“Resistance to the Covid-19 vaccine has also contaminated other vaccinations”

One crisis can hide another. While all attention remains focused on the response to Covid-19 on the African continent, other killer viruses are rampant. At the end of April, the World Health Organization (WHO) and Unicef ​​alerted together on the occurrence of “Major epidemic outbreaks” measles, yellow fever and variant poliomyelitis in twenty African countries in the first quarter, eight countries more than in the same period in 2021.

Between January and March of this year, Africa even experienced a 400% increase in measles cases. Somalia, Nigeria, Ethiopia and the Democratic Republic of Congo (DRC) are among the most exposed countries, but the measles virus being ten times more contagious than the new coronavirus, the worst is to be feared.

These epidemic resumptions were nevertheless predictable and even feared, as mass and routine vaccination campaigns have been disrupted since the start of the SARS-CoV-2 pandemic. For the year 2020 alone, the WHO had recorded delays in primary vaccination against measles for 22 million newborns.

In addition, in 2019, only six countries on the continent had achieved vaccination coverage of 95% of their population and three in 2020. For Tedros Adhanom Ghebreyesus, head of the UN agency, he is now “urgent to put essential immunization services back on track and launch catch-up campaigns”.

Geneviève Begkoyian, doctor in Kinshasa, UNICEF health manager for the DRC, looks back on two years of a pandemic that “absorbs a lot of energy and funding” at the expense of other vaccine-preventable diseases.

Can you tell us what is the epidemic situation in the DRC regarding measles?

Genevieve Begkoyian For the first four months of the year, there were 47,618 cases of measles and 693 children died. This is almost as much as for the whole of 2021, when there were 55,771 cases and 783 deaths. Out of 519 health zones, 179 are at risk: 64 are in an epidemic and 115 are nearby, likely to be reached quickly. We must therefore act very quickly.

Before the age of 1 or 2 years, from birth, a child must receive 17 injections and drops: BCG, polio, etc. It’s systematic. The mother must return six weeks later with her baby to the health center for the follow-up. When they don’t come back, we call them “zero doses”. This cohort was 400,000 in 2021. It is feared that, for 2022, it will be 450,000. These children are not protected, but also pose a risk to those who have not completed their full cycle of vaccination.

For this preventable disease, the vaccination coverage of fully vaccinated babies aged 12 to 23 months had reached 53% in 2020 after three years of efforts by the Congolese state, which had relaunched routine vaccination. In 2021, it fell sharply by more than 10 points to 42.5%. It’s a disaster. This shouldn’t happen. It’s absurd.

What happened ?

The Covid has been there. The DRC is a continent country all on its own, almost four and a half times the size of France, with 90 million inhabitants and 26 provinces, a lot of poverty, and areas of conflict in the east.

If there is one health action that parents can offer their children, it is vaccination. And, until then, there was no refusal, no vaccine hesitation, the coverage rate increased steadily. Except that, for two years, ultra information, with even a certain excess, and rumors on social networks have gradually installed doubt and fear.

In general, when an epidemic occurs, parents whose children have escaped routine vaccination travel with their children to health centers or during mass vaccination campaigns. With the pandemic, people were initially afraid of being contaminated by Covid, a disease about which we did not know much, or of contaminating their children in health centers. Then came the fear of being manipulated, of becoming guinea pigs for an experimental vaccine.

Why ?

The scandal of the AstraZeneca vaccine, which the countries of the North no longer wanted as a health precaution, but which was sent en masse to the countries of the South by the international aid mechanism Covax, has done a lot of damage here. President Félix Tshisekedi did not want it for the Congolese and redistributed 1.7 million doses received to countries that accepted it, such as Angola, the Central African Republic or Madagascar. This episode fueled doubt, even rejection. And then, the Congolese, whose population is very young [74 % ont moins de 35 ans]have seen few people die of Covid, if any.

Officially, there have been only 1,338 deaths, half of them in Kinshasa. People quickly said to each other: “What’s the point of getting vaccinated against a disease that comes from Europe, that you can’t see, and with a vaccine that can cause an embolism or phlebitis? » In mid-May, we were only at 2.4% of Covid vaccination for the first dose and 1.4% for the second. The problem is that this resistance has also contaminated other vaccinations.

What do you think of integrating Covid vaccination into routine campaigns as Ghana and Nigeria have been doing since December 2021?

Today, mistrust is such that it is important not to associate Covid-19 vaccination with others, as recommended by the WHO. The Congolese authorities hesitate. Especially since the priorities are elsewhere. Last year, 20,000 people died of malaria. The Congolese want to recover impregnated mosquito nets, or even have access to the new vaccine. To the east, cholera is rampant along Lake Tanganyika and the Kivus. There are also the measles outbreaks we talked about. The Covid is really the least of their worries.

How do you deal with these challenges?

For measles, by the end of May, we will vaccinate 2.7 million children aged 6 months to 59 months in the 64 health zones in epidemic to try to stop the contagion, then, in June, move on to neighboring health areas. At the same time, we are going to start a big door-to-door campaign against polio for 7 million children in seven provinces by introducing the new oral vaccine, but fear and vaccine hesitancy are feared.

My great concern as UNICEF’s head of health for a country like the DRC, where millions of pregnant women need to be properly monitored and where millions of children are born, I spend 90% of my time on the Covid. There is considerable international pressure. We are overwhelmed by the fear of the Covid and we have forgotten the major diseases that kill in silence. This absorbs too much of our time, an enormous amount of energy and funding that cannot be mobilized for other illnesses.