Immunisation: Involve communities to achieve global health targets

A small scar on the left arm of several Africans is evidence of the administration of the Bacille Calmette-Guérin (BCG) vaccine. BCG provides protection against tuberculosis (TB), an infectious bacterial disease of the lungs and the second leading infectious killer after Covid-19. 

Thanks to immunisation, improved diagnosis and treatment, global TB incidence is falling at about two percent per year, bringing us closer to meeting the goal of a four-to-five  percent annual drop in TB prevalence. 

While those with the scar hardly notice it, it is a subtle reminder of the power of immunisation: the safest and most efficient tool in prevention of disease — especially among children. In the past two decades, over 1.1 billion children have been immunised, saving 4-5 million lives each year and helping to reduce child deaths by half.

Vaccines have also helped prevent more than 20 lethal diseases and curtailed the rise of pandemics, extending life expectancy and giving hundreds of millions of people a chance to live healthier, more productive lives. 

According to the World Health Organisation (WHO), immunisation prevents up to five million deaths every year from diseases such as polio, diphtheria, tetanus, pertussis, influenza and measles.

Unfortunately, millions of people — especially in low-income countries — still do not have access to its lifesaving benefits. The Covid-19 pandemic has put millions of African children at risk, making it extremely challenging to achieve global immunisation targets

By the end of 2020, Africa was home to more than 17 million “zero-dose” children — children who had not received even a single vaccine shot. Today, several countries on the continent are grappling with low uptake of the Covid-19 vaccine and disruption of routine immunisation programmes. 

While African countries have made significant gains in immunisation in the past 20 years, working closely with global health partners to deliver life-saving vaccines that have so far reached 364 million children across the continent, Covid-19 and the joint effort to rapidly reach many people with vaccines has highlighted the persistent challenges we face.

These include lack of local manufacturing capacity, inadequate financing to purchase vaccines, vital infrastructure for last mile delivery, logistical and operational bottlenecks to scale up vaccination campaigns, and the saga of vaccine inequity. 

This comes at a time when, in many pockets across the continent, it may feel like the Covid-19 pandemic is slowly coming to an end. Yet in other parts, such as South Africa, it is clear that the pandemic is far from over and reaching the unvaccinated and most vulnerable continues to be an urgent priority.

To achieve global vaccination targets, not only should we continue to enhance vaccine equity through the Covax facility and investment in local manufacturing, it’s equally important that we invest in and prioritise community-led communication and advocacy initiatives that underscore the importance of vaccines. 

The right information empowers people to make the best decisions for their children, their families, and their communities. Equipping communities with the right information means going beyond talking about immunisation or using fear as a tool to get people vaccinated — we must engage with them as equal partners, answer tough questions, alleviate fears, and illustrate the power of vaccines to protect the people closest to us. 

Governments, health experts, health workers and other stakeholders involved in the design and delivery of immunisation programmes have a responsibility to understand the unique circumstances and challenges in each community if any meaningful engagement is to take place. 

This calls for humility, willingness to learn and respect communities, their cultures, and traditions. By involving community leaders and health volunteers in immunisation planning and implementation, we reinforce a sense of community ownership and agency over health and well-being, thus improving the effectiveness of vaccination programmes. 

Civil society organisations (CSOs) understand the specific needs and context of marginalised populations and hold the trust and confidence of communities. Therefore, CSOs are critical partners as we aim to effectively deliver immunisation to the last mile.

The partnership between Amref Health Africa, Gavi, the Vaccine Alliance, and the Gavi CSO Constituency is an example of how organisations can put communities at the centre of immunisation efforts. Through this partnership, civil society organisations will be supported and mobilised to help strengthen health systems and deliver immunisation services to under-served communities. 

CSOs not only identify and reach underserved and missed communities, and deliver health services in low-resource settings, they also develop new and effective ways to solve community-specific challenges. Supporting and empowering them will be critical to achieving global immunisation targets. The success of CSOs is important to Gavi, as demonstrated in its policy to allocate a portion of their funding to activities undertaken by CSO partners. 

As countries and partners reflect on the dialogue and outcomes from the 75th World Health Assembly, we are reminded that it is our collective responsibility to equitably end the current pandemic, and to prevent and prepare for future pandemics. By engaging communities from the grassroots level and involving all levels of decision-makers — from community leaders to health volunteers — we can ensure that present and future generations enjoy the protection offered by vaccines, and ultimately ensure long life for all.

The views expressed are those of the author and do not reflect the official policy or position of the Mail & Guardian.

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Sheetal Sharma
Sheetal Sharma is chairperson of the Global Alliance for Vaccines and Immunisation (Gavi) CSO steering committee
Githinji Gitahi
Dr Githinji Gitahi is group chief executive of Amref Health Africa
Thabani Maphosa
Thabani Maphosa is Managing Director of Country Programmes, Gavi

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