Monday January 10 2011

The rot in yellow fever vaccination

By Flavia Lanyero

Even as Uganda struggles to cope with an outbreak of yellow fever, some conmen are selling vaccination cards to people who have not been vaccinated, a Daily Monitor investigation has shown.

At the South African embassy for example, six out of 10 yellow cards presented as part of requirements for visa applications, are found to be fake—creating the risk of the disease being spread to countries not infected.

The fraud
At Kampala City Council Hospital, just next to the imposing White Hall that houses the council’s offices, the illegal trade in yellow fever cards is lucrative and bustling.

The “hawkers”, casually dressed unlike their tattered-trouser donning counterparts downtown, are busy; hovering in the hospital compound on the look out for clients to buy the vaccination cards at a give-away price.

The well-knit web starts from the hospital gatekeeper. She is quick to ask whoever is entering the premises what business brings them there. If the answer is to get the vaccine, the small talk begins.

Under normal
circumstances, vaccination and a card for proof costs Shs46,000 at this facility—but if you bargain with these “hawkers”, you could get one for as low as Shs15,000, without even being vaccinated. Our reporter was charged Shs25,000 for the card (read detailed account of this transaction above).

The South African High Commissioner to Uganda, Mr Jon Qwelane, says the black market in vaccination cards is a serious problem. He does not just fear the spread of the disease to his country but the blatant abuse of ethical standards of disease control.

He said even some senior Uganda government officials (whom he opted not to name) have been bounced at the embassy for showing fake cards.

“I definitely will not be complementary to Uganda on this,” Mr Qwelane said. “We can have as many as five to six fake cards out of 10. The thing is what is Uganda doing about it?”

Enacting laws
“Any orderly state starts from the basis of fulfilling their obligations, we should see Uganda councillors enact laws to stamp it out, police arrest people and they are convicted,” he added.

But the Kampala District Director of Health Services, Dr Livingstone Makanga, says whereas officials have heard about the problem no one has been arrested—the last case having been about three years ago.

He says the practice of selling fake cards initially came up because of a shortage of the vaccine but added that the government was now stocking the medicine—and discouraged use of dubious means.

“We have one signatory to the booklets and certificate with particular stamps that are supposed to be authentic. We have written to the different embassies and consulates of the countries notifying them of the changes,” Dr Makanga said.

But these particular cards are genuine, bearing the official hospital stamp and raising the possibility of insiders being involved.

The Centre for Disease Control estimates that a traveller’s risk of acquiring yellow fever is determined by various factors, including one’s immunisation status, location of travel, season, duration of exposure, occupational and recreational activities while travelling, and local rate of virus transmission at the time of travel. The vaccine should be administered 10 days before a person travels.

Mass immunisation
Thirty-nine out of the 53 countries in Africa are at a high risk of transmitting yellow fever, including Uganda.

Last week, the Ministry of Health started a process to secure Shs12 billion as a supplementary budget to fight an outbreak of the disease in northern Uganda. The funds will facilitate mass vaccination in 26 districts, although the disease is still confined in the 10; Abim, Agago, Lamwo, Pader, Kitgum, Gulu, Arua, Kaabong, Kotido and Lira.

The Minister for Health, Dr Stephen Mallinga, while asking Parliament to approve the money request, said the ministry had limited resources and capacity to do laboratory tests for the disease.
Close to 50 people have died and another 190 infected in the past couple of weeks since the disease was first detected.

Health specialists fear that more people could die of the disease. The specialists also worry that the disease could spread further before the vaccination campaign begins.

The Principal Health Officer at the Uganda Virus Research Institute, Dr Julius Lutwama, said if people are not vaccinated on time, some may die. “There is no alternative cure,” he said. Yellow Fever is spread by mosquitoes.

Reports also show that severe attacks by the disease may cause damage to the liver. Treatment is aimed at reducing the symptoms for the comfort of the patient.

While awaiting vaccines, the Ministry of Health has urged people to avoid being bitten by mosquitoes, especially during day time, to destroy mosquito breeding places like stagnant water around homes and to sleep under insecticide-treated mosquito nets.