Covid-19 disruption could erase decade’s worth of global vaccine coverage for childhood diseases, Unicef warns

Immunisation programmes suspended or reduced amid coronavirus pandemic, leaving countries in developing world vulnerable to resurgence in childhood diseases such as measles and polio

A toddler undergoes a measles vaccination at a centre in Temba, western DRC last March. (AFP via Getty Images)

Global efforts to vaccinate children against fatal diseases such as measles and polio could be set back a decade due to the disruption caused by the coronavirus pandemic, Unicef has warned.

Immunisation campaigns and routine vaccine services have been suspended across the world to limit the transmission of Covid-19, leaving countries with weak health systems susceptible to a resurgence in preventable illnesses once lockdown restrictions are lifted and societies reopen.

More than 25 vulnerable countries have placed their immunisation programmes for measles on hold, while the delivery of Ebola vaccinations across central Africa, in countries such as the Democratic Republic of the Congo (DRC) and Central African Republic (CAR), has similarly been suspended or curtailed.

The dramatic decline in commercial flights and limited availably of charters has also compounded the efforts of local and international authorities fighting childhood diseases, with Unicef recording a 70-80 per cent reduction in planned vaccine shipments between 22 March and 1 May.

Many developing countries have subsequently been unable to purchase new supplies and are instead being forced to draw from their three-month buffer stocks, which are now at risk of running out, according to Unicef.

Even before the Covid-19 pandemic, measles, polio and other vaccines were out of reach for 20 million children below the age of one every year – and the current crisis threatens to further raise this figure.

“Our immediate concern is with disruption to currently available vaccines,” Dr Robin Nandy, global chief of immunisation at Unicef, told The Independent. “We expect to go back maybe five to 10 years. The longer the disruptions continue, the more concerned we are as it builds the number of susceptible kids in populations.

“What we’re trying to avoid is countries recovering from the current Covid pandemic then being hit by another outbreak of a vaccine-preventable disease.”

Dr Nandy said the situation was “extremely variable globally”, explaining that while Unicef had advised countries to suspend all immunisation programmes – which target specific diseases over a short period of time and involve the mass mobilisation of people – some nations were continuing to run reduced routine services depending on the scale of their outbreaks.

“There’s huge variability,” he said. “At one extreme you have countries where routine vaccinations are continuing and people are coming to receive this. These tend to be the countries that are least affected by Covid-19.

“Then you have the other extreme where countries have completely stopped routine immunisation; all the workforce has been diverted to deal with Covid-19. There’s no capacity to do immunisation. Human and financial resources and all the attention is going to Covid-19.

“There’s a huge wide spectre that we’re seeing and we’re slowly trying to grapple with that.”

Dr Nancy said that Unicef’s priority remains those countries facing the risk of a “stock-out”, with vaccines supplies down to 20 per cent of their usual capacity in some regions.

“Our aim is to ensure adequate stocks in all countries with disrupted services so that as soon as the social restrictions are lifted they can go out and access vaccines,” he said. “We don’t want that to be an additional constraint.”

The global disruption to vaccine services and campaigns has been far-reaching, and carries serious implications for local and national populations in high-risk countries.

In Pakistan, Afghanistan and Nigeria, polio vaccination campaigns have been stopped as health workers and resources focus on containing Covid-19. The World Health Organisation has admitted that these countries could subsequently see a rise in cases of the childhood disease.

Concern has also been raised over the prospect of an increase in measles transmission once lockdowns are lifted.

Before the Covid-19 outbreak, figures pointed to a resurgence of measles. In 2018, there were 9.7m million cases and 142,300 deaths from the virus, while outbreaks in the DRC and Samoa throughout 2019 further suggested health authorities are losing the fight to eradicate the deadly infection.

For Ebola, the International Rescue Committee, which leads the infection and prevention response against the virus in the DRC, said the country recorded a new case just 48 hours before it was set to officially declare the end of its outbreak. According to Kate Moger, the IRC’s regional vice president for Africa, this setback can be part-attributed to the Covid-19 pandemic.

(A Pakistani health worker administers polio drops to a child at a railway station during a polio vaccination campaign in Lahore last year) (AFP via Getty Images)

“The whole Ebola response was very challenged by Covid starting,” Ms Moger told The Independent. “We were two days away from the declaration that should have been made to declare the end of that outbreak, but then there was a new confirmed case which revealed some weakness in the surveillance over the previous weeks.

“That can be attributed to the fact the coronavirus has very different protocols about how you bring people together, how you train people, how you do awareness-raising – and the [Ebola] vaccination has been affected as they can’t get as many people through the process.”

She added that the procurement of international drugs in the CAR and DRC had been hindered by the closure of airspace and airports across the countries.

Dr Nandy warned that the longer such disruptions continue, the more authorities will need to “nuance and modify” their approach to tackling childhood diseases within the developing world.

He said that, for now, Unicef and its partners were collecting data and conducting epidemiological models to predict what the outcome of the various delayed vaccination campaigns would be on those countries worst affected by the major childhood diseases.

In spite of the setbacks causes by Covid-19, he said that the globe could not lose sight of its long-term goal to increase vaccine availability.

Indeed, a UN report last year showed that global coverage for childhood vaccines including diphtheria, tetanus and pertussis (DTP3) and measles has stagnated at roughly 86 per cent since 2010, well below the 95 per cent required to avert outbreaks.

Dr Nandy admitted that, with so many uncertainties surrounding coronavirus and when a potential vaccine would be found, authorities have been left “planning in the dark”.

“The bottom line is that pre-Covid, 20 million children did not receive their full complement of vaccines. Out of these, 13 million received no vaccine at all,” he said. “So it’s something that we’ve got to really look at in the mirror and ask ourselves that even with the available vaccines, why have we not been able to reach so many kids?”