Health ministry will administer pneumococcal conjugate vaccines (PCV) through the routine immunization service by January next year. PCV is one of the three new vaccines that were launched in June this year.

Senior programme officer with the vaccine preventable disease programme, Tshewang Dorji Tamang, said the preparation was underway.

He said the training of trainers was conducted in Gelephu from November 28 to 30. “The trainers would give the training of the health workers at a district level by this month.”

Bhutan Health Trust Fund has released Nu 9.2M (million) for the PCV 13.

The vaccine would be administered through the routine immunization service in the hospitals, basic health units and outreach clinics across the country to children below one year. Three doses of the vaccine would be given to children at six weeks of age, 10 weeks, and nine months.

The vaccine prevents transmission of pneumococcal bacterial diseases such as pneumonia, otitis media, bacteraemia and meningitis in children under 5 years.

Pneumonia is one of the top 10 diseases in the country. It accounts for 27.8 percent of child deaths in Bhutan. Meningitis accounts for about five percent of child deaths.

Tshewang Tamang said that the PCV was in the ministry’s plan since 2013. “Preparation and surveillance component began from 2013.”

He said in 2017 a study was conducted to determine the cost-utility and outcomes of the PCV 10 and PCV 13. The study found that both PC vaccines were cost effective and provided good value for money.

PCV 13 costs a little more than PCV 10. But health officials said it gave better health outcomes.

In terms of the rotavirus vaccine, which was also launched in June this year, Tshewang Tamang said that both surveillance and disease burden was there.

Rotavirus is a highly contagious virus that infects the intestine and is the most common cause of severe diarrheal disease in infants and young children worldwide. About 13 percent of child deaths in Bhutan are due to diarrheal disease.

However, he said that the Essential Medicines and Technology under the ministry’s Department of Medical Services was carrying out a cost-effective assessment of administering the vaccine into routine immunization service.

“We need to study the cost-effectiveness, Cost versus the impact or effectiveness of the vaccine,” Tshewang Tamang said. “Most probably it would be introduced by the end of 2019. Again, it would depend on the findings of the study.”

The national health policy states that the introduction of new vaccines shall be done only after assessing the disease burden, public health impact, cost effectiveness of the vaccine, affordability and sustainability.

He said that a dose of rotavirus would cost one USD and three doses had to be given to a child below one year. “The cost is excluding the insurance, and transportation and freight charges.”

Rotavirus vaccine, if the study finds it to be cost effective, would be administered to about 14,000 children under one year every year.

With a one-time introduction estimated cost at Nu 4.62M, the vaccine would cost the BHTF Nu 12.52M annually.

Director of public health department, Dr Karma Lhazeen, during the launch of the vaccines, said the new vaccines for children under one-year-old were expected to contribute significantly in the reduction of childhood morbidity and mortality, resulting in improved infant mortality rate and under-five mortality rate.

“We are also working on administering the flu vaccine,” he said. “It takes a minimum of six months to administer a vaccine into routine immunization service considering the logistics and technical readiness.”

The last government had introduced the vaccines in June this year and announced that the three vaccines would be rolled out from January next year.

There are two types of influenza vaccine – trivalent and quadrivalent.

Trivalent influenza vaccine prevents three flu viruses and the cost of vaccine per dose is approximately Nu 288. “For now, we have proposed the government to for trivalent vaccine. This vaccine is effective but gradually we may shift to the quadrivalent vaccine.”

The quadrivalent influenza vaccine prevents four types of flu virus and the cost of the vaccine is Nu 500 per dose.

He said that the peak flu season most began from November. The flu vaccine has to be given a month before the flu season. “This year the season is already over so maybe we would administer the vaccine next year. We would notify the public once the vaccine is introduced.”

He said that the flu vaccine had benefit but the cost was high.

The ministry has proposed three target groups for the vaccine. They are health workers, pregnant women and children of six months to 23 months. “The vaccine cost is high and we have to give the vaccine annually because the vaccine will protect you for only one season. So, we had proposed only these groups of the population.”

Flu vaccine is estimated to cost Nu 58.89M annually with an additional one-time introduction cost of Nu 5M.

If all the three new vaccines are administered into the routine immunization service as the ministry said during the launch of the vaccines in June this year, a total of 14 vaccinations will be provided through routine immunization programme in the country.

Dechen Tshomo