We are living in 21st
century, the age of supercomputers. With the story of super computers, we
should not forget that millions of people are still living with abject poverty
and millions of children having to lose their life before fifth birthday. If we
go through pages of human history, we will read of global pandemics that
created havocs across Europe to Asia. Millions of people had to lose their
invaluable life to cholera, flu pandemics, smallpox, tuberculosis, and
thousands of children got handicapped and live crippled life due to paralytic
poliomyelitis. So this is a story that we should not forget in the backdrop of
increasing population, climate change, poverty and rise in multi drug resistant
micro – organisms due to inadvertent use of antibiotics.
As a fruit of science has
ripened, so do we have various tools to deal with many infectious diseases of
impoverished like cholera. Among those tools available, one is vaccines, which
are safe, effective and affordable compared to other measures. Vaccine should
be understood as a biological product that when given in the form of injection,
droplet, skin patch or aerosol protect against targeted diseases producing
protective response. I have a faith in vaccine and its long term health impact
thereby its contribution in reducing childhood illness and death. So, I do say
again and again that vaccine is boon to human kind. As an example, the greatest
achievement in the human history is the eradication of small pox so far. The
last case of this disease was detected in Ethiopia in 1980s. Another success
story can be the endgame of paralytic poliomyelitis, which will soon be
eradicated from this globe.
A decade long experience
as a disease detective (surveillance medical officer - SMO) in hard to reach
area (HRA) of Nepal searching for vaccine preventable diseases (VPDs) is a
testimony to my faith in vaccine. During my tenure as a medical officer, we had
to manage infectious diseases like Malaria, Visceral leishmaniasis,
Cholera, Enteric fever, Japanese encephalitis, Dengue fever / Dengue
Hemorrhagic fever, Worm infestation, Acute gastroenteritis, Protein Energy
Malnutrition, Acute / Chronic viral hepatitis, Measles / rubella, Vitamin
deficiency, micro- nutrient deficiencies. These diseases are rampant and many
people even lose their life bringing socio –economic rift in family as well as
community as a consequence. Now, the government of Nepal (GoN) has successfully
controlled various infectious diseases through introduction of vaccines against
diseases like measles & rubella, poliomyelitis, neonatal tetanus, Japanese
encephalitis. Some of these diseases are virtually eliminated and some in the
process of elimination. Therefore, the introduction of vaccines along with
other public health measures has contributed significantly in reducing under 5
mortality. I also have to say and should not forget that the role of health
professionals from centre to periphery is commendable. In this efficient public
health delivery mechanism, thousands of female community health volunteers
(FCHVs) are the backbone in its delivery to the community. They are like a
bridge between health system and community. Though, there was a time, Nepal was
going through political instability all over the country, it was FCHVs who made
routine immunization (RI) run in its usual course and mass vaccination like
polio / measles campaign happen throughout country a successful story. However,
there are still some diseases like cholera, enteric fever, viral hepatitis,
which need attention from government and international organization.
In Nepal, a large proportion of people rely on
unimproved sources for drinking water.
Around half of the population (49 %) opts for open defecation, more so
in the rural areas. Only 17 % of populations have adequate access to proper
sewage conditions in urban areas, whereas it is almost non - existent in rural
areas. Also, there are
major limitations in disease reporting through government health system due to
incomplete data, and irregular and inconsistent data reporting, so that the
burden of disease is seriously under - reported. In 2009, there was a huge
cholera outbreak in hilly districts of mid western region, where thousands of
people succumbed to this deadly infectious disease. This disease created havoc
in the region that led to panicky situation causing socio – political
disruption. Since the hilly regions of Nepal is geographically challenging in
terms of access to health care and its delivery, many people have to lose their
life and bear unnecessary suffering. Therefore, the Government of Nepal (GoN)
needs to strengthen surveillance and consider cholera vaccination as a supplement
to other preventive measures (i.e. provision of clean water, sanitation and personal
hygiene) and the provision of treatment, particularly in high risk areas.
Anuj Bhattachan
15th Oct, 2013
2 comments:
Truly said,Cholera is so common for Nepal . If there is cholera our=t break in any other part of the world,and if there's a Nepalese;s/he is the prime suspect.Even,back in 2012,there was an epidemic of Cholera in the Western part of Nepal and it took may lives .
Oral vaccines for cholera could be used for mass immunizations for Nepal.If not the whole country ,we could track the most prevalent areas and begin from those areas.It could be awesome.
ONE QUESTION:HOW MUCH DOES IT COSTS TO VACCINATE ONE PERSON?PUBLIC CAMPAIGN COULD BE USED TO BEGIN WITH INDIVIDUAL VACCINATION.
Thanks Bibushan for your post. As per our experience from Odisha vaccination, the vaccine delivery cost was around $0.49 per dose similar to the vaccine delivery cost estimate for a campaign-based delivery from the “WHO comprehensive Multi-Year Plans Guidelines for EPI Vaccines in 2006.While the vaccine cost $1.80 per dose. And this has to be given 2 dose for an individual at least 2 weeks apart. With this amount you can roughly estimate the total cost depending on target population.
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