Vaccine a prickly issue
WORRYING: RISE IN INFECTIOUS DISEASES DUE TO LOW VACCINATION RATE
Increased number of children in SA are unvaccinated or under-vaccinated.
The concentrated global effort to use vaccination as a public health intervention began in 1974. Since then, vaccination has changed our lives. Worldwide, from 2000 to 2020, childhood vaccination led to the reduction of deaths in children under five by 50% to 5.4 million deaths a year. Vaccinations avert more than five million deaths each year worldwide.
These are deaths that would have been caused by measles, whooping cough, tetanus, polio, diphtheria, pneumonia, rotavirus diarrhoea, and other vaccine-preventable diseases.
But in recent months there have been numerous outbreaks of these diseases. Scientists from the South African Medical Research Council explain why these diseases continue to threaten children’s health in the country.
There is an increased spread of measles in South Africa now.
Measles is a highly infectious disease that spreads through droplets. It is the second-most frequently reported disease outbreak in Africa after cholera.
It accounts for 11.5% of all reported disease epidemics on the continent.
Children who have not been vaccinated against measles are at high risk of the disease and its complications. These include pneumonia, brain damage and death. Measles is one of the most dangerous but preventable childhood diseases. Up to 10% of children under five who develop measles die from its complications.
An effective vaccine against measles has been available for decades. A child requires two doses of the vaccine to develop protective immunity against the disease. The two doses are given at six and 12 months of age in South Africa. At least 95% coverage of two doses of the vaccine is required for herd immunity against measles and protect those who aren’t able to get vaccinated.
Another highly infectious disease that has recently seen an increase in South Africa is pertussis, also referred to as whooping cough. It spreads easily from person to person through droplets produced by coughing or sneezing. Complications of whooping cough include pneumonia, seizures, brain damage and death. The best way to prevent pertussis is through vaccination.
The resurgence of vaccine-preventable diseases in SA is due to immunity gaps caused by low vaccination coverage. A national survey conducted from July to December 2019 found that only 81% of children had received all their vaccine doses scheduled up to 12 months of age.
This has increased slightly to 82% since then, according to estimates from the World Health Organisation (WHO) and the United Nations Children’s Fund (Unicef).
In the past two years, routine immunisation services and coverage of essential childhood vaccines have been disrupted and many catch-up efforts have been postponed due to Covid. This has led to an increased number of children being unvaccinated or under-vaccinated. SA’s low vaccination coverage is due to supply and demand issues.
These relate to the provision of vaccines and the population’s decision to vaccinate. Structural barriers such as vaccine availability and access to health facilities are known to reduce vaccination coverage.
Research also suggests that social and psychological factors, such as concerns about the safety and efficacy of vaccines, influence decisions around vaccination. Some caregivers are confl icted about vaccinating their children.
Vaccine hesitancy represents a motivational state of being confl icted about or opposed to vaccination. Evidence from several SA studies has shown a significant increase in vaccine hesitancy.
This has had a dramatic impact on routine immunisation services and ultimately reduced vaccine coverage over the years.
Globally, many initiatives exist to improve childhood immunisation, especially in low- and middle-income countries. Within the context of the Immunisation Agenda 2030 (IA2030) programme, WHO, Unicef and Gavi, are launching the “Big Catch-Up” initiative. This aims to support countries like South Africa to plan and implement intensified efforts to bolster immunisation.
It has three main objectives: ► To reach children who missed vaccination during 20202022 for catch-up vaccination; ► To restore vaccination coverage to the last best coverage in 2019; and ► To strengthen immunisation programmes to reach under-vaccinated and unvaccinated children.
Interventions that are focused on improving the healthcare system include cold-chain infrastructure improvements to ensure availability and access to vaccines.
Other interventions that can improve uptake of vaccines include using motivational posters or flyers, sending reminders (messages or letters), and material or monetary incentives to caregivers or pay-for-performance schemes for healthcare workers providing vaccinations to children.
Informing and providing education to caregivers and healthcare workers has also been effective in increasing vaccination in children in cases where parents were hesitant.