Missed vaccination risks a child's life as eradicated diseases return

A medic from Mater Hospital administers the typhoid vaccine to a child during the wellness clinic in Buruburu, Nairobi, on July 13, 2025. The campaign for mass vaccination for typhoid and measles ends on July 14, 2025. [Benard Orwongo, Standard] Vaccine hesitancy remains a major setback in the global fight against childhood diseases. Health experts warn that reluctance to vaccinate newborns is fuelling the resurgence of diseases previously eliminated or well-controlled - like measles. This troubling trend is not unique to Kenya. Globally, healthcare providers are sounding the alarm as nations race to meet public health goals of ensuring every child is vaccinated by 2030. Experts stress that all childhood vaccines are equally vital in protecting against preventable illnesses and safeguarding future generations. Currently, Kenya is battling a measles outbreak in 23 counties, even as the Ministry of Health struggles to reach children who missed their vaccines due to persistent stock-outs experienced in recent months. Ruth Nduati, a paediatrician and researcher, explains that vaccines teach the body how to fight diseases. "Before vaccines, we had many severe childhood illnesses and numerous premature deaths. The discovery of how vaccines protect children was a major medical innovation," says Prof Nduati. She adds, "Vaccines contain antigens that fight diseases. In medicine, we haven't reached a point where one dose protects against all illnesses. That's why newborns must receive all routine vaccines - each one protects against a different disease." Under the Kenya Expanded Programme on Immunisation (KEPI), primary vaccines include BCG, oral polio, pentavalent, pneumococcal, injectable polio, rotavirus, measles-rubella, HPV, and tetanus-diphtheria vaccines. Malaria vaccine has also been introduced but is currently only administered in eight malaria-endemic counties. Similarly, the yellow fever vaccine is given to newborns in select endemic regions of the Rift Valley. In Kenya, pregnant women are issued with a baby booklet during antenatal visits. This guide outlines services they should expect, including newborn vaccines. At birth, babies receive the oral polio vaccine (drops) and the BCG injection in the mid-upper. BCG helps prevent tuberculosis (TB), while the oral polio vaccine protects against paralytic polio. Nduati explains that BCG acts as an antigen that trains the immune system to recognise and fight TB bacteria without causing actual infection. While BCG does not fully prevent TB, it significantly reduces severe forms such as miliary TB and TB meningitis - a life-threatening condition affecting the brain and central nervous system. "TB meningitis has a high fatality rate. Even survivors often face lasting effects, including brain damage, cerebral palsy, stunted growth, and lifelong disability," Prof Nduati notes. TB in infants may present with symptoms like persistent cough, weight loss, swollen lymph nodes, weakness, reduced activity, and altered mental function if the brain is affected. Data by Ministry of Health shows that in 2024, 13 per cent of TB cases were in children under 15, up from 12 per cent in 2023. Of the 139,000 TB cases recorded in 2023, at least 17,000 were children. "These vaccines are life-saving. Since newborns have low immunity, they are especially vulnerable to TB and polio," says Edith Anjere, Immunisation Coordinator for Vihiga County. "That's why we urge women to deliver in hospitals, where trained staff can administer the vaccines before mother and baby are discharged." At six weeks, infants receive the pentavalent vaccine (which combines protection against five diseases), along with pneumococcal and rotavirus vaccines. At 10 weeks, the baby is given another dose of Pneumococcal conjugate vaccine (PCV) and a rotavirus injection. By 14 weeks, they receive the injectable polio vaccine (IPV) to boost protection against polio. Children in malaria-endemic counties - Vihiga, Kisumu, Siaya, Homa Bay, Migori, Busia, Kakamega, and Bungoma-are also given the malaria vaccine at six, seven, and nine months, with a final dose at two years. At nine months, children receive the measles-rubella vaccine, followed by a booster at 18 months. In malaria-prone areas, children also get a malaria vaccine dose at that stage. Last week, the country launched typhoid conjugate vaccination, administered to children aged between nine and 14 years, to help prevent typhoid. Typhoid fever remains a major public health concern in Kenya, particularly affecting children under 15 years, with the highest rates reported in those under five. The country records an estimated 126,000 typhoid cases annually, resulting in at least 1,500 deaths. "Vaccines save lives. Every child should receive all the primary vaccines," says Anjere. "If parents have concerns, they should consult a health provider." Prof Nduati adds that vaccination not only prevents death but also reduces disease severity. For example, pregnant women are given five doses of the tetanus vaccine to build their immunity and transfer antibodies to the unborn child through the placenta. As the baby develops in the womb, their vaccination schedule is determined to protect them at each vulnerable stage. For instance, the measles vaccine is given at nine months because antibodies passed from the mother can interfere with earlier doses. Some vaccines, like whooping cough (given at six weeks), are less frequently taken despite their importance. Nduati laments that despite the serious consequences of missed vaccinations, vaccine hesitancy persists. She recalls earlier times when polio paralysed and killed hundreds-now largely controlled thanks to vaccines. "Polio is a terrible disease. It may begin with diarrhoea. Not everyone is paralysed, but many are," she says. "Before polio vaccines, even an American president was infected-he didn't get paralysed, but many did." She adds, "Some older adults, especially those who grew up in Somalia or rural Kenya in the 60s and 70s, still bear the effects-limbs affected, usually one. We no longer see this, but if we stop immunising, it will return." Rotavirus vaccine, she explains, is crucial in preventing severe diarrhoea and pneumonia-two major causes of child deaths in Kenya. Ministry of Health data shows that an estimated 4,500 children under five die annually from rotavirus. In 2007, rotavirus led to 1,431 hospitalisations per 100,000 infants, and 478 per 100,000 children under five. Following high infant deaths in 2009, WHO recommended all countries include rotavirus in their immunisation schedules. Kenya adopted the vaccine in 2014. Similarly, introduction of the pneumococcal conjugate vaccine in 2011 significantly reduced pneumonia deaths. According to 2018-2019 data, pneumonia accounted for six out of every 1,000 under-five deaths, about 15 percent of total child deaths. "Before rotavirus vaccines, children used to die from diarrhoea and dehydration- it was terrible," Nduati recalls. "The vaccine now prevents 70 per cent of infections and significantly reduces the severity of cases." "As a young doctor at Kenyatta National Hospital, we used to admit tens of children daily with diarrhoea. Once WHO introduced the vaccine and we rolled it out, we saw a marked decline." Measles vaccines prevent blindness, diarrhoea, pneumonia, malnutrition, ear infections, and brain damage. Prof Nduati explains that measles causes a dangerous drop in vitamin A, leading to corneal damage and, in severe cases, blindness. "During past outbreaks, many children went blind. That's why we give vitamin A supplements to protect their eyes and reduce mortality," she says. Measles can also lead to lung infections, bronchitis, and weaken a child's entire immune system. Anjere warns, "If a child misses even one primary vaccine, they're at risk of infection. In an outbreak, unvaccinated children suffer the most-with severe consequences, including death." Vaccines in Kenya are free of charge at public facilities, thanks to donor support from Gavi, UNICEF, and WHO. They are also available in private hospitals. Kenya's vaccine coverage stands at 80 percent, but at least 300,000 children still miss out every year. Nduati reiterates that vaccines under KEPI protect against common child illnesses such as pneumonia and diarrhoea. While private hospitals offer more vaccines, she cautions that some operate with profit motives. "Private facilities function like businesses. They offer useful vaccines, but the government prioritises only those that are critical," she says. For example, flu vaccines are not part of public programs because flu viruses constantly mutate. Other private-sector vaccines include those for chickenpox and cholera. Typhoid was once excluded from primary immunisation, but has now been added due to its high prevalence. Despite these efforts, low vaccination rates continue to threaten newborn survival. Measles coverage remains as low as 60 percent. Data from Kenya's health information system shows that 14 counties-including Nairobi, Mombasa, Kakamega, Kisii, Trans Nzoia, Kericho, Bomet, Uasin Gishu, Bungoma, Homa Bay, Kilifi, Kitui, Nandi, and Wajir-account for half of all zero-dose children. Lilian Mutua, head of health promotion in Nairobi County, notes that tracing zero-dose children is key. She emphasises that the first immunisation should be administered immediately after delivery in a health facility, with those delivering at home having their babies vaccinated within two weeks. "Data shows gaps in immunisation coverage. We forecast births per year and quarter using population census data to estimate the number of children needing vaccination. We also consider delivery numbers," says DR Mutua. The county has mapped out immunisation centres in all 17 sub-counties, equipped with cold chains. UNICEF has also supplied coolers to support the programme. Each month, immunisation coordinators from hospitals and sub-counties submit reports to help trace and vaccinate those who missed out. "Vaccination coverage varies by vaccine. If targets aren't met, facilities conduct outreach to bring services closer to communities," she adds. The county promotes vaccination through social media, local administrators, and the Nyumba Kumi initiative. Community Health Promoters conduct door-to-door campaigns, referring those needing injectable vaccines to health facilities. However, challenges remain: a high influx of people from across borders, misinformation, and resistance in gated communities and among some Somali nationals. The county leverages public-private partnerships, with support from UNICEF and other partners, to meet immunisation goals.

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Missed vaccination risks a child's life as eradicated diseases return

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