Tackling influenza in Ghana

Abstract

Q: Do African countries need the same level of flu vaccination as believed to be beneficial in non-tropical parts of the world? A: Most countries don't have a clear idea of what the influenza disease burden is like. If you take the countries in sub-Saharan Africa, because they are located either side of the Equator, it's difficult for them to decide which vaccine to choose: the northern hemisphere or the southern hemisphere. All this is based on having other competing health priorities like malaria, TB, HIV, and even if you look at just my country Ghana, for example, when you take the stats that are reported, you have 'acute respiratory illness' and within that category you can have bronchopneumonia, pneumonia, severe pneumonia, but you don't have a proportion attributable to influenza. Our expanded programme of immunization has hitherto not considered rolling out an influenza vaccine. But I guess most countries have become more aware of the need for an influenza vaccine because of the pandemic [in 2009]. So you find that in the past three to four years, surveillance has increased for influenza. Q: How can the African region address the problem of not knowing what the burden of influenza is? A: Here the World Health Organization (WHO) is playing a good role. Countries have been encouraged to set up national influenza-laboratories and increase their capacity for laboratory diagnosis of influenza. WHO's Regional Office for Africa in particular has pushed and also suggested the use of existing laboratory networks such as those for polio and HIV. In Ghana, we have influenza being part of the integrated disease surveillance response strategy through the Ghana Health Service, and also in line with the international health regulations (IHR) 2005, where there's a concerted effort to get countries to implement the IHR. This is an incentive for the African region to improve its disease surveillance network, and some countries have used both the internal and external resources that have come through pandemic influenza and also set up surveillance for influenza, so you find that there is more information now about the virus circulating. Therefore, countries have realized the need to better estimate influenza disease burden. So again, looking at Ghana for example, we've taken part in the desktop pilot for a draft WHO manual for disease burden, fully supported by our Ministry of Health. We're looking to do a population-based study on influenza and other diseases like malaria, TB and HIV, with support from the Centers for Disease Control and Prevention (CDC), with technical input from WHO. We're looking to do a specific study on pregnant women and their children, and to look into disease burden in those children and use this as the foundation to develop a vaccine efficacy study. Two or three years down the line, we will see evidence that it [influenza] is being tackled. Also CDC, with WHO's input, has set up ANISE, the African Network for Influenza Surveillance and Epidemiology. It's already met three times. These meetings have enabled people to discuss influenza-related surveillance work that is ongoing in Africa. Q: Do you feel that where there is high HIV prevalence, there is a greater need for widespread influenza vaccination? A: The interactions between flu and HIV are unknown, because many countries in Africa don't know the burden of influenza. So actually now there are a couple of studies that are trying to look at the issue. The general advice is that yes, people who are immunosuppressed would be more susceptible to flu but we need evidence to convince the countries that flu vaccine would be a good strategy to help keep immunosuppressed people healthy. Q: Have influenza vaccines not been widely-adopted because governments feel there is no 'return on investment'? A: Perhaps it's the other way around. They feel that there has so far been no compelling evidence for disease burden, which would then boil down to cost-effectiveness. …