In Guinea-Bissau, the implementation of the vaccination programme may be associated with increased mortality. The immunisation coverage for measles vaccine has decreased within the last four years. Failed donor focus and inappropriate monitoring parameters of both new and expensive vaccines and cheaper old vaccines will have implications for child mortality.
In 2008, the Guinean immunisation programme was modified. Diphtheria-Tetanus-Pertussis (DTP) was replaced by pentavalent vaccine (DTP-HiB-HepB), and yellow fever vaccine was to be given together with measles vaccine at 9 months. In evaluating programmes success, donors focus on how many children at the age of 12 months are vaccinated and how many have received the third dose of pentavalent vaccine. In addition, new more expensive vaccinations have put more focus on reducing vaccine wastage rather than using every opportunity to vaccinate.
This has created a situation, where many children who have sought vaccination risk to return home without being vaccinated. Measles vaccine and yellow fever vaccine that come in 10 dose vials and BCG vaccines (against tuberculosis) that come in 20-dose vials will only be opened if at least 6 or 10 children have come for vaccination at the same time. Furthermore, children over 12 months of age do not count in the statistics, and hence they are no longer vaccinated.
Research assessing the effect of the new programme shows that the coverage and timeliness of pentavalent vaccine have increased. However at the same time the proportion of children who were measles-vaccinated dropped and the median age of measles vaccination increased. As measles vaccine has positive effects for child survival, the changes in immunisation programme are very unfortunate and are likely to increase child mortality in Guinea-Bissau.
Rather than using the third dose of pentavalent vaccine as the primary indicator of the performance of the vaccination programme, the number of children having received measles vaccine after the third dose of pentavalent vaccine should be used. A vial of BCG, measles vaccine and yellow fever vaccine should be opened irrespective of the number of children who have come for vaccination.