By Michael Burnett, Senior Researcher, Health Systems Research Unit, Health Systems Trust
As of 2021, 18 million children globally were unvaccinated and a further 25 million were under vaccinated. This is an increase of five million children from 2019. In light of this, research is required that not only looks at coverage, but also identifies demographics and groups at higher risk of being unvaccinated, as well as the barriers to vaccination.
Immunisation has prevented countless illnesses and disabilities as well as saved millions of lives in South Africa. However, vaccine-preventable illnesses continue to be a danger. The Expanded Programme on Immunisation in South Africa (EPI-SA) was introduced with an aim to protect children and pregnant women from diseases that can be preventable, thereby reducing suffering and death from childhood diseases.
The National Department of Health's (NDoH) EPI-SA aims to ensure that 90% of all children have had all recommended vaccinations. During 2016 – 2018, 61% of children aged 12 – 23 months had received all their basic vaccinations, and only 53% had received all age-appropriate vaccinations. This rate was lower for females (59%) than for males (64%) and for those who resided in urban areas (59%) versus in non-urban areas (65%).
The national immunisation coverage for children under the age of one year is still far below the global benchmark of 90%. Furthermore, there are significant coverage differences across provinces and districts. A nationwide campaign to catch up on childhood immunisations was started by the NDoH from November 2020 to March 2021 as a result of a drop in immunisation rates during the COVID-19 lockdown.
Twelve districts (mainly Tshwane Johannesburg, Mangaung, eThekwini, iLembe, Cape Town, Nelson Mandela Bay, Buffalo City, Capricorn, Ehlanzeni, Bojanala (Platinum), and Pixley Ka Seme) have been designated by the NDoH as being in urgent need of catching up during the initial stages of the initiative, which was focused on children under the age of five.
Targeted strategies need to be adopted when implementing interventions to increase coverage, especially at the local municipality and sub-district levels. South Africa comprises of a diversity of settings with anticipated variations in the causes of unvaccinated and under vaccinated children, which are extremely complex. It is crucial to review and unpack the potential causes of these variations across the various levels of the health system, both from the perspectives of patients as well as healthcare workers and officials (that are mainly responsible for the implementation of EPI services). It is also important to understand the demand side barriers from the perspective of communities and patients.
The Immunisation project aims to identify the supply and demand barriers and develop local strategies to improve childhood immunisation in four zero dose districts in South Africa. The objectives of the project are: (1) to identify the barriers affecting the demand for and uptake of routine immunisation services from the perspectives of community members, health workers and local health managers, (2) to determine the factors in the provision of routine immunisation services that affect uptake of services by the eligible population from the perspectives of community members, health workers and local health managers, and (3) to describe context-specific community focused strategies to improve routine immunisation services based on input from local stakeholders
Fieldwork is projected to start in June 2023.
Michael Burnett is a Senior Researcher in Health Systems Trust's Health Systems Research unit and holds in Master's Degree in Psychology. He has more than 15 years' experience working within the South African public health and social care settings across all three levels of government (National, Provincial and District level) focussing on public health programmes, initiatives, and research. He has extensive experience in operational and financial management of projects. Over the course of his 8 years at HST, he was contributed toward a variety of projects and is also a published author in various prestigious journals.