POST 00615E : SINGLE-DOSE VERSUS MULTI-DOSE
Follow-up on Post 00613E
17 November 2003
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Following the posting of the article "Single-dose versus multi-dose vaccine
vials....." in Post 00613E, Femi Oyewole (mailto:[log in to unmask]) from
WHO in Ethiopia and Alozie Ananaba (mailto:[log in to unmask]) from
Nigeria both share their reactions.
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The paper on "Single-dose versus multi-dose" made very interesting reading.
It calls for us to become "masters of the balancing act".
I stand to be corrected, but I think where the single-dose vaccines are
mostly needed- places with high vaccine wastage, places where outreach
services are required- are the same areas where cold chain capacities are
less than adequate and economy is poor.
While I agree that the heat-stable vaccines will benefit from the
single-dose option, can we put in place a system where these vaccines can
be shipped "in instalments" to the countries taking into consideration the
holding capacity of their cold chain and of course the next question will
be - what will be the financial implications and who picks up the tab?
Please advise.
Femi Oyewole, Epidemiologist, WHO/EPI Ethiopia
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Regards.
The issue in discourse is one that has far reaching implications on the
eventual targets of immunization programmes. Comments will generally be
relative depending on what the current practises are in the various countries.
Here in Nigeria south east zone a lot of other services are tied directly
or indirectly to immunization services. Immunization opportunities serve as
the greatest stimulus for utilization of Primary Health Care Services in
this area. Mothers that make themselves available for immunization clinics
are more likely to seek help at those centres if other health conditions do
occur.
Experience has shown that the use of multi-dose vials affords the delivery
outlets only once a month -opportunities to get these vaccines to children-
to avoid wastage. Mothers who present children who are eligible for
vaccination are sent back to come on a date that the provider assumes
enough clients would have accumulated for the multi-dose regimes. Of course
in an environment with poor health-seeking attitude, this is a missed
opportunity.
Single dose vials will in the long run improve on coverage levels of the
vaccines - the main objective of the programme.
Thanks,
DR A O ANANABA
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