its results.

Len’s thought — Maybe they should give us the vaccines at a lower fee/price.

In response, Dr Dlamini said the WHO-Unicef reports and Department of Health both had flawed data, for different reasons.
One of the problems with the WHO-Unicef data was that it drew on an HIV/AIDS survey that asked supplementary questions on vaccine uptake. The focus of the research was not immunisation. The WHO-Unicef also reported separately on DPT3 and Haemophilus influenza B, yet these were now administered as a single shot in South Africa.

The department’s figures were inaccurate because the population estimates it used were too low. These estimates were drawn from Stats SA’s Census 2001, which had under counted babies under the age of one, partly because it did not include immigrant babies.
Vaccinations are provided free to all babies, regardless of nationality at government clinics.
This meant that when officials calculated the coverage rates for a specific vaccination, they were dividing the total number of babies who got the shots by a target population that was too small, and the result was an inflated coverage rate.

The Department will convene a meeting of experts next month, which would include officials from the WHO, Unicef, the Medical Research Council and Stats SA to design a new survey.

It is great to see that when we identify problems we immediately start working on how we can resolve them. This year I have been very encouraged as I see the Parliamentarians in the Health committee take their oversight role to heart.

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