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Analytical summary - Immunization and vaccines development

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In Botswana, the Expanded Programme on Immunization is fully funded by the Government and has maintained high coverage for all recommended vaccines since 2000. A survey conducted in 2007 showed that 90% of surveyed children aged 12–23 months had received all valid doses of recommended vaccines and had under-five card retention of 98%.[1]

There has been a decline in cases of diphtheria, pertussis and neonatal tetanus. Since 1992, there have been no cases of diphtheria reported. Similar trends have been observed for neonatal tetanus, pertussis and polio.

However, the country faces a challenge in maintaining the cold chain in its extremely hot weather. Another challenge is that vaccines such as hepatitis B have not yet been introduced in the country, even though pneumonia is a leading cause of mortality among children aged under 1 year.

Other challenges in implementing the Expanded Programme on Immunization include:

  • limited incentives for staff working in remote areas;
  • multiple roles for nurses lead to burnout;
  • low cooperation of farmers who have high numbers of children in their farms who are neither going to school nor benefiting from programmes such as early childhood development;
  • the nomadic lifestyle of some communities;
  • poorly developed reporting channels from the private sector.

Although serious attention is being given to these challenges, their solutions remain to be reached. The country needs to strengthen the strategies of following up the 10% of the 12–23 months olds that have not been immunized.


  1. National Expanded Programme on Immunization survey. Gaborone, Government of Botswana, Ministry of Health, 2007