Prioritizing vaccine-preventable diseases

WHO, Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and other partners, are working together to ensure equitable access to vaccines in Africa through the COVAX Facility, and with the African Union through the African Vaccine Acquisition Task Team (AVATT).

Several countries have maintained high routine immunization coverage and demonstrated readiness for introduction of COVID-19 vaccines by developing focused national deployment and vaccination plans (NDVPs).¹ In West Africa, Member States have achieved good immunization coverage and their NDVPs were approved by the Regional Review Committee with minor clarifications.

In Nigeria, the National Primary Healthcare Development Agency (NPHCDA), with support from WHO, has put in place measures to ensure that no eligible person misses routine immunization in the country.

In Nigeria, the National Primary Healthcare Development Agency (NPHCDA), with support from WHO, has put in place measures to ensure that no eligible person misses routine immunization in the country. Data for 2020 will only be available in July 2021, but there is much work to be done to reduce the burden of zero-dose children.

Seven countries² have established a national immunization technical advisory group (NITAG) in the past year. Thirty-eight countries in the Region now have such an advisory group.³ Following on WHO’s 2017 recommendation for a two-dose measles (MCV2) regimen, 34 countries have integrated MCV2 into their routine immunization schedule in the past 10 months. These include Madagascar and the northern region of Nigeria.

The five remaining countries⁴ endemic for maternal and neonatal tetanus are making progress towards elimination in the next few years. Eighteen countries are now using tetanus-diphtheria vaccine instead of tetanus toxoid for children aged four years and older, and for women of childbearing age.

Neisseria meningitidis epidemics have dramatically reduced with immunization protecting hundreds of millions of Africans over the past 10 years. However, meningitis outbreaks caused by other bacterial forms of the disease are increasing. The Framework for the implementation of the global strategy to defeat meningitis by 2030 in the WHO African Region, which will be considered by the Seventy-first session of the WHO Regional Committee for Africa, aims to support countries to end bacterial meningitis epidemics by 2030.

Eight countries⁷ in the Region are yet to introduce the rotavirus vaccine, and six countries⁸ have still not introduced the pneumococcal conjugate vaccine (PCV). Despite the global shortage of human papillomavirus (HPV) vaccines, 16 of the targeted 35 Member States have introduced the HPV vaccine. Since July 2020, Mauritania and Cameroon have introduced the human papillomavirus (HPV) vaccine. Benin introduced hepatitis B birth dose in 2020, bringing the number of countries now providing this vaccine to newborns to 14.⁹ This figure falls 11 countries short of the regional target of at least 25 Member States introducing the vaccine by 2020.

The Effective Vaccine Management Assessment (EVMA) conducted in the Region over the past 10 years showed that the performance of the immunization supply chain system in African countries is low, with only seven countries achieving a minimum performance of 80% at each supply chain level. A tailor-made WHO mLearning programme on immunization supply chain systems in the Region will be launched in July 2021.

Tackling the burden of HIV, TB and hepatitis

Steady scale-up of HIV testing and antiretroviral therapy (ART) continues in the African Region. More than 80% of the 25.7 million people living with HIV know their status and 70% of them are receiving life-saving ART.

In 2020, a total of 18.2 million people living with HIV were receiving ART and 13 Member States¹⁰ had achieved or were very close to achieving their 90-90-90 targets. Consequently, new HIV diagnoses and HIV-related deaths in the African Region have fallen by 35% and 46% respectively over the last 10 years.

The African Region has also made good progress, with a 16% reduction in TB incidence between 2015 and 2019. Five high TB-burden countries¹¹ have reached the 2020 milestone for TB reduction. Kenya, Mozambique, Sierra Leone and the United Republic of Tanzania are all high-burden countries and they have already reached the 2020 milestone of a 35% reduction in TB deaths. However, an estimated 2.5 million people live with TB in the WHO African Region, representing 25% of the global burden. Improving access to screening and diagnosis is a priority as only 1.4 million cases were reported in the Region in 2019.

Momentum is building on action to address viral hepatitis, a long-neglected public health problem responsible for most cases of liver cirrhosis and cancer in the Region. WHO has worked with 27 Member States¹² to develop national hepatitis plans. Rwanda and Uganda have established free national public health hepatitis testing and treatment programmes and some other countries¹³ have commenced subnational or pilot projects.

Action on malaria and neglected tropical diseases

The WHO African Region accounts for 94% of the global malaria burden, with more than 215 million preventable cases and 384 000 deaths in 2020. Seven countries¹⁴ achieved the 2020 milestones of reducing malaria incidence and deaths by 40%. However, overall the Region was off track by 37% and 25% for the malaria incidence and deaths milestones respectively.

Even with COVID-19 restrictions in place, indoor residual spraying (IRS) continued in 26 countries¹⁶ and insecticide-treated bednet (ITNs) distribution was done in 33 countries.¹⁷ Thirty-seven countries used the appropriate confirmatory testing procedures before treatment of malaria, and 32 countries are actively monitoring and managing insecticide resistance. Malaria programme and mid-term reviews were conducted in 17 countries.¹⁸

Ethiopia has enhanced surveillance to respond to the spread of the invasive Anopheles Stephensi mosquito species that is associated with urban outbreaks, and seven countries are on alert.¹⁹ Support is also being provided to countries on other emerging threats such as vector insecticide resistance, antimalarial drug resistance, and parasite mutations causing false-negative malaria test results.

Action on neglected tropical diseases (NTDs) is maintaining good momentum, with 41 countries in the Region having been certified free of dracunculiasis.²⁰ Leprosy elimination as a public health problem was sustained in 46 countries.²¹ Côte d'Ivoire and Togo were validated for elimination of human African trypanosomiasis (HAT) in 2020. Benin, Equatorial Guinea and Uganda submitted dossiers for validation of HAT elimination. The annual incidence of HAT in the Region has remained below 1000 cases since 2018.

The Expanded Special Project for Elimination of NTDs (ESPEN), focuses on the five NTDs amenable to preventive chemotherapy.²² ESPEN Collect, a survey support services platform launched in 2018 to support collection of high-quality data using mobile phones to support epidemiological surveys, supported 27 surveys in 11 countries²³ during the reporting period.

Addressing the rising challenge of noncommunicable diseases

The burden of noncommunicable diseases (NCDs) is increasing in the Region, and this epidemiological transition requires that health systems adapt to integrate NCD prevention and control services.

All countries have strengthened the continuity of NCD services as part of the COVID-19 response using WHO guidance.

All countries have strengthened the continuity of NCD services as part of the COVID-19 response using WHO guidance. A six-month supply of insulin was donated to 28 countries²⁶ during the COVID-19 pandemic to prevent diabetes-related morbidity and mortality.

Twenty-three countries²⁷ are using the WHO Package of Essential Noncommunicable Disease Interventions for primary care in low-resource settings, including seven countries²⁸ that are implementing the HEARTS technical package for cardiovascular disease management in primary health care. In Zimbabwe, for instance, about 30 facilities in two districts are now implementing integrated NCD services, covering a population of approximately 160 000. Ten countries²⁹ have scaled up cervical cancer screening and treatment, and countries are also focusing on increasing service coverage and the quality of care towards improving outcomes for children with cancer.

Oral health action plans focusing on noma are being successfully implemented in 10 high-burden countries³⁰ to eliminate noma as a public health problem using WHO’s step-by-step guidance. In Niger, for instance, 27 noma patients benefited from reconstructive surgery, despite service disruptions. This included two patients from Benin and two from Burkina Faso, in line with WHO guidance recommending that neighbouring countries use the Hilfsaktion noma centres in Niger and Guinea-Bissau to care for patients suffering the after-effects of noma.

Thirty-one Member States³¹ are implementing multisectoral NCD national plans. In Senegal for example, implementation of the plan has included the “Be Healthy, Be Mobile” SMS awareness-raising campaigns. This has led to messages on diabetes care reaching nearly 370 000 patients and their families and health care providers, and provision of health messaging, including around COVID-19, as part of a six-week advice programme during Ramadan.

About 85% of people with mental disorders are unable to access needed care in the African Region. To improve access to mental health services, Kenya is implementing the Quality Rights initiative, which aims to ensure that mental health care is anchored in human rights and is recovery-oriented. Nigeria, Sierra Leone and South Sudan have developed and strengthened legislation and strategic plans, which has led to improvements in service delivery for mental health.