Concerns over the pace of vaccination during the COVID-19 pandemic have been amplified by the World Health Organization (WHO) and UNICEF, amidst fears that fewer children will be vaccinated against life-threatening diseases due to the disruption of the crisis.
“These disruptions threaten to reverse hard-won progress to reach more children and adolescents with a wider range of vaccines, which has already been hampered by a decade of stalling coverage,” read a press release issued by the two agencies. “The latest data on vaccine coverage estimates from WHO and UNICEF for 2019 shows that improvements such as the expansion of the HPV [human papillomavirus] vaccine to 106 countries and greater protection for children against more diseases are in danger of lapsing.
“For example, preliminary data for the first four months of 2020 points to a substantial drop in the number of children completing three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3). This is the first time in 28 years that the world could see a reduction in DTP3 coverage – the marker for immunisation coverage within and across countries.”
UNICEF issued a stark warning earlier this year about the potential for COVID-19 to disrupt immunisation efforts. Such efforts were key to ridding the world of smallpox’s scourge and in making polio a thing of the past for the overwhelming majority of countries, including India.
“Parents are increasingly reluctant to take their children to health centers for routine jabs,” UNICEF explained at the time. “Sporadic outbreaks of vaccine-preventable diseases, including measles and diphtheria, have already been seen in parts of Bangladesh, Pakistan and Nepal…many of the health facilities throughout the region, where millions of children are normally vaccinated, have been closed and outreach sessions have been suspended, adding to the challenge.”
Both UNICEF and the WHO have now reiterated concerns over the subject of vaccinations being missed at the global level. The release notes “due to the COVID-19 pandemic, at least thirty measles vaccination campaigns were or are at risk of being cancelled, which could result in further outbreaks in 2020 and beyond.
“According to a new UNICEF, WHO and Gavi pulse survey, conducted in collaboration with the US Centers for Disease Control, the Sabin Vaccine Institute and Johns Hopkins Bloomberg School of Public Health, three quarters of the 82 countries that responded reported COVID-19 related disruptions in their immunisation programmes as of May 2020.”
Henrietta Fore, UNICEF’s executive director, explains that “COVID-19 has made previously routine vaccination a daunting challenge. We must prevent a further deterioration in vaccine coverage and urgently resume vaccination programs before children’s lives are threatened by other diseases. We cannot trade one health crisis for another.”
Reminiscent of the fact that progress against HIV/AIDS was off-track before the pandemic hit is that COVID-19 has underscored the lapses in combating vaccine-preventable diseases through robust immunisation programmes.
“Progress on immunisation coverage was stalling before COVID-19 hit, at 85 percent for DTP3 and measles vaccines,” the WHO/UNICEF release notes. “The likelihood that a child born today will be fully vaccinated with all the globally recommended vaccines by the time she reaches the age of five is less than twenty percent. In 2019, nearly fourteen million children missed out on life-saving vaccines such as measles and DTP3.
“Most of these children live in Africa and are likely to lack access to other health services. Two-thirds of them are concentrated in ten middle- and low-income countries: Angola, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan, and Philippines. Children in middle-income countries account for an increasing share of the burden.” For India, in terms of measles alone, as previously reported by Health Issues India
“The past eight years saw more than twenty million children miss out on the first dose of the measles vaccine with almost 170 million children under ten unvaccinated as a result. This was the finding of UN research which – in the Indian context – saw that 2.9 million Indian children did not benefit from the all-important first dose.”
In the context of diphtheria, we noted
“Diphtheria vaccine coverage in the 2015-16 period stood at around eighty percent. In recent years, mistrust of vaccines and a misperception that the disease is no longer a public health threat have driven declining vaccination rates. According to a 2017 study, “information about coverage of diphtheria boosters is not routinely collected through these surveys, but is expected to be low. Few studies also indicate low diphtheria immunity among school-going children and adults.”
The WHO/UNICEF release does note that “regional coverage for the third dose of DTP in South Asia has increased by twelve percentage points over the last ten years, notably across India, Nepal and Pakistan. However, that hard-won progress could be undone by COVID-19 related disruptions.”
The need of the hour is for health systems – both in India and globally – to ensure that the disruption to vaccination programmes is mitigated as far as possible. To address COVID-19 is undoubtedly a necessity, but so is ensuring that vaccine-preventable diseases do not resurge in tandem. Public health systems face multiple challenges – and to undo the progress made against diseases which immunisation can avert (an area where India has experienced success) will only undermine the nation’s wellbeing.