Vaccines have been one of the greatest medical achievements of our time, saving countless lives and preventing the spread of deadly diseases. However, despite the benefits of immunisation, many children around the world are still not being vaccinated, which can have serious health consequences. 

In fact, according to the UNICEF State of the World’s Children 2023 report, 67 million children missed out entirely or partially on routine immunisation between 2019 and 2021. While 48 million children missed vaccinations entirely.

Health-e News spoke to Professor Hannelie Meyer and Professor Rose Burnett, two leading immunisation experts in South Africa, to learn more about the country’s progress in this area and the impact of the Covid-19 pandemic on immunisation rates. Meyer is the head of the South African Vaccination and Immunisation Centre at Sefako Makgatho Health Sciences and Burnett works with her.

Why is it important for children to be immunised/vaccinated from birth?

Childhood immunisation is extremely important as it is life-saving. According to the World Health Organisation, childhood immunisation specifically saves at least 5 million lives per year. It is one of the most cost-effective ways to prevent the spread of infectious diseases, not only amongst children but in the community at large.

When most of the people in a community are immune to a particular infection that is spread from person to person, the natural transmission of the infection is effectively stopped.

What are some of the negative health consequences of not being immunised from birth?

Newborn infants’ immune systems are not fully developed, making them vulnerable to infections. Babies and children who are not vaccinated or partially vaccinated for any reason, run the risk of contracting harmful vaccine-preventable diseases such as polio, tetanus, measles, diphtheria, which can cause severe illness, complications, disability or even death. 

For example, in unvaccinated children, measles can result in secondary infections such as pneumonia and encephalitis which may result in death. And babies who are not vaccinated against polio are at risk of contracting the disease which can result in paralysis and life-long disability. While tetanus causes life-threatening breathing problems which often result in death.

How do childhood vaccines work?

Vaccines contain small amounts of either a weakened germ or part of a killed germ that causes a particular disease. When a child is given a vaccine, the body’s defences are activated. The immune system starts making cells and antibodies that recognise specific parts of that germ and is then able to practise fighting the disease. 

This response means that if the child is exposed to the actual disease-causing germ, the cells and antibodies are already present to fight the disease. The immune system is thus prepared to recognise and fight diseases in advance. This means the child does not become seriously ill if those disease-causing germs are encountered at a later stage. Once the immune system knows how to fight a disease, it provides long-term protection against disease and can often protect the child for many years.

Which childhood vaccines are offered freely at South Africa’s public health facilities?

The vaccines recommended by South Africa’s Expanded Programme on Immunisation(EPI) are available free of charge in public sector clinics and protect infants up to the age of 24 months against 10 vaccine-preventable diseases causing the highest morbidity and mortality in South Africa.

At birth, babies are given one dose of the Bacille Calmette-Guerin vaccine(BCG) to protect against tuberculosis. The oral polio vaccine is given twice, at birth and again at six weeks to protect against polio. While the hexavalent vaccine provides protection against diphtheria, tetanus, pertussis, polio, haemophilus influenzae type b infections and hepatitis B. Three primary doses are given at 6 weeks, 10 weeks and 14 weeks of age, while a booster dose is recommended at 18 months of age.

Two doses of the oral rotavirus vaccine(RV) are given at 6 weeks and 14 weeks, and three doses of the pneumococcal conjugate vaccine(PCV) at 6 weeks, 14 weeks and 9 months of age. And the measles vaccine is given at 6 months and again at 12 months. In the private sector, there are additional vaccines available, for example, to protect against meningococcal disease, mumps, rubella and chickenpox.

Is SA doing enough to ensure that all children are immunised from birth?

All life-saving vaccines scheduled from birth to 18 months are available for free in public clinics, and free birth doses are available at public sector hospitals. Each child is issued with a Road to Health Book, which contains the recommended immunisation schedule and space where the vaccinator records details of each vaccine administered and the date of vaccination. Parents and caregivers should check their children’s Road to Health Book and make sure that they are up to date with all their scheduled vaccines.

If a child missed any doses, the parent/caregiver should take the child to the nearest health facility to get the catch-up doses. Children who have missed any of their childhood immunisations, still have a chance to catch up on missed vaccinations. It is never too late to be vaccinated and it is also safe to receive an additional dose of a vaccine.

Has SA managed to close childhood immunisation gaps created by the Covid-19 pandemic?

The Department of Health and other stakeholders are actively developing strategies to address these immunisation gaps based on available data and within the limits of resources available. However, closing these immunisation gaps will require a combined effort from all stakeholders, including the public themselves, and using multiple strategies.

Examples of strategies include integration of immunisation services with other health services, strengthening health systems, catch-up vaccination campaigns, social mobilisation and community engagement to increase confidence in vaccination and prevent the spread of misinformation, digital solutions and public-private partnerships.

Is low immunisation to blame for the measles and whooping cough outbreak in SA?

Yes, the measles outbreak has been attributed to consistently lower than optimal vaccine coverage of the routine measles 1 and 2 doses, which increases the risk of being infected and of spreading the disease. The same applies to whooping cough, due to low vaccination coverage of the pertussis vaccine. 

A decrease in vaccination coverage can be attributed to a number of reasons or factors, including lack of access to services, change in people’s health-seeking behaviour and vaccine hesitancy. Unfortunately, all these factors have been fuelled by the Covid-19 pandemic.

According to the National Institute for Communicable Diseases(NICD), a measles outbreak has been declared in all the provinces in South Africa except for the Eastern Cape. – Health-e News.