Zimbabwe: Saving Zim From Cholera, One Vaccine At a Time

Rumbidzayi Zinyuke — Health Buzz

This week, the country launched a massive oral cholera vaccination campaign during which at least 2,3 million Zimbabweans will receive a single dose.

Cholera has been with us since February last year when the first case was detected in Chegutu.

Back then, no one expected that the outbreak would grow rapidly to affect more than 21 000 people while claiming the lives of more than 400 people.

In 2008, about 98 000 cases of cholera were reported and more than 4 000 people died.

The last outbreak to be reported in the country was in 2018 and this one affected more than 10 000 people.

After this outbreak, Government rolled out an oral cholera vaccination which was targeting people in the most affected areas.

And this was successful as it worked to put a stop to new infections and prevent the outbreak from reaching the magnitude of the 2008 epidemic.

This is the same vaccination campaign now being rolled out by Government and its partners to try and arrest the current outbreak.

With support from World Health Organisation, UNICEF, Gavi-the vaccine alliance, the International Coordination Group for Cholera control (ICG) and other national and international organisations, the Ministry of Health and Child Care is on course to vaccinate those most at risk of the diarrhoeal disease.

The vaccine vials being used in the ongoing campaign.

For this round, 2,3 million people aged one-year-old and above, living in 160 wards within 26 high risk districts in Harare, Mashonaland West, Mashonaland East, Mashonaland Central, Manicaland, Masvingo and Midlands are being targeted.

These districts are considered the main drivers for the outbreak.

The main operational strategy used in this campaign is house-to-house to minimise gatherings and further spread of the disease.

This is being complemented by fixed vaccination points in all health facilities within the catchment area.

While it has only been a few days since launch, uptake has been good according to those on the ground.

But as with all vaccines, there is bound to be mistrust and misconceptions surrounding the deployment of vaccines.

Remember the Covid-19 vaccination campaign which was also met with resistance from some sections of the country.

The main reason there was hesitancy was lack of knowledge about these vaccines, which were suddenly being introduced.

Of course that campaign was successful as people later realised why it was important for them and their families to get the jab.

The same needs to happen now.

Almost everyone knows about cholera and what needs to be done to prevent it but there are some who do not know about the vaccine as one of the tools that can be used for protection against the disease.

Some may just have negative attitudes towards vaccines in general.

Thus there is need to up the awareness campaigns so that everyone knows why they need to get it.

Kuwadzana 6 community health worker in Mrs Queen Bvunzani said: “Cholera is a terrifying disease. We have been encouraging people to come early to hospital and to report any diarrhoea cases to the clinic as soon as possible.

“We have also been educating them about the cholera vaccine which is now being rolled out. We are telling people to continue practicing good personal hygiene and drinking safe water even after getting the vaccine.”

She said as they went about the community with the vaccine, many people accepted it although a few refused.

“Their reason for declining the vaccine was that there are too many vaccination programmes around. Some said they had been vaccinated against Covid-19, then polio and now cholera. Some are not sure that after taking all these vaccines they will still be safe.

“Of course we continue to tell them how these vaccines are safe so that they can make an informed decision,” she said.

It is these misconceptions and the mistrust that need to be addressed to ensure communities do not unknowingly reject lifesaving medicines.

According to the World Health Organisation, the cholera vaccine is effective at preventing cholera.

But the health body recommends the use of the vaccines as an additional measure to other interventions such as provision of proper sanitation and availability of clean water to prevent the disease.

The first cholera vaccines were developed in the late 1900s. These were the first widely used vaccines made in a laboratory.

Since then, there have been newer vaccines that have been developed and approved for use.

Cholera vaccines are safe in pregnancy and to those with poor immune function.

These vaccines are licensed for use in more than 60 countries and remains cost effective for countries where the disease is common.

As with most vaccines, adverse effects could be recorded but these have been few with regard the oral cholera vaccine.

These include gastro-intestinal discomfort, fatigue and vomiting in some instances.

Government has however, put in place a monitoring, reporting and investigation mechanism for any adverse reactions to the vaccine that may be reported.

UNICEF Zimbabwe chief of health and nutrition Dr Alex Adjagba said the cholera vaccine being used in Zimbabwe is the Euvichol-Plus vaccine, produced by EuBiologics of Korea.

This vaccine was approved by WHO in 2015 and is recommended for use in individuals aged one year and above.

“Normally you need two doses, given two weeks apart and these doses will give you protection for approximately two to three years. If one needs a booster dose, it should be administered three years after the second dose.

“But currently, there is a global shortage of cholera vaccines. The manufacturers are not able to meet the demand from countries in need of the vaccines. Because of this shortage, the International Co-ordinating Group on Vaccine Provision has been managing the distribution of vaccines to ensure that everyone can get it.

“Since Zimbabwe received 2,3 million doses, we cannot give two doses because then, we would need more doses to reach the targeted population. So Zimbabwe is giving one dose of the vaccine which will give protection of six months to those who get it,” he said.

This means those who are at risk will get six months of being safe from infection while Government is rolling out other long term measures to curb future outbreaks.

But just because someone has received this protection, it does not mean they can do away with taking personal hygiene seriously.

Dr Alex maintains that vaccination is just an additional tool and everyone will need to continue accessing clean and safe water as well as proper sanitation to effectively end cholera infections.

“People should understand that hygiene is important. They cannot do away with regular hand washing under running safe water, drinking treated or boiled water or eating properly cooked food. The impact of cholera is visible to more than 20 000 people so communities need to continue being safe,” he said.

The issue of misconceptions surrounding vaccines is one that keeps rearing its head and pulling in the opposite direction of progress that would have been made.

But Dr Alex said most of these can be addressed through creating continuous awareness around vaccines.

He said it is not something to be thrust on people but should be done well ahead of time to ensure that people do not feel like they are being forced to take the vaccine.

“Most misconceptions with regard to any vaccine are probably due to inadequate awareness. We have to do a lot of communication to sensitise the nation on these. There are myths about the link between vaccines and infertility, safety, religious beliefs where people think they are made from ingredients which they are not supposed to consume.

“Health care workers need to keep educating people so that they do not feel an awareness campaign is only being done just so they can take a vaccine,” he added.

Since this epidemic started, collaboration has been a key part of the national response.

Working with all stakeholders, including the communities themselves, will definitely go a long way in ensuring the vaccination campaign coupled with other preventive measures becomes successful.

After all, prevention will always be the better option.

And vaccines can get us there.

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