The scourge of a vaccine
The late Alvin Toffler American writer and futurist is noted to have stated, “the illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.” No time have I found this quote more poignant than in the last few days when I have experienced the height of intellectual and scientific blasphemy that any society may care to inflict on themselves.
In these days I heard and read some of the most bizarre information about immunisation and the process of drug registration that made me question whether the World Health Organisations (WHO) advice on the movement of pharmaceuticals in international commerce applied to Ghana. All through graduate school and in my professional practice, I have known that a standard prerequisite for any pharmaceutical to be transported internationally, except for military use, required that the product was licensed in its country of origin. Thus, the first exception I took in the conspiracy fuelled debate about why the Malaria Vaccine Phase IV trials were taking place in Ghana was as to why the product licence was issued in Europe. It was the red flag that indicated to me that many who were engaging in this debate were approaching it from an emotional rather than an objective standpoint.
I was of this view because the Phase III trial of RTS,S/AS01 (RTS,S) as it was known then was conducted over 5 years (2009–2014) in seven sub-Saharan African countries: Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique and the United Republic of Tanzania. Thus, in my view, if there was a clandestine intention to rake havoc and sterilise Ghanaians from birth, it could have been undertaken much earlier on the blind slide of the larger population without any of the acrimonies that were being experienced. I took the position therefore that the only option was to engage in open debate pitching the evidence of usefulness against all who cared to debate. It was an open invitation from me to anyone to pitch their truth against mine on this particular topic.
However, as I undertook this endeavour, I began questioning why we had gotten here in the first place. The fact is the government of Ghana applied to be part of this process without any cohesive action. Following the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) announcement on July 24, 2015 that it had adopted a positive scientific opinion, under the Article 58 process, for RTS,S in children aged 6 weeks to 17 months; ten African countries including Ghana applied to the WHO to be included in the rollout of this vaccine. Of the ten, only three were selected. On the basis of the rigour of the selection process, this was a vote of confidence in the contribution that some of Ghana’s medical research institutes had made to malaria research. It was also an acceptance of the emphasis Ghana had placed on well-functioning malaria and immunization programmes. Currently, the country has an immunisation rate of over 95% in all children under five years, much higher than most countries in the world.
The selected countries have had about three years to prepare for this exercise. In fact, on the 20th of February 2019, the 11th draft of a 36-page document “Malaria Vaccine Implementation Program: Communication Strategy for Ghana” was released. This document was to be the basis of engaging the general public, media groups, and other stakeholders to ensure the smooth running of the process and effective citizen education. Sadly, the final document has never been released as I write. It suffered the shelving curse. Information indicates that there was some miscommunication between officials of the Ghana Health Service (GHS), the Attorney General’s Department and the World Health Organisation resulting in a failure to roll out any training for media outlets and other stakeholders or the full implementation of the contents of the document. Thus, even on the eve of launching the program, the full list of participating health facilities in the selected regions was not public knowledge. This information was released in a frenzied four-hour blitz by officials of Ghana Health Service after the backlash of the uninformed negative press had started on Friday May, 3 days after immunisation was underway.
I was mortified when I saw the volume of information being dumped. In my mind’s eye, it was akin to an uncoordinated wartime bombing. I was not too sure if the GHS had thought through response for the firefight it had wrongly got itself into. In my state of confusion, I paused and asked myself what the GHS was trying to achieve? I came to the conclusion that if their aim was to educate the public on the usefulness of this exercise, their actions depicted the height of communication panic and knee jerk action, devoid of any public relations crisis management savvy. The best that volume of information was going to do was to give any propagandist an unwarranted shot of adrenaline, resulting in going to town claiming those in charge were prepared. The truth is those in charge had dropped the ball; they had botched this so badly.
It was at this point that I remembered Toffler’s introductory quote and realised we as a people were becoming typical examples of twenty-first-century illiterates. We had failed to unlearn following the Ebola debacle and with our brains full could not relearn from such a brilliant document, let alone implement its contents. Once again, our bureaucrats had managed to sit at the table, collect sitting allowances, craft a document and see its contents go stale. Characteristic of nature, which abhors a vacuum; the uninformed spin-heads filled the communication space and went to town with their conspiracy theories and boy oh boy the gullible bought into them swallowing their misinformation hook, line, sinker, and rod.
As one who is becoming accustomed to aspects of our gallery playing behaviour, in times like this, a chill runs down my spine. This happens because malaria is not a disease that affects only Ghanaians. If it was then perhaps, we could close our borders and go at each other’s throat without batting an eyelid. Unfortunately, malaria kills approximately 438,000 people a year worldwide and causes illness in hundreds of millions more, with most deaths occurring among children living in sub-Saharan Africa. In Ghana, though its overall contribution to our death burden has dropped by 42.2 per cent in the last 10-years, it places second only to neonatal disorders as causing the most premature death in early life. With rubbish engulfing us by the day, our water bodies becoming more stagnant and muddier and our gutters chocked with a mixture of our excreta and filth; we have demonstrated that we are further away from the eradication of the Anopheles’ mosquito than the generation before us ever was. Therefore left to our devices, malaria will continue to plague us and exact a huge toll.
To do so will not only be the height of irresponsibility but an indication to the world at large and the international health community that our commitment to health is all but a bleat of hot air. This is why some of us will impress on those responsible for ensuring such programs are a success to be up and doing and not be this pedestrian in their actions. They cannot continue to be reactionary to negative news and only shut the stable door minutes after the horses have bolted. This was definitely avoidable, however, it has turned into a massive bloodbath.
By Kwame Sarpong-Asiedu