It’s a Tuesday morning at Colesberg’s Kuyasa clinic and there is a healthy and very apparent bustle of children. Whether strapped to a mother’s back, or swaddled in a blanket or old enough to walk themselves over, Tuesdays and Thursdays are widely known as immunisation day, so the place looks more like a playground today. Kuyasa clinic is where many of the children throughout the town’s townships come for their vaccines.
Through a series of articles, the online health publication, Spotlight, have been widely covering South Africa’s immunisation programme. Although they have found this area to be one of the country’s success stories, there are concerns about the decline in vaccination over recent years and the hope is that this will move both communities as well as those in the corridors of power to swiftly act accordingly.
Spotlight’s research shows the global and local contributions made by effective immunisation over the decades. Thanks to a vaccine developed in the 1950s, much of the world is virtually (with the exception of two regions in Pakistan and Afghanistan) free of Polio – once a highly dangerous viral infection that attacks the nervous system. Smallpox has been eradicated across the globe. ‘In 1974,’ the publication notes, ‘132 of every thousand children born in South Africa died before their fifth birthday. Today, that number is at 35.’ Immunisation was a notable contributor to this positive outcome.
Furthermore, immunisation is also cost-effective, has benefits that improve cognitive function, longevity and basically the general prospects of a healthier life. In January 2024, the Expanded Programme on Immunisation (EPI-SA) launched the updated childhood immunisation schedule which ‘outlines all essential vaccines children need from birth through 12 years of age.’
‘It includes protection against life-threatening diseases such as measles, polio, tuberculosis, hepatitis B, and pneumococcal infections. Vaccines are administered at specific ages—starting at birth and continuing at 6 weeks, 10 weeks, 14 weeks, and throughout early childhood. The schedule also highlights important guidelines, such as not administering the rotavirus [a highly contagious viral infection that primarily causes gastroenteritis in infants and young children] vaccine after 24 weeks.’
Last year, during the measles outbreak a different health publication approached this freelancer to do a write-up of people’s general attitudes towards vaccination in his home town. The concern back then was to check whether the Northern Cape Provincial Government’s response was adequate in meeting that health emergency and also to assess whether communities maintained a positive outlook towards vaccination.
After all, even though there are communities who – owing to anything from superstition to misinformation – sometimes tend to hold an unfavourable perception towards vaccines (vaccine hesitant), the general trend has been positive. However, with the Covid-19 pandemic and all the attendant conspiracy theories, alarming videos splashed all over the internet, the conspiratorial jargon, as well as those utterly shameful comments shared by French doctors Jean-Paul Mira and Camille Locht, there may have been shifts in attitudes inasfar as vaccination is concerned especially on the Mother Continent.
For instance, Spotlight note that ‘one serious concern is that vaccination rates in South Africa appears to be falling. Only 75% of children in South Africa had received all recommended vaccines by their first birthday, according to the latest District Health Barometer report. This is down from 83% five years earlier.’ Similar post-Covid patterns have been recorded in other countries as well.
‘In February 2020,’ notes the US publication, Science Insights, ‘82% of Americans reported high confidence in the CDC [Centers for Disease Control]. By May 2020, that had already fallen to 68%. By 2022, it was 56%. A modest rebound to 60% by 2024 was not statistically significant.’ A host of various other health bodies experienced similar declines which they still have not recovered from. Interestingly, however, they also found that these decreases had less to do with the public’s faith in medicine itself ‘so much as in the centralized institutions responsible for pandemic messaging and policy.’
But in South Africa, views may be somewhat different. In 2023 UNICEF released a statement noting a startling 30% decline in confidence in childhood vaccines – ‘the largest sustained backslide in childhood immunisation in 30 years’ – in the country, ‘fuelled by the Covid-19 pandemic.’ The diversion of immunisation resources to fight the pandemic led to a 29.9% decline in the perception of the importance of vaccines for children.
The lockdown and similar restrictions meant that ‘children born just before or during the pandemic are now moving past the age when they would normally be vaccinated, underscoring the need for urgent action to catch up on those who were missed and prevent deadly disease outbreaks.’ The 2022 measles outbreak is therefore somewhat attributed to this. UNICEF thus urges governments to identify those children who missed out on vaccination as well as to build public confidence in vaccines in general.
That said, one finds that various socio-economic barriers stand in the way of poorer communities accessing these vaccination services. Unlike Colesberg, where the clinic is largely within walking distance, in rural communities the commute to a public health facility can sometimes mean forking out money that one simply cannot afford. These are some of the social determinants of health which must be tackled if we wish to ensure that all South Africans enjoy equal access to healthcare.
The last word I’ll give to Spotlight who, by shedding light on this area, have indeed lived up to their name: ‘In terms of the vaccines provided [in SA] it remains excellent, but the fact that immunisation rates are lower than they should be is setting off very loud alarms. Let’s hope it is heard in the corridors of power. Many children’s lives literally depend on it.’
Featured image: Stock.adobe.com