In the first of a series of in-depth stories, Nessa Chilakata speaks to girls affected by missing vaccines or inaccurate testing
What vaccine inequity means if you’re a young woman in Uganda
Every single birth, every child born in Uganda is licensed for a pair of vaccines, but the majority of adolescent girls who get those vaccines don’t get the ones they need because of a devastating national supply problem.
Almost all of the high-income countries that do business with the World Health Organisation to offer those global vaccination immunisations include provisions to cover all pregnant women during pregnancy and throughout their lives.
But, unfortunately, in Uganda, pregnant women and lactating mothers are not required to have any vaccinations during pregnancy. As a result, there are hundreds of women who might be pregnant, but who don’t get to get a single vaccine because their blood type prevents them from having the right vaccine for their exact circumstances. They might even not get to the right vaccination, because their blood types make the doctor make a guess based on their gender.
The same problem is applied in two categories of other pregnant women – “G8 – standard” and “Form XVI – serial”. Those who qualify for G8 vaccines are at least 20 years old, have normal blood type, and either are overweight or have diabetes or severe hypertension. Some pregnant women are excluded even in those categories because it’s too late for them to get the right vaccination – they are still in pregnancy. Others who qualify for the G8 vaccine lose the capacity to be vaccinated because they have lost their pregnancies or already have anencephaly, a condition resulting in incomplete brain development.
The chance of being dropped is higher for pregnant women who are obese, are diabetic, have hypertensive diseases or develop anencephaly.
To clear up that inaccurate supply situation, children’s vaccines are now introduced to every pregnant woman starting at the age of 20. Their age for the vaccinations is calculated based on the child’s age at birth.
A mother gives her newborn to a midwife in an ambulance. Photograph: Lukila Nsengiyumva/Reuters
Eight years ago, Ugandan president Yoweri Museveni declared pneumonia the country’s biggest killer of children under five years old, giving an impetus to intensive efforts to immunise children against it.
According to statistics from the Ministry of Health, pneumonia kills more than 6,000 children under five each day in Uganda – more than malaria and diarrhoea combined.
Targeting pregnant women and lactating mothers would, in theory, ensure that most of these children would get to receive the pneumococcal vaccines and other key childhood vaccines. According to health experts, a 15% reduction in pneumonia mortality would also reduce the number of newborn deaths by 1.2 million. That’s close to one baby dying every minute, every year.
“The two biggest killers of children under five years old are pneumonia and diarrhoea,” the health minister, Jane Ruth Aceng, said. “With these routine immunisations for pregnant women, we will overcome these challenges to save children’s lives.”
In Uganda, nearly eight out of 10 children are not getting the pneumococcal vaccines that would save their lives. Earlier this year, Aceng herself made a passionate plea for more vaccines to help deliver on the president’s pledge.
She believes targeting pregnant women will prevent young mothers from dying of pneumonia.
“Given the high unmet need of immunisation and pneumonia, we must focus on pregnant women to keep every child alive,” she said.
If these innovations prove successful, Uganda would see its deadly two-fold public health crisis reduced to one: pneumonia death.
This series is funded by the Bill & Melinda Gates Foundation