Childhood vaccines are free in South Africa’s public clinics. But new parents might get an unpleasant surprise when they learn that vaccines against some childhood infections aren’t available in the public sector. 

South Africa’s childhood immunisation schedule includes vaccines against 11 different diseases for children aged 0 to 15 years. At the moment, this schedule does not include vaccines against four infectious diseases: chickenpox; hepatitis A, rubella (German measles) and meningococcal meningitis. 

Government’s decisions on which vaccines to include in the programme are informed by the recommendations of the national advisory group on immunisation. These recommendations are based on factors such as scientific evidence on vaccine safety and effectiveness as well as how widespread a disease is in the country. 

‘’The childhood diseases that are not included in the public schedule may not be prevalent in South Africa but they are still very serious infectious diseases,’’ warns Lindi Mathebula, a research assistant at the South African Medical Research Council. Mathebula was previously involved in the Western Cape’s expanded programme for immunisation. 

These diseases are continuously monitored by the Germs-SA annual surveillance. According to this surveillance, the prevalence rate for Hepatitis A is 3 per 100,000 people. 

‘’However there has not been any indication of death from the disease in South Africa between January to July 2023,’’ says Mathebula.

The mortality rate for children who are infected with chickenpox is also very low being 1 per 100,000 cases as compared to adults with 25 per 100,000 cases. 

Meningococcal meningitis disease can be prevented by vaccination. The average incidence for meningococcal meningitis in the population over the past decade is 1 per 100,000 people. ‘’Over the last decade in South Africa, approximately 17% of people with meningococcal disease have died.’’  

‘’The effect of not vaccinating a child can lead to them developing preventable diseases that can lead to them becoming disabled, or immunocompromised as a growing child or even as an adult. These infections can be severe and even fatal,’’ warns Mathebula.

Impending updates 

In October 2023, the health minister Dr. Joe Phaahla announced that a combination 2-in-1 measles-rubella vaccine will be made available in public health facilities in 2024.

Rubella or German measles is an infectious disease caused by the rubella virus. It is usually a mild disease in children. But it can have serious consequences in pregnant women by infecting their unborn babies and causing congenital rubella syndrome, an illness  found in infants from the maternal infection of the rubella virus during pregnancy.   

The virus usually circulates all over South Africa around late July and early september. These frequent outbreaks occur in day care centres, schools and tertiary education institutions.  

Once the available stock runs out, the current measles-only vaccine will be replaced with a single vaccine containing the measles and rubella vaccines. The vaccine will be given to babies at six to 12 months according to the government vaccine schedule. 

’’For now there is no set date to when the vaccine will be available,’’ national health spokesperson Foster Mohale tells Health-e News. 

According to Mohale, all childhood vaccines are procured through a national tender. This is based on the recommendations made from new scientific evidence and the availability of new vaccines. 

‘’The end of one vaccine tender, is the start of a new one. This provides an opportunity to introduce new vaccines into public sector facilities,’’ he says. 

Not all bad

Despite these omissions, the government’s immunisation schedule is comprehensive, argues Lynda Steyn a pharmacist at Amayeza, a company that provides information about medicine to health professionals. 

‘’The government vaccination schedule covers a wide range of diseases and it reaches most children in the country,’’ she says. 

The recently published District Health Barometer shows that 82.2% of babies under 12 months of age received all their vaccine doses in the year 2022/23. The barometer is an annual publication that provides a detailed breakdown of South Africa’s public health services. 

But, parents should still get their children vaccinated against the four diseases not included in the government vaccine schedule. These vaccines are available at private doctors or private baby wellness clinics, at a cost. 

‘’Yes, these vaccines are expensive. But parents need to be reassured that their children are being protected against most of the preventable diseases that are circulating,’’ says Steyn.

Public good 

Childhood immunisation is an important public health intervention in preventing the spread of diseases which can lead to outbreaks and epidemics.  

‘’Additional vaccines that are provided in private healthcare are essential for all children. Children that are receiving these vaccines are in a way increasing herd immunity for the children that are not able to receive the vaccines from the public healthcare,’’ says Mathebula.

Herd or population immunity is when other people receive indirect protection from surrounding people who are vaccinated against an infection. The concept became widely popular in recent years because of the COVID-19 vaccination drives. – Health-e News