Vaccines can protect children for a lifetime from deadly and devastating diseases such as polio, measles and tetanus. (Reuters)

Comment: SA must close the immunisation gap that parallels class

Helen Rees, Shabir Madhi
Vaccines take centre stage in times of crisis but outside of public health emergencies they do not always get the attention they deserve.

Just 30 years ago, the average South African woman would have had four children, with the expectation that only two would live to celebrate their fifth birthdays. Today, parents no longer need to live with the same fear, in large part as a result of a remarkably powerful public health tool: the introduction of vaccines.

They can protect children for a lifetime from deadly and devastating diseases such as polio, measles and tetanus. In South Africa, the introduction of pneumococcal and rotavirus vaccines in 2009 is estimated to have helped reduce under-five mortality by 8% to 10% in just a few years.

The power of vaccines takes centre stage most often when emergencies occur, such as the Ebola outbreak and now the unfolding Zika tragedy. With both, the first response was to call for the urgent development of vaccines. In the case of Ebola, the private and public sectors moved quickly to fund vaccine research, and researchers mobilised in a way never seen before. Residents of the affected countries supported and enrolled in clinical trials, and political leaders committed their support.

Unfortunately, in noncrisis times, immunisation does not always get the attention it deserves. In the African region, the reasons are varied: limited resources for health, competing health priorities and disruption of services caused by war, displaced people and climate change.

Vaccines unavailable
The result is vaccines are often either unavailable or underused in many regions around the continent, and especially in underserved areas. Six African countries report that less than 50% of their populations receive routine vaccinations, and one in five children on the continent do not receive the vaccines they need.

In an effort to close this immunisation gap, African ministers, advocates and other global leaders will join together for the first-ever Ministerial Conference on Immunisation in Africa, taking place on February 24 and 25 in Addis Ababa, Ethiopia. A major theme of the conference will be the need for a broad commitment to expanding access to immunisation services across sectors.

South Africa has much to offer other countries at the meeting in Addis, in part as a result of its history of strong government commitment. South Africa funds all of its immunisation expenditures without global assistance. In 2009, the government budgeted R600-million a year for pneumococcal vaccines and R200-million a year to fund a rotavirus vaccine. These vaccines are targeted at preventing the most common causes of severe disease and death resulting from pneumonia and diarrhoea, respectively. Today, 40% fewer children are being admitted to hospital for pneumonia and diarrhoea because of the introduction of these live-saving vaccines into the public immunisation programmes.

South Africa is also a leader in supporting new vaccine research and development. Its scientists contributed to the clinical development of the pneumococcal and rotavirus vaccine, and to the science that supported the introduction of the human papillomavirus vaccine that prevents cervical cancer.

SA's role
The country’s laboratory and clinical scientists are at the forefront of research into HIV and tuberculosis vaccines. There are also new initiatives underway, such as the African Local Initiative for Vaccinology Expertise at the University of the Witwatersrand, which aims to expand Africa’s footprint across the spectrum of vaccinology research.

But just as South Africa has much to offer, it also has a lot to learn from other countries. Vaccination coverage is, for example, inequitable around South Africa. For example, measles dropout rates are only 5% in KwaZulu-Natal as opposed to the over 20% rate in the Western Cape. For South Africa to better understand the heterogeneity of coverage in different districts, an immunisation coverage survey is recommended to guide future programming.

It’s not good enough that such life-saving tools like vaccines are only reaching some children – we can and must reach all children, particularly those who have the poorest access to curative healthcare and who stand to benefit the most from prevention of illness through vaccination.

If we want to take bold action to close the immunisation gap and reach every child with this life-saving intervention, there are several steps we must take, both in South Africa and on the continent.

For one, local-level involvement must be central to an immunisation strategy. By bringing residents of an area into the planning process, we can ensure health centres are well stocked with the vaccines, so that when a caregiver brings a child in to receive immunisations they aren’t turned away.

Cross-sector collaboration
By working with civil society, faith-based organisations and religious leaders, more families will understand the importance of immunisations and demand them for their children. And when they do demand them for their children, we’ll need strong systems in place that can give them these vaccines. This means trained and reliable health workers and an infrastructure that can transport vaccines safely, which need to be kept cold.

Any steps to improve immunisation coverage must focus on equitable distribution. We know that child­ren from homes where the parents have less education or income are less likely to receive the immunisations they need. The same is true for those living in remote areas or those that are difficult to get access to. We cannot close the gap without prioritising these groups.

Addressing these problems to make major progress on immunisation coverage will be central themes at the conference in Addis, and having South Africa at the table is vital for sharing and learning between countries.

Vaccines remain the backbone of efforts to improve child health, and strong commitment across sectors is essential to their success. We are optimistic that the continent will rise to meet the challenges.

Helen Rees is the executive director of the Wits Reproductive Health and HIV Institute of the University of Witwatersrand. Shabir Madhi is the executive director of the National Institute for Communicable Diseases and professor of vaccinology at the University of the Witwatersrand.

Zika virusEbola virus vaccines