Nepal research has lessons for global vaccination efforts

Gavi – the Global Alliance for Vaccines and Immunization – is meeting in Geneva to discuss progress on its plans to vaccinate an additional 300 million children by 2020. The Oxford team are working on assessment of the introduction of new vaccines in one of the world’s poorest countries.

With limited resources, Nepal needs to make sure that any vaccines it introduces will be effective.

Professor Andrew Pollard, Oxford Vaccine Group 

The latest work is built on ten years’ partnership between Oxford University's Oxford Vaccine Group, Kathmandu’s Patan Academy of Health Sciences and New Zealand’s Otago University. Together they have studied the spread and prevention of serious bacterial infections in Nepali children. Nepal is one of the world’s least economically developed countries in the world and infection-related illness imposes a high burden on its society and economy. Infections are particularly an issue for children less than five years of age, with pneumonia the leading cause of death for the age group.

Oxford’s Professor Andrew Pollard explained: ‘Vaccination is key to preventing fatal and serious infectious diseases in childhood – and throughout life. With limited resources, Nepal needs to make sure that any vaccines it introduces will be effective. We have worked with the Nepali doctors to assess a vaccine against Hib, an important cause of meningitis and pneumonia, and that vaccine is now part of Nepal’s expanded programme of immunisations.

‘We also looked at different ways to use a pneumonia vaccine that protects against ten types of pneumococcus, a common bacteria that can also cause pneumonia and meningitis. Our study with the team in Nepal showed that a programme of two doses of the vaccine in early life and one at nine months was a more effective way to prevent infections. The Nepalese Government adopted that programme last year.’

The team are now carrying out a four year evaluation to assess the impact of the pneumonia vaccine programme, funded by Gavi. This important follow-up impact study will look at the number of children hospitalised with meningitis and pneumonia as well as the number of children in Kathmandu carrying the pneumococcal bacteria.

The four-year study will also provide in-depth understanding of the effectiveness of vaccination in Nepal. That can provide lessons for vaccination efforts worldwide and ensure we meet the 300 million target.

Professor Andrew Pollard, Oxford Vaccine Group

The funding has also enabled the team to provide extra training to microbiology technicians at Patan hospital, enabling them to identify different strains of pneumococcus to improve monitoring of the bug and so strengthen efforts to limit its impact.

Professor Pollard said: ‘Gavi aims to reach 300 million more children with vaccines between 2016 and 2020, preventing a further five to six million more deaths. The information from Nepal regularly feeds into a global database, allowing researchers to spot emerging trends and perhaps identify weaknesses in the bacteria that we can target. The four-year study will also provide in-depth understanding of the effectiveness of vaccination in Nepal. That can provide lessons for vaccination efforts worldwide and ensure we meet the 300 million target.’