South Africa Facing Escalating Childhood Vaccination Crisis as Measles Outbreaks Spread
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JEREMY MAGGS: There are alarming warnings for South Africa regarding the potential decline in the progress made against preventable childhood diseases. The data shows that the percentage of infants under one year without vaccinations has increased significantly from approximately 12% in 2017 to over 36% in just the first quarter of this year.
The rise of diseases such as measles and rubella is already being documented. This situation prompts a critical question: what is causing parents to refuse free vaccines that are clinically proven to save lives?
At the forefront of this discussion is Professor Shabir Madhi, dean of the Faculty of Health Sciences and a professor of vaccinology at Wits University in Johannesburg. Professor, thank you for joining us again on the programme.
How does a nation with complimentary vaccines for children end up with over one-third of its infants not receiving any vaccinations? What’s going on here?
SHABIR MADHI: Jeremy, the figures released by the National Department of Health are certainly concerning, but we first need to critically evaluate the data for its accuracy.
It seems highly improbable that the situation could have deteriorated so quickly in South Africa.
When the National Department of Health released this data, it was derived from estimations of the number of children born over the past year and the number of vaccine doses delivered to healthcare facilities, which is how they arrive at their calculations.
Read: Covid pandemic created immunization gaps in Africa
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Thus, this is based on administrative estimates rather than an actual survey to ascertain the vaccination percentage among children.
South Africa does indeed face a challenge with under-vaccinated children, but I find it extremely hard to believe that suddenly one-third of children are not receiving at least one vaccine dose.
JEREMY MAGGS: Professor, I understand the need for data verification, but do you think, based on your observations, that vaccine hesitancy is on the rise? Additionally, is the health system adequately reaching out to children?
SHABIR MADHI: There is certainly an issue with vaccine confidence, and multiple factors contribute to this situation.
Measles serves as a critical indicator of vaccine coverage due to its high transmissibility. If 95% of the population does not receive two doses of the measles vaccine, outbreaks are inevitable.
This year alone, South Africa has reported over 3,500 measles cases, indicating that our vaccination coverage is far from adequate, which is truly concerning.
What contributes to the lack of trust in vaccines? There are significant issues surrounding the healthcare facilities.
Parents often lose faith in the immunization program when they encounter closed clinics or when clinics are out of vaccines, requiring them to return on another day.
This creates significant barriers.
We must reassess the structure of our primary healthcare to ensure it is accessible and convenient for parents, moving beyond limited hours, such as 8:00 am to 12:00 pm, for vaccination clinics.
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Furthermore, misinformation and disinformation are permeating public conversation, which also negatively impacts vaccine confidence.
It’s a complex issue, but healthcare facility shortcomings play a significant role in the insufficient vaccination rates among children in South Africa.
JEREMY MAGGS: Professor Madhi, without improvements in this structure, restoring confidence will be a challenge. How difficult do you think this will be, and have we perhaps hit a tipping point that makes this an almost insurmountable obstacle?
SHABIR MADHI: I don’t consider it an insurmountable challenge. It requires political will and commitment from healthcare workers. Furthermore, the government needs to actively promote the importance of vaccinations.
Additionally, parents may have grown complacent due to the success of vaccinations.
It has become rare to hear of a child dying from measles today, which was not uncommon in the early 1990s, for instance.
Thus, vaccines have made a significant impact, and this potential complacency is another reason the government should engage communities more effectively to highlight the role vaccinations play in reducing childhood mortality in South Africa and relieving pressure on healthcare facilities by preventing hospitalizations due to vaccine-preventable diseases.
JEREMY MAGGS: Concerning measles, as previously mentioned, thousands of cases have been reported already this year. Are we now beyond warnings of outbreaks and actually experiencing one?
SHABIR MADHI: Yes, indeed. We’ve been experiencing ongoing measles circulation in South Africa, leading to epidemics that we faced last year and continue to see this year.
This indicates that our vaccination program is far from sufficient.
To effectively control measles transmission, every child must receive two doses before the age of two. Currently, we’re probably reaching no more than two-thirds of children getting these two doses, which is severely problematic.
Once again, the occurrence of these measles outbreaks is a clear sign that our immunization efforts are failing.
JEREMY MAGGS: When officials claim we are losing herd immunity, what does this mean for both vaccinated and unvaccinated children?
SHABIR MADHI: Herd immunity refers to a situation where, even if a new measles case is introduced, it won’t spread due to a sufficient percentage of the population being immune.
The active circulation of wild-type measles indicates that we are far from achieving herd immunity.
This isn’t a new concern; it has persisted for over a decade due to inadequate measles vaccine coverage.
However, the more pressing worry is for unvaccinated individuals, who are at a heightened risk of infection, as well as those who are immunocompromised. Even vaccinated individuals might not be fully protected, or they may be unable to receive certain vaccines due to their health conditions.
Thus, unvaccinated children and immunocompromised individuals both face significant risks due to the spread of diseases like measles.
JEREMY MAGGS: Thank you very much, Professor Shabir Madhi, Dean of the Faculty of Health Sciences and Professor of Vaccinology at Wits University. Your insights are greatly appreciated.