In 2019, South Sudan experienced significant child mortality from preventable diseases. Pneumonia and diarrhea were particularly deadly, accounting for 19% and 10% of under-5 mortality, respectively. Rotavirus is especially impactful, causing 24.4% of diarrheal disease deaths in low- and middle-income countries.
Vaccination emerges as a crucial public health strategy, preventing an estimated 3.5 to 5 million deaths from vaccine-preventable diseases. Given the substantial burden of these illnesses, prioritizing comprehensive vaccination programs is essential for reducing child mortality and improving overall health outcomes.
South Sudan has a mortality rate of 98.8 per 1000 live births for children under five (U5) years with malaria, diarrhea, and pneumonia accounting for about 70% of their deaths. Malaria, the mosquito-borne parasitic infection and leading cause of death among children under 5 years in the country is now being curbed through the launch of a malaria vaccine in South Sudan to protect them against it and its sequelae. However, key vaccines that limit pneumonia and diarrhea are yet to be introduced in South Sudan.
percentage of surviving infants who received the 3rd dose of DTP vaccine, an early childhood vaccine, was 73%
Pneumonia and diarrhea, two dangerous killer diseases with some vaccine-preventable accounted for 19% and 10% respectively, of U5 mortality in South Sudan in 2019 alone. Rotavirus contributes 24.4% of deaths caused by diarrheal diseases in low- and middle-income countries (LMICs). It is imperative to prioritize the reduction of the burden of these diseases through vaccination. Vaccination, which is one of the most critical public health interventions of the century, averts the mortality of more than 3.5 to 5 million individuals from vaccine-preventable diseases.
Fortunately, with advances in vaccine development and introduction worldwide, some causes of pneumonia and diarrhea are now vaccine-preventable. The PCV (pneumococcal conjugate vaccine) protects not only against pneumococcal-caused pneumonia but also meningitis, and when administered to children U5 years, has an indirect effect on the protection of adults especially the elderly. The Rotavirus vaccine also exists, and its administration is recommended along the DTP (Diphtheria, Tetanus, Pertussis) vaccine
According to UNICEF, in South Sudan, the percentage of surviving infants who received the 3rd dose of DTP vaccine, an early childhood vaccine, was 73%. This shows the impact vaccination can have on preventing and reducing mortality. South Sudan's national ministry of health is on the right path with the policy decision to concurrently introduce Pneumococcal Conjugate (PCV) and Rotavirus vaccines by the end of the first quarter of 2025. Notably, it will be the first time two vaccines will be introduced simultaneously in the country.
In April 2023, the second global forum on the prevention of childhood pneumonia was held in Madrid, Spain. During this forum, Dr. Victoria Anib Majur, then Undersecretary of the national Ministry of health, emphasized the government's commitment to introducing the PCV (Pneumococcal vaccine) and Rotavirus vaccines in 2024. This commitment reflected the ministry's determination to protect South Sudan's children from pneumonia and diarrhea by keeping these issues on the health policy agenda.
GAVI has agreed to fully fund the procurement of vaccine consignments
Following Dr. Anib's tenure, her successors ensured that an application for introducing these vaccines was successfully submitted to, and approved by, GAVI, the vaccine alliance, in 2024. GAVI has agreed to fully fund the procurement of vaccine consignments to be rolled out. While these are commendable steps, GAVI's approval also highlights the need to address the remaining gaps necessary for successfully introducing the PCV and Rotavirus vaccines in South Sudan.
To effectively introduce the two vaccines concurrently, it is imperative to support the institution of certain prerequisites. Firstly, support for South Sudan's national Ministry of Health to develop a robust action plan and schedule with a matching budget for vaccine introduction. The development of such a plan should be cognizant of the reality of a dismally underfunded health sector, and the need to widely disseminate it and ensure buy-in from various immunization actors in the country.
Secondly, an open and objective assessment process of the health system's infrastructure to determine capacity and readiness, including skilled human resources and cold chain availability for concurrently introducing of the two vaccines is crucial. Thirdly, support for advocacy and increasing public awareness about the imminent introduction of the two vaccines and their public health benefits to elicit demand and anticipation for the vaccines and avert vaccine hesitancy.
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As the world marked Immunization Day on November 10,, 2024, under the theme; "humanly possible: saving lives through immunization," we call upon South Sudan's national Ministry of Health, humanitarian and development partners, and citizens at large to combine efforts and ready South Sudan for effective introduction of PCV and Rotavirus vaccines by the first quarter of 2025. These efforts should generate a budget-matched plan and schedule for the two vaccines' introduction, assess health system infrastructure readiness, and support public awareness. They should also not fall short of monitoring and evaluation of the vaccine introduction program to enable learning and accountability for use in subsequent vaccine introduction programs.
By supporting these key steps towards readiness for concurrent PCV and rotavirus vaccines' introduction, we could afford South Sudan a giant leap towards reduced under-five mortality rates, ensuring healthier futures for South Sudan's children, and making significant strides towards achieving global health goals.
Dr. Emmily Koiti is the Executive Director - South Sudanese Women In Medicine (SSWIM).
Dr Anne Pita Lomole is a Paediatrician and Infectious Disease Consultant with an interest in vaccinology.
