Immunisation is one of the most impactful and cost-effective public health interventions known to effectively prevent mortality and reduce morbidity. However, despite increased global vaccination coverage and uptake observed over the years, Africa is still lagging behind.
Vaccines protect us throughout life, without which we face the risk of serious, and sometimes life-threatening illnesses and disabilities from diseases like measles, meningitis, pneumonia, tetanus and polio, amongst others. Currently, immunisation prevents over 4 million deaths yearly, and in the African Region alone, around 800,000 lives are saved every year because of vaccines.
Besides offering protection from preventable diseases, immunisation brings children and families into contact with health systems, providing an avenue for the delivery of other basic health services and laying the foundation for primary health care. Hence, ensuring universal access to vaccines is a critical entry point for universal health coverage (UHC). Immunisation also holds broader social and economic benefits, with an estimated return on investment of $44 for every $1 spent on childhood immunizations in Africa.
The problem of vaccine uptake and coverage in Africa is multifaceted and its magnitude may vary from country to country. However, the fundamental issues remain the same
Globally, immunisation has played a crucial role in decreasing child mortality, reducing under-five deaths from 12.5 million in 1990 to 5.3 million in 2018. The African region has also made significant strides in increasing access to immunisation and driving down child deaths, with monumental achievements such as the recent eradication of indigenous wild polio, and several diseases, like maternal and neonatal tetanus, at the brink of elimination.
Despite these achievements, the African Region still lags significantly behind other regions of the world in access to vaccines. About 1 in 5 African children do not receive all the necessary and basic vaccines. Hence, every year, over 30 million children under five still suffer from vaccine-preventable diseases (VPDs) in Africa. Of these, over half a million children die from VPDs annually, representing approximately 58% of global VPD-related deaths. In recent years, the suboptimal immunisation coverage and uptake in Africa has been further hampered by disruptions caused by the COVID-19 pandemic.
There is therefore an urgent need for African countries to develop strategies that effectively address the challenges limiting high vaccination uptake and coverage to achieve a reduction of VPDs, as well as prevent the re-emergence of once-scarce deadly diseases.
Challenges impeding vaccination uptake and coverage in Africa
The problem of vaccine uptake and coverage in Africa is multifaceted and its magnitude may vary from country to country. However, the fundamental issues remain the same. In most African countries, particularly in the rural settings, challenges include the long distances needed to reach remote populations, a lack of adequately trained personnel to administer vaccines, non-existent or intermittent access to electricity to manage the cold chain, and frequent vaccine stock-outs at health facilities.
Another challenge is inadequate local investment and overreliance on foreign aid to fund vaccine procurement and delivery. This model of financing immunization programmes is not sustainable and currently facing unprecedented financial constraints due to recession during the COVID-19 pandemic. Other issues include political instability, poor maternal education, poverty and inadequate health insurance, religious factors, as well as emerging challenges caused by the COVID-19 pandemic.
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Strategies to increase vaccination uptake and coverage in Africa
Addressing the challenges of vaccination uptake and coverage in Africa requires collaborations among relevant stakeholders, including governments, local and international funders, cold-chain handlers, health workers, and local communities. Bloom Public Health recommends the following strategies:
• Increasing strategic local investments for sustainable funding: African governments must prioritise funding for the strengthening of health systems that support robust immunisation programmes to deliver vaccines to all populations, including the most vulnerable. This includes investment in infrastructure, services, and equipment to improve and maintain effective cold chains in remote areas. African governments should therefore explore public-private partnerships (PPPs) for sustainable investment and capacity-building.
• Adoption of innovative technologies to reach remote populations: There is an urgent need for the rapid adoption of new technologies, such as drones, to access hard-to-reach areas and the evaluation of their applicability to specific scenarios. Bloom Public Health’s partner, Zipline, has transformed healthcare delivery worldwide through automated, on-demand delivery using drones thereby reducing delivery time from hours by road to minutes.
• Increasing maternal health education and public awareness: Maternal education is closely associated with immunisation service uptake. Positive perceptions of vaccine safety and importance of vaccination for health are crucial factors in vaccine uptake. Therefore, intensive community engagement and effective health communication are needed to disseminate accurate information and facilitate optimal vaccine uptake. Leveraging mass media, such as radio-based health promotion campaigns, is an important strategy to raise community awareness and encourage mothers to vaccinate their children.
Other strategies include implementing regular immunisation outreach programs that target priority populations, increasing training of health workers on vaccine administration, and addressing vaccine supply issues through improved local vaccine research and manufacturing.
Conclusion
Immunisation remains a low-cost, high-impact health intervention and a key driver of universal health coverage (UHC). Given its crucial role in reducing the burden of disease on individuals, families and communities, concerted efforts are needed to expand vaccine coverage and uptake and to ensure Africans everywhere have access to the basic health services they need to survive and thrive.
