Vaccines are known to be a cheap, effective way to save lives. Yet their introduction into national immunization programmes must be supported by data – and with the exception of The Gambia – the acquisition of good data remains a problem in West Africa. Consultative Workshop on paediatric bacterial meningitis surveillance: from left – Dr Thomas Sukwa (WR The Gambia, WHO); the Minister of Health & Social Welfare – Hon Fatim Badjie; Dr Martin Antonio (Senior Scientist – MRC Unit: The Gambia and Coordinator – PneumoWAR consortium); Dr Jason Mwenda (WHO AFRO); Mr Peter Noble (Director of Operations, MRC Unit: The Gambia)
In 2001, the WHO supported the establishment of the Paediatric Bacterial Meningitis (PBM) Network in selected countries in Africa. The Pneumococcal Disease Surveillance in the West Africa Region (PneumoWAR) consortium, led by Dr Martin Antonio (MRC Unit: The Gambia), was set up in 2009, and is part of this network. The aims of the network are to:

Provide evidence of Haemophilus influenzae type b (Hib) and Pneumococcal disease burden
Generate data on Streptococcus pneumoniae serotypes circulating in the region
Support advocacy for the introduction of Hib and Pneumococcal vaccines
Provide a framework to evaluate the impact following vaccine introduction.

WHO/AFRO’s surveillance strategy is to promote integrated disease surveillance with the objective of building sustainable, country-owned, intra-country networks of laboratory-based surveillance. Consequently, WHO has established a supporting sub-regional reference laboratory at the MRC Laboratories in The Gambia to enhance pneumococcal surveillance for the West African region. This involves partnership of all the WHO PBM Network - participating Ministry of Health-PBM sites in 22 countries (selected on the basis of performance, as well as likelihood of early uptake of new vaccines).

Monitoring vaccines
In 2009, The Gambia became one of the first countries in Africa to introduce the WHO-recommended pneumococcal conjugate vaccine - PCV-7 (Prevnar) – into its Expanded Programme on Immunisation. This is undoubtedly a major achievement in the country’s attempts to improve the health and save lives of its children. However, serotype replacement and anti microbial resistance have been observed in relation to pneumococcal conjugate vaccines and it is not known at present how this will impact on the vaccine’s effectiveness in Africa. Thus, surveillance is vital in tracking pathogens and understanding the changes that occur for the development and implementation of new vaccines and new diagnostics.

Better trained staff for better surveillance
In April 2011, The Medical Research Council Unit in The Gambia, in collaboration with WHO AFRO and the Ministry of Health of The Gambia, organised a second sub-regional hands-on laboratory training/workshop aimed at building PBM surveillance capacity among clinicians, laboratory and data staff. Participants from over 15 countries took part in the sessions which were held at the MRC’s laboratories in Fajara and the Royal Victoria Teaching Hospital in Banjul.

Providing leaders and opinion makers with the facts
The training was followed by a three day advocacy workshop at the Kairaba Hotel, Kololi, organized on the premise that African Governments are willing to introduce new vaccines into their national immunization programmes as long as a strong, evidence-based case for sustainable introduction can be made. In his opening remarks at the workshop, Dr Thomas Sukwa (on behalf of Dr Luis Gomes Sambo – Regional Director: WHO AFRO) said ‘the speedy and timely availability of quality data is crucial to the introduction of vaccines for diseases that are vaccine preventable. PBM has made a significant contribution in supporting vaccine introduction: 45 out of 46 countries now have the Hib vaccine; 6 out of 46 countries have introduced the pneumococcal conjugate vaccine (PCV-7) including The Gambia. Several other countries have also applied for support from GAVI to roll out the vaccines.’

Representatives from the region’s Expanded Programmes on Immunisation also discussed the issues surrounding data quality: among the obstacles identified were wrong laboratory results, and inconsistent results being shared with EPI managers as a result of laboratories not using Standard Operating Procedures.

Informed decision making
Although it is hoped that the children of West Africa will benefit from pneumococcal vaccination, ultimately the job of PneumoWAR and the PBM Network is to obtain objective data which may argue either for or against vaccine implementation. Pneumococcal disease is a major cause of mortality and morbidity in the sub-region: PneumoWAR aims to provide the evidence base on which the region’s Governments, Ministries of Health and Finance may make their decisions in relation to the implementation of the vaccines.