Burden of needle injections of childhood vaccines in Africa, South and South-East Asia: Impact of additional new vaccines

Vaccinations remain a cornerstone of public health, effectively reducing the burden of infectious diseases, particularly in children. However, the increasing number of routine vaccine injections, especially in low- and middle-income countries (LMICs), has raised concerns among parents and healthcare providers, potentially impacting vaccine acceptance and adherence. This scoping review aims to investigate the number of injections administered across different age groups in LMICs, with a focus on Africa, South and South-East Asia. Data was sourced primarily from the World Health Organization immunization portal, alongside information on vaccines in development from various global health organizations. The study analyzed routine injectable vaccines by age group, examining national immunization schedules to estimate the number of injections and healthcare visits required and the distribution of injections and visits across different regions. The review highlights the complexity of vaccination practices in LMICs, where children receive numerous injections due to the inclusion of multiple vaccines in the Expanded Program on Immunization. The findings suggest that while vaccines are critical for preventing infectious disease, the high number of injections and visits may contribute to vaccine hesitancy, necessitating a reassessment of immunization strategies. For instance, as new vaccines are progressively introduced, the total number of injections administered to infants in particular could rise from the current 12 to between 18 and 26 injections. This review contributes to the ongoing discourse on optimising vaccine delivery, advocating for the adoption of needle-free technologies and combination vaccines to reduce the number of injections and visits to improve vaccine uptake.