The marked drop in childhood vaccinations this year, fuelled by the upheavals caused by the Covid-19 coronavirus pandemic, has ignited concerns from childhood healthcare experts of the resurgence of outbreaks of vaccine-preventable diseases.
While South Africa has seen a significant drop in vaccinations, owing to disruptions to access to health care services, the decline is a dynamic that also been observed in other countries including the US and Australia.
According to the World Health Organisation (WHO), immunisation is one of the most cost-effective public health interventions to date, saving an estimated 2 million to 3 million lives worldwide each year.
As a direct result of immunisation, the world is closer than ever to eradicating polio and deaths from measles, a major childhood killer. Deaths from measles declined by 73% globally between 2009 and 2018, saving an estimated 23.2 million children’s lives.
“The emergence of Covid-19, however, threatens to reverse this progress by severely limiting access to life-saving vaccines,” the WHO said earlier this year.
And because of South Africa’s fragile public health system, experts say that the country can ill-afford vaccine complacency that could lead to resurgences in childhood disease outbreaks during this time when Covid-19 still poses the real threat of a second wave.
“As people start to travel and interact more, we can expect to see outbreaks of diseases, including vaccine-preventable diseases if there are gaps in children’s vaccinations. One of the most concerning diseases is measles, which is highly dangerous for children and spreads very fast,” Dr Melinda Suchard, head of the Centre for Vaccines and Immunology at the National Institute for Communicable Diseases, told City Press this week.
“There is a real risk of disease outbreaks in future years due to groups of unimmunised or under-immunised children.”
As far back as August this year, Health Minister Zweli Mkhize cautioned against children missing their immunisations, saying: “We have noticed that some babies and children are missing their immunisations and growth-monitoring during this time. Many of the illnesses we vaccinate against – such as measles, polio and meningitis – are much more dangerous for children than Covid-19.”
Recently, Spotlight reported that the department of health had noted that there had been a 21 percentage point decline in immunisation coverage, dropping from 82% in April 2019 to 61% in April this year.
The online health publication also quoted national health department spokesperson Popo Maja as saying that between April and August there had been a 10% decline in primary vaccinations for children under the age of one, and that seven out of eight metropolitan municipalities were not able to vaccinate at least 80% of their children with all primary antigens.
Cape Town-based paediatrician Dr Iqbal Karbanee echoed Suchard’s concerns, encouraging that parents whose children hadn’t been up-to-date with vaccines do so by the end of November to build up the necessary immunity before the start of the 2021 school year.
“As the pandemic is unfolding, we’re understanding that it has lots of other effects – whether it’s on immunisation or the mental health of people. There were a lot of effects that no one could have predicted, so we’re feeling our way as we go along.
“At the beginning of the local outbreak the messaging was ‘stay at home, stay isolated’ and South Africans have taken that very seriously. Unfortunately, however, many people have since stopped going to clinics because one of the issues in those settings is overcrowding and people waiting in queues,” he explained.
Karbanee – the chief executive of Paed-IQ Babyline, a 24/7 telephonic-based helpline for medical advice given by paediatric nurses – said logistical and supply chain complications caused by lockdown restrictions on movement and travel also impacted the supply of vaccines.
"The effect of the hard lockdown was that there were fewer vaccines available, so when people did try access them they found that they were not available and this complicated matters further,” he added.
Karbanee said that while the department of health had issued a catch-up schedule for parents who may have delayed and missed their children’s key vaccinations, parents still needed to act with haste.
“Once we vaccinate a child, it takes about four to six weeks for the immune system to react to the vaccine and develop immunity, so we want to give enough time for their immune systems to kick in and start developing the necessary antibodies,” he said.
Suchard said that while there had been generally lower rates of most infectious diseases in children this year owing to the lockdown and social distancing, in previous years, particularly in 2017, measles outbreaks in private schools were problematic.
“Actually, this year we found out that the number of acute illness in children reduced significantly, so children just haven’t been getting as sick as they normally would. And a large reason for it is that most haven’t been going to creche and stayed home, and therefore aren’t being exposed to those illnesses.
“While it is a good thing initially, a child’s immune system has to learn to deal with infections. If they are not exposed to minor illnesses there may be a problem because they then might not develop the immunity that they should. We need to bear that in mind,” Karbanee warned.
Contact the Amayeza Vaccine Helpline on 0860 160 160 or email firstname.lastname@example.org for queries regarding vaccine catch-up