Health and Healthcare Systems

This is how the world can get routine vaccinations back on track

French President Emmanuel Macron listens to a researcher as he visits an industrial development laboratory at French drugmaker's vaccine unit Sanofi Pasteur plant, in Marcy-l'Etoile, near Lyon, France June 16, 2020. Laurent Cipriani/Pool via REUTERS     TPX IMAGES OF THE DAY - RC2AAH9MLY40

COVID-19 is disrupting immunization efforts in many vulnerable areas of the world. Image: REUTERS

Sean Fleming
Senior Writer, Forum Agenda
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  • COVID-19 is disrupting immunization efforts in many vulnerable areas of the world.
  • 80 million children under the age of one may miss life-saving vaccination.
  • Learning from how some countries recovered from other disruptions could be vital.

Around the world, 80 million children under the age of one could go unvaccinated because of coronavirus-related disruption to medical outreach projects.

In a report called Immunization Coverage: Are We Losing Ground?, UNICEF details how diseases such as diphtheria, measles, and polio pose a real and present danger to millions of the world’s most vulnerable. Getting routine vaccination programmes back on track rapidly could mean the difference between life and death for millions of children.

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“As we recover from COVID-19, our aim should not be to just make up lost ground, but to break through the long stagnation that has held us back for the last decade,” the report states.

Vaccination coverage by UNICEF region, 1980-2019.
Vaccination coverage by UNICEF region, 1980-2019. Image: UNICEF

Rapid action and strategic investment

Based on data from the WHO, UNICEF, Gavi, and the Sabin Vaccine Institute, the report also outlines how disrupted immunization programmes have been strengthened in the past. The causes for vaccination disruption can be be wide ranging, including political instability, localized disease outbreaks (such as Ebola), and simply running out of vaccine stocks.

Learning from those experiences could help speed up the recovery of vaccination initiatives in the post-pandemic era. For instance, in 2014, a state of emergency was declared in Liberia, as the government fought to contain an outbreak of Ebola. Routine vaccination programmes were put on hold while many medical facilities were temporarily closed and resources were diverted towards treating the outbreak.

That led to a sharp drop in vaccine coverage, leaving people vulnerable to diseases like measles, which continues to ravage many poorer parts of the world with devastating consequences.

Once the Ebola outbreak was under control, the Liberian government developed a plan to ensure a more resilient approach to vaccinations in the future. In 2016, it increased its immunization budget to $650,000, a 1,200% rise from its 2015 figure.

It also took a range of steps to strengthen its response. These steps included:

  • The creation of an Immunization strategy to better reach urban slums
  • Special training for health workers, refreshers for experienced workers and mentorship for vaccination teams
  • Completion of one national vaccine store and two regional cold stores.
  • The implementation of electronic supervision tools and electronic surveillance checklists.
  • Boosted community involvement through advocacy meetings and social mobilization

Such efforts and a swift response helped return Liberia’s vaccination levels to pre-Ebola levels within a year. As the report explained, other countries achieved similar levels of success recovering from vaccination disruption, such as Central African Republic, Côte D’Ivoire, Kazakhstan and Viet Nam.

Vaccination setback and recovery patterns.
Vaccination setback and recovery patterns. Image: UNICEF

Immunization has saved many millions of lives, reduced the number of people living with post-recovery infection-related complications, and delivered many economic benefits. While immunization is always important, it is more key during the pandemic to reduce unnecessary strain on struggling health systems.

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.

Disruption to immunization programmes from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles," said the WHO Director General Dr Tedros Adhanom Ghebreyesus at a briefing earlier this year. "But it doesn’t have to be that way. Vaccines can be delivered safely even during the pandemic, and we are calling on countries to ensure these essential life-saving programmes continue.”

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