Clinics hit by vaccine shortages

Parents dependent on public health facilities left in dark amid diphtheria and tetanus stock scarcity

FRUSTRATED with being given the run-around, a Cape Town school nurse says she’s battling to have her pupils vaccinated against diphtheria and tetanus.

Speaking on condition of anonymity, she said she noticed in July last year that clinics did not have their supply of vaccines, which in turn affected the school’s stocks.

“Because we have an agreement with a clinic, we did not get our stock from them. They kept on telling me there was no stock. The result was me asking parents to take their kids to the clinic. And like me, they’ve been turned away because of little or no stock. It’s been extremely frustrating for us,” she said.

The other alternative is for parents to have their children immunised privately, which can be a costly affair.

South Africa has been experiencing a protracted shortage of the DT (diphtheria and tetanus) vaccine.

Reports of the critical state shortages started as early as last year.

“We’re still getting reports of shortages and stockouts nationwide,” said Kopano Klaas, case manager for the Stop Stockouts Project.

“The project is a consortium of six civil society organisations dedicated to assisting thousands of people whose lives are threatened by the chronic shortages of essential medicines and children’s vaccines in South Africa.”

Klaas said that people were being turned away from government facilities because of this.

Immunisations against DT are available at all primary health-care clinics and centres. It falls under the Global Vaccine Action Plan (GVAP), endorsed by the 194 member states of the World Health Assembly. The framework aims to prevent millions of deaths by 2020.

Professor Claudia Gray is a paediatrician with sub-specialist accreditation in allergology. In her view, childhood vaccination is not a question of “if”.

“Vaccines are a form of ‘active immunity’ – which means that they stimulate the immune system to form protective antibodies against certain diseases,” she said.

The DT vaccine provides protection against three diseases: diphtheria (which can cause fatal swelling in the throat area), pertussis (whooping cough) and tetanus (a condition of severe muscle spasms caused by contamination of dirty wounds).

“Children require a series of three doses in the first year of life and then a booster dose at 18 months and preschool. Delays in these doses can mean inadequate protection against these potentially serious diseases,” she said.

In 2017, the Western Cape battled an outbreak of diphtheria. There were four cases of vaccine-preventable disease in the Helderberg, with one reported fatality.

Two of the infected were children, and it’s likely they did not receive their vaccines, said National Institute for Communicable Diseases consultant Professor Lucille Blumberg.

“The message (from this) is that children must get their booster vaccination shots at 18 months and at school-going age,” she told media.

The shortage of the vaccine doesn’t appear to be only a South African problem. A study of global vaccine use found that one in three World Health Organisation member states experienced at least one stockout of one vaccine for at least a month every year. Worryingly, 38% of sub-Saharan African nations reported stockouts annually.

According to The Economist Intelligence Unit, a GVAP study showed that most stockouts were the result of government funding delays, delays in procurement processes, and poor planning and stock management.

In 9% of these cases, the stockouts were due to global supply shortages.

Klaas said that government had a borrowing protocol as a way to prevent shortages. “If there’s a problem at one of the clinics, then they are able to borrow from other clinics. But there have been very few reports of that happening,” he said.

When the Western Cape Department of Health was approached for comment, the response was “stock shortages”.

“The TD vaccine is procured centrally by the national Department of Health and has been out of stock in South Africa since late 2018,” the department said.

The national Department of Health had not responded to queries at the time of publication.

THE shortage of vaccine doesn’t appear to be only a South African problem. A study of global vaccine use found that one in three World Health Organisation member states experienced at least one stockout of one vaccine for at least a month every year.