Vaccines remain one of the most cost-effective and critical medical interventions to successfully eradicate vaccine-preventable diseases while reducing the burden of disease and mortality from diseases such as pneumonia and other associated pneumococcal diseases¹, writes Professor Prakash Mohan Jeena, paediatric pulmonologist and head of the paediatric intensive care and pulmonology department at the University of KwaZulu-Natal.

Vaccines have proven effective in eradicating and eliminating preventable diseases, with smallpox caused by the variola virus (VARV) and rinderpest from the rinderpest virus (RPV) now eliminated, thanks to vaccine intervention initiatives². 

Similar benefits are now being realised with the implementation of pneumococcal conjugate vaccines (PCVs), with PCV7 being introduced in 2009 and the more advanced PCV13 emerging in 2011³. PCVs have had a resounding impact, and have averted as many as 175 million cases and 624,000 deaths associated with pneumococcal disease⁴. 

While statistics from the World Health Organization (WHO) confirm that medical interventions such as vaccinations are needed to tackle the plight of preventable diseases such as pneumonia, more needs to be done, particularly when considering that over 740,180 children died from pneumonia in 2019. The disease remains the single most infectious cause of mortality in children worldwide and accounts for up to 14% of deaths in children under the age of five⁵. 

Reducing disease incidence in South Africa

The South African Department of Health’s Expanded Programme on Immunisation (EPI) recommends that children receive three doses of the PCV13 vaccine⁶ to protect against potentially serious and even deadly infections⁷ caused by pneumococcal disease. This includes Streptococcus pneumoniae – a leading cause of bacterial pneumonia and Invasive Pneumococcal Disease (IPD) such as pneumococcal meningitis⁸. While PCV7 had little effect on lowering meningitis incidence, global studies have indicated that PCV13 has proven effective in reducing the impact of this disease by as much as 48%⁹.

When considering the burden of pneumococcal disease in children between 0 and 59 months, the number of infected children with pneumococcal disease drastically declined from 107,600 cases per year between 2005 and 2008 to an estimated 41,800 between 2012 and 2013. While several interventions such as HIV care and prevention initiatives were in place during this time, this reduction can be largely attributed to the introduction of effective PCV medications¹⁰. 

More needs to be done to increase childhood immunisation in SA

Vaccines save lives, and the repurposing of Clairwood Hospital in Durban is a good example of this. Once a healthcare facility that dealt primarily with infectious diseases, the hospital has had to adapt its practices in recent years as infectious disease wards remained empty. 

South Africa’s immunisation coverage rate is lower than the 90% coverage rate set forth by the Global Vaccine Action Plan¹¹, with the country recording 83.9% in 2020, according to the EPI National Coverage Survey Report 2020¹². While these figures are up from the 81.9% recorded in the 2018/2019 period¹², more needs to be done to increase South Africa’s childhood immunisation rate to prevent future disease outbreaks¹³. 

What’s holding South Africa back?

While there are several factors that lead to low immunisation coverage rates, including the impact of COVID-19¹⁴, the Academy of Science of South Africa’s Root Causes of Low Vaccination Coverage and Under-Immunisation in Sub-Saharan Africa consensus study report suggests that the overarching reasons include education, low trust, difficulties in accessing reliable immunisation services, and poor vaccine stock availability¹⁵. 

As such, Community Healthcare Workers (HCWs) need to be more involved in the mission of the EPI programme as they are instrumental in raising awareness of the dilemma and driving educational community-based vaccination campaigns¹². 

While South Africa’s EPI is successful, there continue to be challenges related to human resources capacity. Apart from the real-time collection, collation and analysis of data, the programme needs to invest in a robust health facility network and community-based interventions to drive immunisation coverage across all districts in the country, including tapping into the power of mainstream and social media to do so¹².  

The Global Alliance for Vaccines Initiative (GAVI) has also come to the party to provide access to vaccines for children in low-income countries, and to date, has helped with the vaccination of nearly half of the world’s children against deadly and debilitating infectious diseases¹⁶. 

Since South Africa falls under the middle-income category, it does not have access to the subsidized vaccine benefits of its low-income counterparts. However, manufacturing affordable vaccines locally will be greatly beneficial to the country, offering several advantages. 

The many benefits of local vaccine manufacturing 

Manufacturing vaccines locally will increase South Africa’s health security, ensuring a seamless and adequate supply of vaccines for its citizens. It will also stimulate the economy by increasing the GDP, creating additional employment opportunities and growing the local sector’s technological expertise¹⁷. 

Manufacturing vaccines locally will reduce the country’s dependency on importation and reliance on foreign trade, and make life-saving vaccine interventions more affordable to meet South Africa’s needs¹⁷. 

Notably, the Biovac Institute and other local manufacturers have been instrumental in the packaging and manufacturing of vaccines to enable the country to respond to regional epidemics and vaccine-preventable diseases. As a result of a partnership with the government, the ongoing success of the institute is key to the provision of affordable vaccines for national health management and vaccine security¹⁸.

The benefits of local vaccine manufacturing are plentiful and will continue to ensure that, apart from the economic benefits, more South African children will have access to affordable interventions that will ensure they live healthy and productive lives, and become integral members of our future society.

References:

1. Immunization against vaccine-preventable diseases is essential to protect children [Internet]. [cited 2022 Jun 19]. Available from: https://www.unicef.org/southafrica/stories/immunization-against-vaccine-preventable-diseases-essential-protect-children

2. dev-site. 8 Diseases (Almost) Eradicated from Existence Thanks to Vaccines [Internet]. Makati Medical Center. 2021 [cited 2022 Jun 21]. Available from: https://www.makatimed.net.ph/blogs/8-diseases-almost-eradicated-from-existence-thanks-to-vaccines/

3. Kleynhans J, Tempia S, Shioda K, von Gottberg A, Weinberger DM, Cohen C. Estimated impact of the pneumococcal conjugate vaccine on pneumonia mortality in South Africa, 1999 through 2016: An ecological modelling study. PLoS Med. 2021 Feb 16;18(2):e1003537.

4. Ten year public health impact of 13-valent pneumococcal conjugate vaccination in infants: A modelling analysis. Vaccine. 2020 Oct 21;38(45):7138–45.

5. Pneumonia [Internet]. [cited 2022 Jun 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/pneumonia

6. [No title] [Internet]. [cited 2022 Jun 20]. Available from: https://www.health.gov.za/wp-content/uploads/2020/11/epi-schedule.pdf

7. CDC. Pneumococcal Disease and the Vaccine (Shot) [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2022 Jun 20]. Available from: https://www.cdc.gov/vaccines/parents/diseases/pneumo.html

8. Müller A, Kleynhans J, de Gouveia L, Meiring S, Cohen C, Hathaway LJ, et al. Streptococcus pneumoniae Serotypes Associated with Death, South Africa, 2012–2018. Emerg Infect Dis. 2022 Jan;28(1):166.

9. Oligbu G, Collins S, Djennad A, Sheppard CL, Fry NK, Andrews NJ, et al. Effect of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis, England and Wales, July 1, 2000–June 30, 2016. Emerg Infect Dis. 2019 Sep;25(9):1708.

10. Mollendorf C von, von Mollendorf C, Tempia S, von Gottberg A, Meiring S, Quan V, et al. Estimated severe pneumococcal disease cases and deaths before and after pneumococcal conjugate vaccine introduction in children younger than 5 years of age in South Africa [Internet]. Vol. 12, PLOS ONE. 2017. p. e0179905. Available from: http://dx.doi.org/10.1371/journal.pone.0179905

11. Website [Internet]. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00984-3/fulltext

12. [No title] [Internet]. [cited 2022 Jun 21]. Available from: https://www.health.gov.za/wp-content/uploads/2022/03/National-EPI-Coverage-Survey_Final-full-report-Dec-2020.pdf

13. Rupiah K. Drop in child vaccinations a danger [Internet]. The Mail & Guardian. 2021 [cited 2022 Jun 21]. Available from: https://mg.co.za/health/2021-05-10-drop-in-child-vaccinations-a-danger/

14. Nnaji CA, Wiysonge CS, Lesosky M, Mahomed H, Ndwandwe D. COVID-19 and the Gaping Wounds of South Africa’s Suboptimal Immunisation Coverage: An Implementation Research Imperative for Assessing and Addressing Missed Opportunities for Vaccination. Vaccines. 2021 Jun 23;9(7):691.

15. [No title] [Internet]. [cited 2022 Jun 21]. Available from: https://research.assaf.org.za/bitstream/handle/20.500.11911/189/2021_assaf_low%20vaccination_under_immunisation%20_consensus.pdf?sequence=1&isAllowed=y

16. About our Alliance [Internet]. [cited 2022 Jun 21]. Available from: https://www.gavi.org/our-alliance/about

17. Website [Internet]. Available from: https://www.medbox.org/pdf/6225e524c577e93e13254e13

18. Biovac [Internet]. Biovac. [cited 2022 Jun 21]. Available from: https://www.biovac.co.za/