Abstract
Despite South Africa’s substantial investments in and efforts at ensuring universal access to immunisation services, progress has stalled and remains suboptimal across provinces and districts. An additional challenge is posed by the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has disrupted immunisation services globally, including in South Africa. While there is growing evidence that missed opportunities for vaccination (MOV) are a major contributor to suboptimal immunisation progress globally, not much is known about the burden and determinants of MOV in the South African context. Herein, we make a case for assessing MOV as a strategy to address current immunisation coverage gaps while mitigating the adverse impacts of the COVID-19 pandemic on immunisation services. We illustrate a practical implementation research approach to assessing the burden of MOV among children in primary care settings; for understanding the factors associated with MOV; and for designing, implementing, and evaluating context-appropriate quality improvement interventions for addressing missed opportunities. Such efforts are vital for building health system resilience and maintaining immunisation programme capacity to optimally deliver essential health services such as routine childhood immunisation, even during pandemics.
Highlights
Immunisation has long been recognised as one of the greatest advances in public health [1,2]
Routine immunisation services in South Africa are provided at no cost through the Expanded Programme on Immunisation of South Africa (EPI-SA) [18]
To ensure funding and sustainability, it is vital that missed opportunities for vaccination (MOV) assessment activities and remedial action plans be endorsed by key immunisation programme decisionmakers and stakeholders, such as EPI programme managers, immunisation partners, and other relevant stakeholders at the local and national levels
Summary
Immunisation has long been recognised as one of the greatest advances in public health [1,2]. The immense public health and socioeconomic benefits of immunisation prompted the World Health Organization (WHO) to launch the Expanded Programme on Immunisation (EPI) in 1974, as the first ever global health effort to promote and ensure universal access to vaccines for all children [4,5] This improved access to immunisation at the population level has helped to avert approximately four million child deaths every year from vaccine-preventable diseases [6,7,8]. An estimated 20 million infants do not have access to vaccines or do not complete the vaccination series, the majority of whom reside in a few countries of sub-Saharan Africa, including South Africa [12,13,14] These gaps are further complicated by the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has disrupted essential health services nationally, including routine immunisation [15,16]. The disruption has resulted from a shift in the focus of health services to COVID-19 pandemic response, movement restrictions and physical distancing, and the fear of contracting COVID-19 during health facility visits [17]
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