George Armah, PhD
Ghana, University of Ghana
In this spotlight, the Rotavirus Champion Interview Series delves into lessons from Dr. George Armah’s decades of research and advocacy accomplishments. Dr. Armah is a senior research fellow and associate professor at the Noguchi Memorial Institute for Medical Research at the University of Ghana.
“Advocacy for immunization support must go beyond the vaccine introduction.”
– George Armah
ROTA: How did rotavirus first become a priority in Ghana?
Dr. Armah: We were one of the first on the continent to work on rotavirus after its discovery in 1973. Everyone thought severe gastroenteritis was just [caused by] bacteria. There were a lot of antibiotic prescriptions given out. We trained other budding scientists to diagnose rotavirus.
What has been your role in rotavirus vaccine advocacy in Ghana?
Armah: In the past it‘s taken about 13 years for vaccines to be brought to Africa [after being introduced in high-income countries]. We needed to shorten that. And so, with Duncan Steele, we set up the African Rotavirus Network, sharing, collecting, and using our data. Then data from clinical trials showed that yes, [rotavirus] vaccines worked in Ghana. The data from the clinical trials and the “country-owned” evidence-based data on rotavirus epidemiology and burden of disease was critical for the advocacy and demand for the vaccine when it was available.
How did you work to implement rotavirus vaccines?
Armah: We set up a small team involving scientists, policymakers, and food and drugs authority. Every region had its own peculiarity, and forming these groups allowed us to tease out some of those things. Challenges included:
- Vaccine storage: the government, UNICEF, and other partners helped expand storage.
- Accessing hard-to-reach areas, especially during rainy seasons: Our Community Health and Education Initiative Program helped ensure we could reach here.
- Product switch: We are doing our final training for the ROTAVAC and plan to rollout before the end of the year (2020). Because of the multi-dose vials, the vaccine storage space is now reduced.
After the second year of immunization and we brought hospitalizations [for gastroenteritis in children <5] down about 49%—that was amazing. My friends who are clinicians in hospitals say they are not seeing severe diarrhea in their wards. Although people still get diarrhea, it is not severe enough to warrant hospitalization.
What are the challenges to communicating about rotavirus vaccines?
Armah: I’ve never liked the top down approach. We need to engage with people, using data that we have generated for them.
We told mothers and caretakers that rotavirus vaccine will prevent severe diarrhea due to rotaviruses. However, it doesn’t prevent all diarrhea. If you tell them it prevents all diarrhea, and they get diarrhea, they think “oh your medicine doesn’t work.” So, you must be very clear that it prevents severe diarrhea caused by this virus.
How do you retain high levels of trust in immunization?
Armah: If there is an issue, tell them the truth, and discuss with them how you are solving it. But if you hide it from them and they find out, then that’s it, they’ll never trust you again. Vaccination and immunization is about trust and believing in you.
The vaccination card for the child is something that mother’s hold dearly to their hearts. Of late, we’ve had some anti-vax advocates create a presence, but the funny thing is that they started with measles. Mothers know the impacts of the measles vaccination on their children, so the anti-vaxxers did not have much influence.
What are your priorities today related to rotavirus vaccine?
Armah: Advocacy doesn’t end with introduction, it must always continue. My biggest concern has always been with sustainability: Without Gavi support, will countries sustain it?
We are now gathering a lot of data on the economic impact––showing how much you spend if you take off vaccination, and how much you save because of vaccination. There are a lot of cost benefits. You save on hospitalizations, on your hospital attendants, you save on laboratory tests, you save on critical care from other areas. We need to convince politicians by gathering this information then put it into a form that is easy to understand.
We are also planning a study to look at the potential impacts of the vaccine switch.
How has the pandemic affected routine immunization and rotavirus vaccine coverage in Ghana?
Armah: For the first three months or so, people were scared of getting infected when going out to hospitals so mothers were not taking their kids there. The EPI attendance fell about 30%, and rotavirus was definitely affected.
The Rotarix Rotavirus vaccine is administered at 6 and 10 weeks, which means that once you go past that, you may miss a window. Because of this, rotavirus coverage came down about 60%, but over the past 3 months, we’ve worked to get the coverage back up to 80%, still down from 93%, what it was in 2019.
The ministry did a really great job of reassuring people that with all the necessary precautions––wearing masks, washing hands, maintaining distance––the chances of getting infected are pretty low. When you get to the immunization clinic, everything is well-spaced out, an open environment, so the chances of getting infected are minimized.
Any final thoughts on rotavirus vaccine advocacy that you would like to share?
Armah: I hope every child can get vaccinated. It would be a shame if we deny any child the chance of getting vaccinated, to get a better life in the future.