Botswana commemorates historic milestone

Botswana has joined the rest of the world in commemorating the 50th anniversary of the expanded Programmeon Immunisation (EPI) and also launched the African Vaccination Week (AVW) under theme, EPI@50 in Gaborone on Tuesday.

With a steadfast commitment to public health and well-being, the country joined hands with countries across the globe to commemorate her historic milestone and reinforced the importance of vaccination in safeguarding communities against infectious diseases.

Giving a keynote address, Permanent Secretary in the Ministry of Health (MoH), Professor Oathokwa Nkomazana said over the past five decades, the EPI has been at the forefront of the global fight against vaccine-preventable diseases, saving countless lives and transforming communities.

“From the eradication of smallpox to the near elimination of polio and drastic reduction in measles, and rubella cases, the impact of immunisation has been nothing short of extraordinary. Through the years, we saw reduction in diarrhoea cases and pneumonia, which for a long time, have been the major cause of morbidity and mortality amongst our children under the age of five,” she explained.

“It is in recognition and celebration of 50 years of existence of EPI which was launched by WHO in 1974. The 50th anniversary provides a significant occasion to recognise the programme’s successes, underscore its impact on lives saved, and inspire renewed efforts to enhance routine immunisation initiatives.”

She added that Botswana made a marked achievement in the goal of immunisations since the introduction of the national immunisation programme in the country in 1979.

Nkomazana pointed out that through EPI@50’s expanded immunisation efforts, remarkable achievements had been realised, including; successful eradication of diseases such as smallpox; significant reduction in the burden of diarrheal diseases, amongst the under-fives; expansion of the EPI programme to offer 13 vaccines (antigens), which was a substantial increase from the six vaccines that were available five decades ago; enhanced availability of vaccines and improvements in vaccine management and storage practices; well-structured organisation of the EPI with dedicated officers overseeing the programme at national, district, and facility levels, alongside the establishment of a national immunisation schedule and strengthened surveillance mechanisms leading to improved disease monitoring and response capabilities.

Furthermore, she emphasised that the country has over the years prided itself with coverages above 80% to 90% for most vaccines, leading to a significant decrease in Vaccine Preventable Diseases (VDPs). She said the use of vaccines was one of the greatest scientific innovations that proved to be a cost-effective public health strategy, had significantly decreased childhood morbidity and mortality. She added that vaccines were also responsible for a huge reduction in the incidence of many diseases including measles, tetanus and others.

“In recent years, the African region made major gains including elimination of wild polio, maternal and neonatal tetanus. MoH prides itself in having recently conducted a successful supplemental immunisation activity (SIA) with the novel Oral Polio Vaccine 2. The national administrative coverage for this campaign was 81%. Despite these achievements, it has not been an easy journey,” she said.EPI@50 encountered formidable challenges, including disorganisation within the immunisation programme, constrained by limited human, infrastructure, and capital resources.

Restricted access to vaccines, stemming from their limited availability, resulted in a drop in vaccination coverage, exacerbated by an insufficient number of skilled personnel to effectively carry out immunisation activities.

For her part, UNICEF representative Joan Matji commended the government for ensuring that no child is left behind when it comes to receiving essential live saving vaccines and other child health interventions.

She added that last year they released, ‘The State of the World’s Children 2023: For Every Child, Vaccination’ report. She explained that the report sent a red alert on the steep decline in child routine immunisation coverage after the COVID-19 pandemic.

“This is worrying as vaccines have proven to be one of the most successful public health interventions to control the deadliest of infections. In Eastern and Southern Africa, we have experienced a six percent decline in child immunisation coverage compared to pre-Covid times, with over 4.6 million children missing out on life-saving vaccines in the last three years, especially the marginalised and poorest communities,” said Matji.

“Botswana has not been spared in respect to the declining coverage of childhood vaccinations. The vaccination level of all childhood vaccines fell short of 70% coverage, which is a mark commonly used for herd immunity, thereby showing a gap that needs to be closed urgently for the survival and thriving of Batswana children. The decline in vaccination rates cannot only be attributed to the COVID-19 pandemic. Qualitative data from various sources indicate that there is low perception on the importance of vaccines. There is also vaccine hesitancy in some communities.”

Matji explained that the two Polio vaccination campaigns undertaken in 2023 post pandemic were an indication of hesitancy as the campaign could not reach the planned target despite vaccines being available and administered at community and household level. She therefore, said they should continue to implement innovative behaviour change interventions to build community confidence in vaccines.

She added that could be done through community dialogues to stem the influence of rumours and misinformation and bolster widespread support for immunisation, just as was done in Motokwe.

For her part, WHO officer in charge Dr Tebogo Madidimalo said despite the notable strides made over the years, there remained a pressing challenge where over 20 million children worldwide, particularly in developing countries were still missing out on essential vaccinations.

He said that was evident from the alarming number of ‘zero dose’ children who had not received any vaccinations whatsoever. “In our African region, the COVID-19 pandemic has starkly revealed our vulnerabilities. The pandemic-induced disruptions in healthcare services led to a significant decline in routine immunisation coverage, which serves as a critical reminder of the need to bolster our vaccination efforts continuously,” he said.

“These disruptions resulted in most countries in the region failing to meet WHO’s immunisation coverage target of 90%. It is imperative that routine immunisation is reinforced as a fundamental component of primary healthcare. This will not only help in controlling outbreaks of vaccine-preventable diseases, but is also essential for achieving universal health coverage.”