Vaccines in the City: Why urban immunisation needs an urban solution

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OPINION

By Sharon Namasambi

If vaccines are free and clinics are nearby, why do so many urban children still fall through the cracks?

Immunisation is one of the simplest, most powerful ways to protect our children's future. Yet in Kampala, where life moves fast and survival often takes priority, vaccines alone are not enough. What we need are systems designed to fit the daily realities of urban families.

On a Tuesday morning in Katanga, one of Kampala's busiest informal settlements, the air buzzes with vendor shouts and roaring boda-bodas. Grace, a 23-year-old mother of two, is already at her tomato stall when she shows me her youngest son worn vaccination card. At 20 months old, little Daniel received his measles-rubella vaccine at nine months, but the space for his second dose at 18 months remains blank.

"I wanted to take him," Grace explains, "but the clinic only vaccinates in the mornings, three days a week. That's when I make most of my sales. If I miss the stall, we don't eat."

This impossible choice between immediate survival and long-term health protection play out across Kampala daily, explaining why vaccine-preventable diseases like measles continue to flare up despite free, accessible vaccines. For many parents, the real cost of immunisation isn't money; it's lost time, missed income, and long queues at health facilities.

Kampala, as Uganda's economic hub, should offer the easiest access to health services. Instead, it remains a hotspot for vaccine-preventable disease outbreaks. A 2022 Gavi Alliance study revealed that while nearly all children in Kampala begin vaccination, only 4 in 10 complete their schedules, and just a quarter receive doses on time. As of June 2025, Ministry of Health data shows minimal improvement in these completion rates. This isn't about vaccine availability or parental willingness; it's a delivery system mismatched to urban realities.

Where distance to health facilities creates rural barriers, cities present a different maze of obstacles. Parents in informal jobs risk losing daily wages for clinic visits, while formal workers face rigid schedules with limited leave days. Private clinics may vaccinate children but fail to record doses in the national system, making follow-ups impossible and leaving children "invisible" to health trackers.

Families relocate frequently or children switch caregivers, causing appointments to be missed. Meanwhile, misinformation spreads rapidly through social media and messaging platforms, with false vaccine claims going viral faster than health authorities can respond. When so few children complete vaccination schedules, immunity (body’s ability to resist or fight off sickness) gaps widen, creating perfect conditions for outbreaks.

If cities breed unique challenges, they also hold potential for innovative solutions. Urban immunisation needs flexible, city-specific approaches that work with, not against, the urban rhythm. Evening and weekend vaccination sessions eliminate the work-versus-health dilemma for parents like Grace. Mobile outreach units at markets, taxi parks, and busy centres meet families where they already are, removing travel barriers and long queues.

Digital integration through SMS reminders and verified social media campaigns can prompt timely action and counter misinformation using trusted local voices. Health systems can offer vaccines during any clinic visit, ensuring no opportunity is missed, while strengthening partnerships between public and private providers to improve tracking and continuity of care.

No mother should choose between feeding her family today and protecting her child from preventable diseases tomorrow. This requires coordinated action from all stakeholders. Parents can advocate for flexible clinic hours and join community groups pushing for better services. Health facilities must extend operating times and strengthen partnerships with private providers to close system gaps.

Policymakers need to fund innovative delivery models that reach working families where they are, when they can access services. By redesigning immunisation systems to match the pace and realities of city life, we can close immunity gaps and build healthier futures for all urban children. Our cities demand urban solutions, and our children deserve nothing less.

Urban life is fast-paced, fluid, and unforgiving. Our immunisation systems must evolve to match it.

The writer is a Field Epidemiology Fellow with the Uganda Public Health Fellowship Program, Ministry of Health, hosted at the Uganda National Expanded Program on Immunisation (UNEPI).