In early October 2018, the Democratic Republic of Congo (DRC) declared a new plan to significantly increase immunization in the Democratic Republic of Congo. This plan, known as the Mashako Plan, in honor of former DRC Minister of Health Leonard Mashako Mamba, draws support from the Bill and Melinda Gates Foundation, Gavi (the Vaccine Alliance), WHO and UNICEF. Created in the wake of recurrent outbreaks of infectious diseases, including Ebola, cholera and measles-rubella, the Mashako Plan intends to provide vaccine coverage to an additional 220,000 children in the Democratic Republic of Congo and help decrease the nation’s high child mortality rates to improve the overall health of the nation.
The Democratic Republic of Congo’s Mortality rate
The Democratic Republic of Congo has the ninth highest under-five mortality rate in the world, with 91.1 deaths per every 1,000 live births. All of the nations with higher under-five mortality rates are also in Sub-Saharan Africa. Six of them, i.e. Somalia, Chad, the Central African Republic, Sierra Leone, Mali and Nigeria have mortality rates above 100 per 1,000 live births. The infant mortality rate is 72 deaths per 1,000 live births and the neonatal mortality rate is 29 deaths per 1,000 live births in the DRC.
These mortality rates actually represent significant progress. In 1990, the under-five mortality rate was 184 deaths per 1,000 live births, the infant mortality rate was 118 deaths per 1,000 live births and the neonatal mortality rate was 41 deaths per 1,000 live births. Even in 2013, the DRC had the fifth highest under-five mortality rate.
Immunizations and Vaccines in the DRC
A lack of access to vaccines contributes to the DRC’s exceptionally high child mortality rates. The health system is greatly dependent on donors and the government only provides eight percent of the total funding for immunization. The remaining funding for immunization in the Democratic Republic of Congo is supplied by Gavi (49 percent), the World Bank (25 percent), UNICEF (9 percent), WHO (5 percent) and USAID (4 percent).
Vaccines that continue to be in high demand are Bacillus Calmette-Guerin (for tuberculosis); diphtheria, tetanus and pertussis (DTP); hepatitis B; polio; varicella (for chickenpox) and tetanus. In recent years, pentavalent (which protects against diphtheria, pertussis, tetanus, hepatitis B and Hib), pneumococcal and yellow fever vaccines have also become increasingly important.
As with mortality rates, progress has been made in immunization coverage in the past few decades. In 1999, only 25 percent of children in the DRC received a vaccine for diphtheria, tetanus and whooping cough. As of 2018, 81 percent of children received this vaccine due to the continued support from Gavi, the Vaccine Alliance.
However, this percentage is still low and overall immunization coverage needs to be increased. 1.8 million children in the DRC do not receive all of the necessary vaccines each year, contributing to outbreaks of polio, measles and yellow fever.
Mashako Plan and Immunizations
In response to these outbreaks, calls to improve coverage have been made within recent years. Felix Kabange Numbi Mukwampa, the DRC’s Minister of Health in 2016, declared at the African Ministerial Conference that universal access to immunization was central to health and development in the nation. Immunization in the Democratic Republic of Congo is crucial not only to reduce disease and death but also create relationships between families and healthcare providers, increasing the overall health of communities.
The Mashako Plan intends to increase immunization sessions by 20 percent, reduce stock outages by 80 percent, conduct monthly inspections of immunization provision and form a committee that will meet weekly to organize and allocate funding and supplies. It will primarily focus its efforts on eight of the DRC’s 25 provinces: Ituri, Kasai, Haut-Katanga, Mongala, Kwilu, Tanganyika, Kinshasa, Tshuapa and Haut-Lomami. In order to ensure vaccines are available, one of the largest vaccine storage facilities in Africa was opened on October 10, 2018, in the Kinshasa province.
According to Gavi, the DRC’s current Minister of Health, Dr. Oly Ilunga Kalenga, explained that this plan is being implemented because “vaccination is the most cost-effective public health intervention.” He went on to say, “when children get vaccinated, they are protected against all sorts of preventable diseases that would otherwise prevent them from developing their full potential.” An investment in immunization in the Democratic Republic of Congo is an investment in the future of the nation.
Nonprofits and the DRC
In order to accomplish this, the Gates Foundation is providing funding and technical support and PATH is coordinating the implementation along with the DRC National Ministry of Health and international organizations, including Gavi, WHO and UNICEF. The goal is to reach more than 90 percent immunization coverage by 2022.
Whether or not this plan will be successful is largely dependent on the commitment of the DRC’s government as well as the international organizations that pledged to provide funding and support. These parties all contribute to the ability of the DRC to implement a plan on this scale and without the promised assistance, its goals may not be attainable.
Hopefully, coverage for immunization in the Democratic Republic of Congo will increase significantly as a result of the Mashako Plan and the nation will be able to work its way to an immunization rate of nearly 100 percent to reduce its child mortality rate.
– Sara Olk