Senior Program Officer, Jonas Mbwangue, explains the importance of sustainable immunization financing in his memorandum to Cameroon’s Prime Minister this week:
From all implemented health interventions in Cameroon, immunization has been one of the most effective and most economical. It has eradicated smallpox, reduced by 99% to date the national incidence of poliomyelitis, and dramatically lowered morbidity, disability and death from diphtheria, tetanus, whooping cough and measles. Since 1975, The Expanded Program on Immunization (EPI) has been active in Cameroon. Beginning in 1982, the administered package of antigens in the region was increased, and since 2008, the EPI has been administering vaccines to children between the ages of 4 and 8 against diseases: tuberculosis, polio, tetanus, Diphtheria and Pertussis. In 2004, protection against yellow fever was introduced. Vaccines against Hepatitis B and Heamophilus influenza Type B have been available in the region since 2005 and 2009, respectively. Cameroon’s immunization package will be expanded with the introduction of pneumococcal and Rotavirus vaccines in 2012.
Despite this progress, Mbwangue warns that due to government under-financing of the EPI, the country risks not achieving the Millennium Development Goal (MDG) 4 of reducing by two thirds the under-5 mortality rate by 2015. Disease outbreaks continue to emerge, decimating children with diseases such as measles, yellow fever, and neonatal tetanus. Immunization coverage, increased between 2005 (79.72%) and 2008 (83.96%) thanks to support from GAVI. Since 2009, however, coverage rates have experienced a decline (80%), lingering at levels far from the 2011 target of 90%. The comprehensive Multi-Year Plan (CyMP) 2007-2011 predicted that 80% of the regions in Cameroon would have coverage of 90% in 2009. This has not been reached; the Coastal, Southwest and Northwest Regions still lag below 80%, 72% and 62% respectively. In general, the EPI performance has slowed since the decrease of GAVI resources in 2009, revealing the EPI’s donor dependency.
The Strategy Paper for Growth and Employment (DSCE) predicted that Cameroon would reach the status of an emerging country in 2035. This vision challenges the government to invest more on education and children’s health in order to build the human capital needed to accelerate development. The most effective way to ensure the productivity and skills of the country’s demographic dividend is to reduce mortality of children aged 0-5years. This is possible through fully immunizing every child with routine and new antigens can reduce by 25% the morbidity and mortality due to diseases preventable by immunization, which must be considered a “best buy” for the Government.
Immunization is therefore a public good that children should receive in order for communities to acquire herd immunity, contributing toward the elimination of certain diseases. Herd immunity, i.e. 90% of national coverage, cannot be achieved unless the government puts in place a mechanism for sustainable immunization financing. Toward this end, discussions were held in April 2010 between the Parliamentarians, Mayors and the Ministries of Health, Finance, Economics and Homeland Security, after which the establishment of a National Immunization Fund was recommended. This fund will receive contributions from the public treasury, FEICOM (Municipality Equipment and Investment Fund), the private sector, and external donors. It will have an independent status, with a Board of Directors and it will be managed either autonomously or be entrusted to an existing public financial institution.
The implementation of this recommendation requires a decision of the Head of Government for (i) the adoption by Parliament and promulgation by the Head of STATE, a law on Immunization, which covers aspects of policy, regulation, administrative, monitoring and financing of all operations of immunization, (ii) institutionalization, by order of the National Immunization Fund and (iii) the development of regulations for the establishment of a Health Commission / Immunization within the municipal councils and an immunization budget line at the municipal or communal and FEICOM levels. The promulgation of the law and the establishment of the National Immunization Fund by 2012 will enable the country to meet the MDG # 4, which is to reduce by 2/3 the mortality of children aged 0-5 by 2015.