WHO fearful supplies of vaccines against childhood diseases could run short by late 2021

Rising pressures on pharmaceutical industry could lead to a drop in production of non-Covid vaccines by the end of the year, placing hundreds of thousands of lives at risk, writes Samuel Lovett

Nurses wearing protective gear administer a vaccine against measles to a child at a health centre in Palu, Indonesia (AFP via Getty)

The World Health Organisation (WHO) is fearful that supplies of lifesaving vaccines against a number of childhood infectious diseases, including measles, diphtheria and polio, could run short by the end of 2021 due to Covid-19 disruptions.

With global manufacturing capacities currently focused on the production of billions of coronavirus vaccine doses, the WHO is liaising with industry leaders, governments and health campaigners to ascertain how this will impact the rollout of other jabs in the months to come.

Hundreds of thousands of worldwide deaths are prevented every year thanks to a variety of vaccines that protect against measles, mumps, diphtheria, tetanus and pertussis (whooping cough), which are administered to children in early infancy.

An excess of doses within the international supply chain and the ability of manufacturers to so far manage demands has meant that countries have not yet struggled to obtain these jabs.

But as Covid vaccine production continues to increase, consuming vital resources and placing greater strain on manufacturing plants, the WHO is concerned that the availability of shots against various childhood diseases could fall or be delayed.

Tania Cernuschi, team lead for the WHO’s global access, immunisation, vaccines and biologicals department, told The Independent: “There is worry that this could change in late 2021 and that’s because there is probably a built-in delay between when an issue materialises upstream and when it impacts production. This has been flagged.”

She said the WHO was keeping a particularly “close eye” on vaccine supplies for polio, pneumococcal infections, diphtheria, tetanus, influenza, measles and human papillomavirus (HPV).

“We’ve been discussing with experts and immunisation partners to understand the extent of risks on the supply of other vaccines, and to try and quantify the probability and the extent of that impact,” Ms Cernuschi added.

“For now, what we have is confirmation that the risks are real to production of other vaccines.”

She explained that there was rising pressure on manufacturing processes, the supply of crucial vaccine ingredients, equipment needed to store doses, workforce, and fill-and-finish capacity, which is often carried out in factories separate to where supplies are produced.

The challenges involved in distribution has been identified as another area of concern. Export restrictions – as seen with India – increasing freight costs, and stretched healthcare services in some of the world’s poorest countries could all derail the future delivery of vital non-Covid vaccine doses.

“That said, so far there been’s no known impact on the availability of existing vaccines to meet the requirement of countries,” Ms Cernuschi said.

“That is because manufacturers have been able to manage the risks and leverage stocks of materials that are difficult to procure and because there is also excess supply in some of the markets and alternative sources that are being leveraged.”

Other experts have warned that access to these vaccines has been one of the greatest challenges thrown up by the pandemic, which has diverted the resources of already-stretched local health services away from routine immunisation programmes to tackling Covid-19. 

Many campaigns were also paused over the past 12 months as part of efforts to limit the spread of Covid-19, while reluctance has grown among some people to visit their local health clinics, further affecting uptake.

What is a real concern now is that we start to get back measles outbreaks, diphtheria – the kinds of really basic infectious diseases that vaccines normally prevent

Professor Heidi Larson, director of the Vaccine Confidence Project

“Look at what’s going on in India. How can you run a childhood vaccination campaign in that kind of environment,” Professor Heidi Larson, director of the Vaccine Confidence Project, told The Independent.

“HPV vaccines, that’s often a school-based programme, particularly in the UK. If there’s no school, how do you give the vaccine if there’s no system in place? You can presumably still get it in a clinic but again you can barely get seen.”

As of August 2020, the WHO reported a 20 per cent reduction in global immunisation rates against HPV.

“What is a real concern now is that we start to get back measles outbreaks, diphtheria – the kinds of really basic infectious diseases that vaccines normally prevent,” said Prof Larson. “They risk coming back because coverage has dropped.”

The Measles & Rubella Initiative said last year that more than 117 million children in 37 countries were in danger of missing out on a measles vaccines up to December 2020. Unicef and the WHO also warned in November that poliovirus transmission is expected to increase in Pakistan, Afghanistan and many under-immunised areas of Africa.

Concern over coverage and rising infections was present long before Covid-19. In 2019, nearly 14 million children worldwide missed out on vaccines against diphtheria, tetanus, pertussis and measles, with cases of the latter increasing from 132,490 in 2016 to 869,770 in 2019 – the largest reported rise since 1996.

With coverage rates expected to further fall in the near future, and the spectre of dwindling non-Covid vaccine supplies looming in the distance, the prospect of a surge in transmission of these infections seems inevitable.

“Of the childhood infectious diseases, measles is the biggest worry as that’s hyper infectious,” Prof Larson said. “You really need a much higher percentage of vaccination coverage for measles than other diseases.”

She said India was particularly at risk of certain diseases returning due to the events of the last year, along with those countries facing conflict and humanitarian crises. “I think it’s also going to depend on who already has low coverage in the background,” she added.

Kate Elder, a vaccines policy adviser at Medecins Sans Frontieres, said that a pandemic compounded by outbreaks of other vaccine preventable diseases would “be devastating, particularly for people in developing countries that already have poor access to medical care”.

She told The Independent: “Can you imagine if we rolled back the hard-won progress we’ve made against diseases like measles and polio because we bowed to the pharma industry dictating to us that they’re going to have to decrease production of other essential vaccines in order to make Covid vaccines? We shouldn’t stand for it. Governments shouldn’t let it happen.”