Act to save children are at risk as Covid-19 disrupts vaccination programme

A couple poses for a photo after welcoming the first child at a Nairobi hospital. Covid-19 has greatly disrupted vaccination programmes across Kenya and the world, putting children at risk. Photo: Dorcas Moraa.

UNICEF estimates that at least 80 million children under one at risk of childhood diseases.

By Mike Mwaniki

The COVID-19 pandemic is disrupting life-saving immunisation services not just in Kenya, but around the world, putting millions of children – in rich and poor countries alike – at risk of diseases such as diphtheria, measles and polio. 

The World Health Organisation, UNICEF and Gavi, the Vaccine Alliance, gave the warning ahead of the Global Vaccine Summit held on June 4 2020, at which world leaders came together to help maintain immunisation programmes and mitigate the impact of the pandemic in lower-income countries. 

Experts say the lives of two million children can be saved globally each year, if they have access to vaccines and factual information.

At the meeting, the world came together to pledge $8.8 billion to Gavi, which will enable the organisation  to protect the next generation and reduce disease inequality by reaching an additional 300 million children with vaccines by 2025.

In Kenya, in order to deal with this situation, both the national government and devolved units must invest more in vaccines and strengthen their ability to plan, forecast and budget for essential supplies, Covid-19 notwithstanding.

According to health experts, for every shilling invested in immunisation, the government saves an average of Sh16 in the health system, and the wider economy benefits with Sh44, preventing death and disabilities in children and keeping parents and families working.

Dr Rose Jalang’o, an official of the Health Ministry’s National Vaccines and Immunisation Programme, says the ministry spends an estimated Sh1.4 billion each year to procure vaccines and related supplies to meet Gavi co-funding obligation.

To deliver immunization services, the doctor adds, the government spends Sh4 billion annually for that purpose.

This comes as the World Health Organisation (WHO) issued new advice to countries on maintaining essential services during the pandemic, including recommendations on how to provide immunisations safely.

Dr Peter Okoth, a UNICEF health specialist, says that immunisation had been identified as a priority by the government and other health partners including UNICEF, WHO and Gavi for child health and survival.

Data collected by the WHO, UNICEF, Gavi and the Sabin Vaccine Institute, indicates that provision of routine immunisation services is substantially hindered in at least 68 countries and is likely to affect approximately 80 million children under the age of one living in these countries. 

Since March 2020-during the period that Kenya confirmed the first Covid-19 case, routine childhood immunisation services have been disrupted on a global scale that may be unprecedented since the inception of expanded programmes on immunisation (EPI) in the 1970s. 

More than half (53 per cent) of the 129 countries where data were available reported moderate-to-severe disruptions, or a total suspension of vaccination services during March-April 2020. 

The WHO Director-General, Dr Tedros Ghebreyesus notes: “Immunisation is one of the most powerful and fundamental disease prevention tools in the history of public health…

 “Disruption to immunisation programmes from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles,”.

Dr Ghebreyesus added: “At the Global Vaccine Summit in London, donors pledged their support to Gavi, the Vaccine Alliance, to sustain and accelerate this lifesaving work in some of the most vulnerable countries…

“From the bottom of my heart, I urge donors to fully fund the Alliance. These countries, these children especially, need vaccines, and they need Gavi.”

Reasons given for the disrupted services vary. Some parents are reluctant to leave home because of restrictions on movement, lack of information or because they fear infection with the COVID-19 virus. 

And many health workers are unavailable because of restrictions on travel, or redeployment to COVID-19 response duties, as well as a lack of protective equipment.

The Gavi chief executive, Dr Seth Berkley says: “More children in more countries are now protected against more vaccine-preventable diseases than at any point in history…

 “Due to COVID-19 this immense progress is now under threat, risking the resurgence of diseases like measles and polio. Not only will maintaining immunisation programmes prevent more outbreaks, it will also ensure we have the infrastructure we need to roll out an eventual COVID-19 vaccine on a global scale.”

Experts also say transport delays of vaccines are exacerbating the situation.

UNICEF, for example, has reported a substantial delay in planned vaccine deliveries due to the lockdown measures and the ensuing decline in commercial flights and limited availability of charters. 

To help mitigate this, the organisation is appealing to governments, the private sector, the airline industry, and others, to free up freight space at an affordable cost for these life-saving vaccines. 

In the meantime, Gavi recently signed an agreement with UNICEF to provide advance funding to cover increased freight costs for delivery of vaccines, in light of the reduced number of commercial flights available for transport. 

The UNICEF Executive director, Henrietta Fore says: “We cannot let our fight against one disease come at the expense of long-term progress in our fight against other diseases…

 “We have effective vaccines against measles, polio and cholera. While circumstances may require us to temporarily pause some immunisation efforts, these immunisations must restart as soon as possible, or we risk exchanging one deadly outbreak for another.”

Dr Jalang’o, argues that where intense political and financial commitment have been made, more children have successfully been vaccinated and protected from major childhood diseases.

In addition, health officials agree, every effort must be made to ensure communities are made aware of the benefits of vaccination, the risks of not having children vaccinated and that services are made available to these communities through outreaches.

The WHO representative to Kenya, Dr Rudi Eggers describes immunisation as one of the most successful and cost-effective health interventions.

“Efforts by the Health Ministry and Counties should be geared towards increased sustainable financing of immunisation programmes, equitable access to immunisation services, creating demand for immunisation services, improved oversight and innovations through operational research,”.

According to the WHO survey, many countries have temporarily and justifiably suspended preventive mass vaccination campaigns against diseases like cholera, measles, meningitis, polio, tetanus, typhoid and yellow fever, due to risk of transmission and the need to maintain physical distancing during the early stages of the COVID-19 pandemic. 

Measles and polio vaccination campaigns, in particular, have been badly hit, with measles campaigns suspended in 27 countries and polio campaigns put on hold in 38 countries. 

At the same time, at least 24 million people in 21 Gavi-supported lower-income countries are at risk of missing out on vaccines against polio, measles, typhoid, yellow fever, cholera, rotavirus, HPV, meningitis A and rubella due to postponed campaigns and introductions of new vaccines. 

In late March, concerned that mass gatherings for vaccination campaigns would enflame transmission of COVID-19, WHO recommended countries to temporarily suspend preventive campaigns while assessments of risk, and effective measures for reducing COVID virus transmission were established.

WHO has since monitored the situation and has now issued advice to help countries determine how and when to resume mass vaccination campaigns. 

The guidance notes that countries will need to make specific risk assessments based on the local dynamics of COVID-19 transmission, the health system capacities, and the public health benefit of conducting preventive and outbreak response vaccination campaigns. 

Based on this guidance, and following growing concerns about increasing transmission of polio, the Global Polio Eradication Initiative (GPEI), is advising countries to start planning for the safe resumption of polio vaccination campaigns, especially in polio high-risk countries.

Despite the challenges, several countries are making special efforts to continue immunisation. Uganda, for example, is ensuring that immunisation services continue along with other essential health services, even funding transportation to ensure outreach activities. 

And in Lao PDR, despite a national lockdown imposed in March, routine immunisation in fixed sites continued with physical distancing measures in place. 



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