Despite the end of African Vaccination Week , the topic has never been more relevant than now, with South Africa rolling out its Covid-19 vaccination programme.
IOL caught up with Dr Kerrigan McCarthy, specialist pathologist at the National Institute of Communicable Diseases (NCID), to chat about South Africa’s broader Expanded Programme on Immunisation (EPI), as well as the importance of vaccinating children.
McCarthy also busts some major misconceptions about vaccines, including the reported side effects of the COVID-19 vaccines.
Last week marked Global/African Vaccination Week (24 – 30 April 2021). What is the importance of educating the population about immunisation?
Over the last 100 years, vaccination against life-threatening illness has saved millions of lives across the world, improved socio-economic stability, and allowed resulting financial savings to accrue across many sectors.
However, collectively, we are in danger of taking these benefits for granted and forgetting the gains we have made. In our present time, our lives have seen the social and economic destruction due to the COVID-19 pandemic. We cannot imagine how devastating a world it would be where not only SARS-CoV-2 but also polio, diphtheria, tetanus, pertussis (whooping cough), measles, hepatitis B and childhood pneumonia could step through our communities unimpeded.
Therefore, it serves us well to remember the benefits of vaccination and to count the savings in our personal lives, nationally and globally. If we go back to our grandparents, if they are still alive, many who were born before the 1960s and living in South Africa may remember the last polio outbreaks that swept across the country and how terrifying it was.
Doctors who were practicing in South Africa during the Fifties and Sixties can also describe stories of diphtheria patients, and how young children died of breathing and heart problems. Some of us may have suffered from vaccine-preventable diseases such as measles or meningitis, and we may know the impact that those illnesses have made on our lives. These are the kinds of stories we need to hear.
South Africa currently has an immunisation/vaccination programme in place for COVID-19. What are some of the other immunisation programmes available?
South Africa implements vaccination of children according to the Expanded Programme on Immunisation (EPI), which was established in 1974 by the World Health Organization (WHO) to develop and expand immunisation programmes throughout the world. Initially, the programme focused on diphtheria, tetanus, pertussis and measles.
Since then, additional vaccines have been added to the EPI as evidence for safety, efficacy and economic benefit has emerged. Today, vaccines against 10 commonly occurring bacterial or viral pathogens are included in the South African EPI. In addition to the EPI programme, the South African government also purchases a million influenza vaccines annually.
These are distributed to vulnerable groups, including pregnant women. Life-saving rabies vaccine and immunoglobulin is available free of charge at public-sector hospitals to persons exposed to potentially rabid dogs.
Other vaccines – such as hepatitis A, varicella and meningitis – which are not in the EPI are made available to specific vulnerable populations, such as persons undergoing transplantation, by motivation at tertiary hospitals.
The EPI vaccines may be supplemented by private purchase of additional vaccines against childhood illnesses – some of these include vaccines against rubella, mumps, varicella, hepatitis A and meningitis. Certain vaccines are also recommended for travellers, and can be purchased at government or private clinics. These include vaccines against yellow fever, cholera, typhoid, hepatitis A and meningitis.
Vaccinating children at a young age is extremely important with South Africa providing free immunisation at state clinics. Can you provide more insight into these free vaccines and the benefits to families?
Presently, the South African EPI includes vaccination of children against tuberculosis, diphtheria, tetanus, pertussis, hepatitis B, haemophilus influenza B, polio, rotavirus, streptococcus pneumoniae and human papilloma virus. The EPI vaccines are freely available at all primary healthcare clinics across South Africa.
The School Health Programme also administers vaccines to school-aged children, including a booster against tetanus and diphtheria (ages 6-7 and 12), and the vaccine to protect against human papilloma virus (age 7).
On administration of their first vaccination, ideally at birth, all children are provided with a Road to Health booklet, which healthcare workers use to document which vaccines a child receives, including date of receipt and the vaccine batch number.
The booklet contains helpful resources to support caregivers, such as growth charts, developmental milestones, advice about the treatment of common ailments such as diarrhoea, warning signs of severe illness and how to register for a childcare grant.
How are vaccination programmes able to reach underserved and marginalised communities?
Is there still a lot of work to be done in this area, both in educating communities but also providing them with existing and newly available vaccines?
The South African Medical Research Council (SAMRC) and VIDA recently did a national vaccination coverage survey. The results showed that only 76% of children under the age of 18 months are fully vaccinated.
An analysis of the results showed that common reasons for missed doses included health service delivery issues such as vaccines being out of stock at the clinic, the clinic was closed or staff were not present to administer the vaccine; the primary caregiver was not aware that the child was due for a vaccine; the child was ill and the clinic deferred vaccination; access issues such as the caregiver was at work or ill, or the clinic was too far; and parental refusal.
These findings are helpful as they can direct our efforts towards interventions that will increase the uptake of vaccines. Clearly, helping caregivers to understand the benefits of vaccination is important, but strengthening the health system, especially vaccine supply chain management, is perhaps the most integral way to ensure uptake of vaccines.
What are some of the major misperceptions or myths people have about vaccinations?
The most important thing to bear in mind is that vaccination saves lives. It is the most tragic thing when a person dies, but even more tragic when a person dies of a disease that can be prevented through a simple vaccine.
By and large, vaccines are incredibly safe medicines, as the standards for judging its safety are very high. However, many people are deeply suspicious that the safety of vaccines is not objectively reported on because of the concern that there are hidden profit motivations or political agendas linked to vaccination science.
People are correct to read the evidence critically, rather than adopt a universal trusting approach. However, it is helpful to balance one’s anxiety about “conspiracy theories” or cover-ups of bad science by observing that even the best governments and organisations fail to implement perfect public health plans.
Therefore, the chances of a successful conspiracy theory or cover-up are nigh impossible. Furthermore, history has shown us that bad science will always surface, as will corruption.
Research has also shown that the level of trust that a caregiver places in their healthcare providers will determine vaccines uptake.
People who hesitate to take vaccines are often influenced by ideologies and those in which they place their trust, not by statistics regarding how safe vaccines are or how rare adverse events take place. Objective, trustworthy opinion leaders need to voice their support or vaccination to assist people who are uncertain about its worth.
South Africa’s COVID-19 vaccine roll-out resumed last Wednesday. We already know there are various groups that are prioritised, and the various stages at which each group will receive the vaccine. For newborn babies, do they receive the vaccination at birth?
Children and persons under 18 years of age are not eligible to receive any COVID-19 vaccines. This is because the large vaccine trials have not been conducted in children and there is no evidence to show that COVID-19 vaccines are safe for them. However, a number of groups are enrolling adolescents and trials in children are likely to take place soon.
There have been reports from around the world of side effects and people contracting COVID-19 despite being vaccinated. What are the chances of this in South Africa and do people need to be concerned?
Extremely rare cases of a new condition called vaccine induced thrombocytopenia and thrombosis (VITT) syndrome has been documented in countries where more than a million people have been vaccinated. People with this side effect develop blood clotting – sometimes in the brain, but also in other organs within seven to 10 days after receiving the vaccine. They also have very low platelets. So far, it appears that this side effect occurs in about six of every one million people who receive the vaccine.
The reason for the syndrome is not yet fully understood, but it is likely related to an immune/antibody response to the vaccine. It is important to investigate serious side effects like this to know how large the risk is, who is at risk and what the risk-benefit ratio is.
Presently, authorities have concluded that this side effect is extremely rare compared with other causes of blood clots, including clots due to SARS-CoV-2, and that younger people are more at risk than older people.
However, it is important to keep in mind that the benefits of vaccination far outweigh the risks. South Africa has a pre-existing surveillance programme for adverse effects following immunisation and is rolling out an electronic-based system for recording vaccine side effects.
The system is called the MedSafety App. More in-depth surveillance systems are being planned that will also allow us to pick up extremely rare side effects that result from taking the vaccine.
Are there any specific lessons the state has learnt during the current roll-out of the COVID-19 vaccine?
The National Department of Health (DoH) is coordinating the vaccine rollout. Any vaccination programme is logistically difficult to implement and manage. The COVID-19 vaccine is perhaps one of the most difficult as South Africa does not have a pre-existing adult vaccination programme.
All the systems, ranging from supply chain management, data collection and analysis to vaccination and monitoring of side effects, need to be developed and implemented for the first time.
The NCID’s contribution to the COVID-19 vaccine roll-out includes ongoing surveillance for cases of disease (epidemiological monitoring), monitoring the effectiveness of the vaccine by molecular sequencing of SARS-CoV-2 strains and follow-on immunological testing, and providing technical advice to support surveillance for adverse effects following immunisation.