A mug and a mission—protecting children from pneumonia

November 10, 2017 by Lauren Newhouse

Perspectives from The Gambia’s immunization program manager

Dawda Sowe standing outside.

Dawda Sowe. Expanded Programme on Immunization manager in The Gambia. Photo: PATH/Lauren Newhouse.

Among the odds and ends in his office, Dawda Sowe stores an unlikely treasure. A mug.

In and of itself, it’s just a piece of ceramic. But upon closer examination, it becomes clear that the mug is special—a relic from a time when The Gambia was blazing a trail among low-resource countries to introduce a vaccine against the most common cause of severe childhood pneumonia, the pneumococcus.

On the mug is a photograph of the first Gambian child receiving the pneumococcal conjugate vaccine (PCV).

The person delivering the vaccine—Mr. Sowe.

At the forefront of history

Mr. Sowe has spent his career on the front lines of immunization in The Gambia, and of pneumococcal vaccine history for that matter. Through achievements and setbacks, he’s been there—acquiring a unique vantage point along the way.

Today, he manages The Gambia’s Expanded Program on Immunization (EPI) within the Ministry of Health and Social Welfare. His office hums with energy as staff go about the complex work of coordinating the nation’s immunization program. Their goal—to ensure that every child receives their routine vaccinations.

“I work with a team of technical staff responsible for different immunization components,” Mr. Sowe explains. “As program manager, I coordinate across these staff so that the different building blocks work out as expected. I also advocate for immunization program support and propose vaccine introductions.”

Some of the components he’s talking about include logistics around vaccine availability and distribution; data management to identify immunization trends and drop outs; communications to address barriers to services and improve coverage; and surveillance to monitor disease trends.

“Why should cost be a barrier to saving lives when the market is there?”
— Dawda Sowe

A day to remember

“The two vaccines we always say are reducing the most infant mortality are rotavirus and pneumococcal vaccines,” he explains. “I was part of the EPI team when The Gambia introduced pneumococcal vaccine in 2009. We were the second country supported by Gavi, the Vaccine Alliance to introduce after Rwanda. Back then, I was a communications officer focused on advocacy so that people would accept the vaccine. Our theme was, ‘Immunize your child to save lives.’”

The opening day ceremony in Serekunda, The Gambia was a big deal—launched with a speech by the then Vice President. It was there that Mr. Sowe made history by vaccinating the first Gambian child against pneumococcal disease.

“Pneumococcal disease was the leading cause of childhood deaths back then,” Mr. Sowe recalls. “Now, it no longer holds that top spot. We’ve seen infant deaths and illness from pneumonia and other pneumococcal diseases fall significantly with the contributions of pneumococcal vaccine and other treatment and prevention measures.”

In fact, in The Gambia, pneumococcal pneumonia cases have since declined by more than 60% among children younger than 5 years old. Other invasive pneumococcal diseases like meningitis and sepsis (blood infection) have also dropped, by more than 50%.

Mug with photo of a man vaccinating an infant, with text, "Immunize your child."

This gift mug, distributed around the time that The Gambia was introducing PCV in 2009, shows Dawda Sowe administering pneumococcal vaccine to the very first Gambian child on opening day. Photo: PATH/Lauren Newhouse.

Why should cost be a barrier to saving lives?

Today, it’s clear how much Gambians value this lifesaving vaccine. Uptake is a laudable 95% among children nationwide. But, the job is not done. Enduring hurdles include reaching the last remaining children, resolving storage and cold chain issues, and maintaining the man power to do the work.

And then there’s the cost.

Current pneumococcal conjugate vaccines are one of the most complex and expensive kinds of vaccines to manufacture. At regular price, they’re entirely unaffordable for low-resource countries. A financing mechanism called the Advance Market Commitment (AMC) helps bring the price into more feasible territory for these countries.

For The Gambia, the AMC price is currently $3.11 USD per dose. Each child needs three doses, however, which adds up to more than $9 per child. Additionally, Gavi then pays 95% of the AMC price and The Gambia picks up the remainder under a co-financing policy. When all is said and done, pneumococcal vaccines make up around a third of Gavi’s global funding portfolio. To be sure, making all of this work is no simple undertaking.

“Even with the discount, it’s still a substantial sum for us to pay as a low-resource nation if you factor in the other vaccines in our portfolio,” explains Mr. Sowe. “We’ve never defaulted on our co-financing obligations, but if that were to happen, all that we’ve achieved would go down the drain. For countries graduating from Gavi support, funding their vaccine portfolio is getting even more difficult. This is a high-impact intervention. Why should cost be a barrier to saving lives when the market is there?”

At PATH, we concur. Which is why we’re collaborating, in The Gambia and beyond, to advance the development of more affordable pneumococcal vaccines. Success would free up valuable country and donor funds for other health priorities and lessen the risk of countries ceasing to use the vaccine for affordability reasons.

A journey for the ages

In the effort to immunize The Gambia’s children against pneumococcal disease, from the first to the last, Mr. Sowe’s journey has put him at pivotal moments in his country’s history. On traversing that terrain, he says that the philosophy has been as ever-present as the work itself. “Saving even a single life is important because you don’t know what that life could be in the future.”

Surely the child on the mug, who was given a better chance at survival and good health, would agree with that.

Want to learn more about vaccines against pneumococcal disease and how PATH’s work fits in? Read the National Geographic article “Here’s Why Vaccines Are So Crucial.”

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