COVID-19 impact on Immunization
by Rijul Singh Uppal on 24 Sep 2020 1 Comment

Immunization is amongst the most cost-effective global public health measures to date that helps save an estimated 2 to 3 million lives every year. As a direct result of global immunization policies, the world is close to eradicating polio and global deaths from measles declined 73 per cent during 2000–2018. However, this has been disrupted by the emergence of the COVID-19 pandemic, as per UNICEF/WHO data resource “Immunization Coverage: Are we losing ground”.


The COVID-19 pandemic has put an unprecedented burden on healthcare systems, overstretching them to the extent where essential health services such as vaccination services have been disrupted. In the majority of low income countries, health infrastructure and services were already in a fragile state and in many lower-middle countries the health infrastructure was not resilient. The COVID-19 outbreak created a big gap in the delivery of health services to the poor and needy as national focus shifted to contain and combat the pandemic. 


A July 28, 2020 story by the World Economic Forum states, “Immunization has saved many millions of lives, reduced the number of people living with post-recovery infection-related complications, and delivered many economic benefits”. It further states that “2019 data showed there were already 14 million ‘zero-dose’ children who had missed out on vaccines entirely, concentrated in just 10 middle- and low-income countries: Angola, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan and The Philippines. Some of these countries have since been hard hit by COVID-19, creating a range of new vulnerabilities”.


Per the WHO/UNICEF National immunization coverage estimates, in 2019, figures for the coverage rate of DTP3 reached 85 per cent, up from 20 per cent in 1980. Globally, the percentage of children receiving the Diphtheria, Tetanus, and Pertussis (DTP) vaccine is often used as an indicator of the strength of routine immunization services. Disruptions in health systems that prevent sustainable vaccination services are generally due to factors such as under-invested national immunization programmes, conflict and disease outbreaks.


The WHO estimates that in 2020, some 80 million children under the age of one live in countries where immunization programmes faced disruptions caused by COVID-19 due to limited access to health centres, low availability of PPE kits for healthcare workers and the general fear of the pandemic. This meant that countries suddenly face the threat of COVID-19 along with the threat of outbreaks of vaccine-preventable diseases and deaths. Such disruptions can have a ruinous impact on child mortality.


COVID-19 related disruptions in delivery and uptake of vaccines have caused an alarming decline in the number of children receiving these life-saving vaccines. UNICEF and WHO warn that these disruptions have the potential to reverse decades of progress of immunization programs. Preliminary data estimates by WHO and UNICEF from the first four months of 2020 point towards a substantial reduction in DTP3 coverage for the first time in nearly 30 years.


Starting March 2020, routine vaccination programs have globally halted on an unprecedented scale since the 1970s. WHO states that more almost 53 per cent of the 129 countries where data was available had reported disruptions or suspension of immunization programs during March-April 2020.


A WHO, UNICEF, and Gavi pulse poll conducted in June 2020 in collaboration with the Sabin Vaccine Institute, Johns Hopkins and the US CDC revealed that 75 per cent of the 82 countries that responded reported disruptions in immunization programs caused by or related to the COVID-19 pandemic as of May 2020. The disruptions were caused by various factors such as reluctance of parents to leave home, lack of information, fear of infection, unavailability of health workers due to movement restraints, and transport delays of vaccines caused by disruptions in the vaccine supply chain.


Many countries also temporarily suspended preventive vaccination programs against vaccine-preventable diseases as part of the national physical distancing campaigns and to avoid risk of transmission during the early stages of the COVID-19 pandemic. It is estimated that measles and polio campaigns are the worst hit with as many as 38 nations having put polio campaigns on hold and 27 countries having suspended measles campaigns.


However, despite all challenges, many countries have made special efforts to continue their vaccination programs. Burkina Faso conducted mass vaccination in July 2020, along with a four day immunization campaign against polio. In Syria, UNICEF and WHO supported the government in organizing a five day national immunization campaign in June to close vaccination gaps. Lao PDR ensured that despite a national lockdown, routine immunization continued with COVID-19 measures in place. The Ugandan government ensured that immunization programs continue and even funded transportation to ensure outreach. Across various countries, the easing of lockdown restrictions have resulted in resumption of immunization programs using innovative approaches like mobile vaccinations centres.


Till 2019, the biggest threat to global health was vaccine hesitancy which caused a spike in vaccine-preventable diseases in many countries. The COVID-19 vaccine too will take top priority once it is available as nations will focus on vaccination programs as well as developing supply chains to distribute vaccines. This also threatens the implementation of regular immunization programs. To address these issues and resume regular immunization services at pre-COVID-19 levels, countries will need to lay emphasis on mass campaigns as well as on key elements of risk communication and community engagement in the post pandemic immunization campaigns.


The author is a freelancer

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