Unvaccinated and vulnerable: Children are driving a wave of deadly outbreaks

Major outbreaks of diseases that kill mostly children are spreading around the world, a grim legacy of disruptions to healthcare systems during the Covid-19 pandemic, which has left more than 60 million children without a single dose of standard childhood vaccines.

By mid-year, 47 countries reported serious measles outbreaks, up from 16 countries in June 2020. Nigeria is currently facing the largest diphtheria outbreak in its history, with more than 17,000 suspected cases and almost 600 deaths to date. Twelve countries, from Afghanistan to Zimbabwe, report circulating poliovirus.

Many of the children who missed their vaccinations have now forgone routine immunization programs. So-called ‘zero-dose children’ are responsible for almost half of all child deaths from vaccine-preventable diseasessaid Gavi, the organization that helps finance vaccination in low- and middle-income countries.

Another 85 million children have been under-immunized as a result of the pandemic – meaning they have received only part of the standard course of different vaccinations needed to be fully protected against a particular disease.

The costs of the inability to reach these children are quickly becoming apparent. The number of deaths from measles increased by 43 percent (to 136,200) in 2022 compared to the previous year a new report from the World Health Organization and the Centers for Disease Control and Prevention. The figures for 2023 indicate this the total could be twice as high again.

“The decline in vaccination rates during the Covid-19 pandemic has led us directly to this situation of rising disease and child mortality,” said Ephrem Lemango, UNICEF deputy director of immunization, who is responsible for the supply of vaccines to almost half of children in the world every year. . “With each new outbreak, the toll on vulnerable communities increases. We must act quickly now and make the investments needed to catch up with the children who have been missed during the pandemic.”

One of the biggest challenges is that the children who missed their first vaccinations between 2020 and 2022 are now older than the age group typically seen routinely in primary health care centers and in normal vaccination programs. Reaching them and protecting them from diseases that can easily become fatal in countries with the most vulnerable healthcare systems will require an extra boost and new investments.

“If you were born within a certain time, you will be missed, period, and you will not be caught just trying to restore normal services,” said Lily Caprani, UNICEF’s chief of global advocacy.

UNICEF is asking Gavi for $350 million to buy vaccines to reach these children. Gavi’s board of directors will consider the request next month.

UNICEF is urging countries to carry out a catch-up vaccination blitz, an exceptional, one-off program to reach all missed children between the ages of 1 and 4.

Many developing countries have some experience in conducting catch-up campaigns against measles, targeting children aged 1 to 5 years, or even 1 to 15 years, in response to outbreaks. But now those countries must also supply the other vaccines and train staff – mostly community health workers who are only used to vaccinating babies – and procure and distribute the actual vaccines.

Dr. Lemango said that despite the urgency of the situation, it had been a struggle to put plans in place for such campaigns and that he hoped most of them would come together by 2024.

“When we came out of the pandemic there was a hangover – no one wanted to run campaigns,” he said. “Everyone wants to return to normality and regularly strengthen immunization. But we already had unfinished business.”

In some countries, such as Brazil, Mexico and Indonesia, healthcare systems have recovered from the severe disruption caused by Covid-19 and have returned to or even exceeded pre-pandemic vaccination rates. But others – especially countries where vaccination rates were already significantly lower than UNICEF targets – have not caught up to their previously lower levels.

The countries with the most zero-dose children are Nigeria, Ethiopia, India, the Democratic Republic of Congo and Pakistan. Many with the lowest coverage levels are facing mounting challenges, such as the civil conflicts in Syria, Ethiopia and Yemen, the growing population of climate refugees in Chad, and both issues in Sudan.

Ghana’s experiences are representative of the challenges of many lower-income countries. Parents were unable to take their children for routine shots when communities went into lockdown to protect against Covid, and when those restrictions were lifted, many parents still stayed away for fear of infection, said Priscilla Obiri, a community nurse in charge of vaccinations. in low-income fishing communities on the outskirts of the capital Accra.

Of the children Ms. Obiri sees today at a typical pop-up vaccination clinic, where she sets up a table and a few chairs in the shade at an intersection, as many as a third will receive incomplete vaccinations, or sometimes no vaccinations at all. , she said. She agrees with their mothers on a plan to close the gap.

But some parents cannot or do not want to take their children to a clinic. “We have to go to the community and hunt them,” she said.

As Ms. Obiri and her colleagues try to regain that lost ground, they face a new challenge: misinformation campaigns and hesitancy about Covid vaccines have overcome and eroded some of parents’ traditional eagerness to get their children routine immunizations, according to the Vaccine. Confidence Project, a long-term research initiative at the London School of Hygiene and Tropical Medicine.

“Across 55 countries, there was a steep decline in the number of people who said routine immunization is important for children between 2015 and 2022,” said the project’s director, Heidi Larson, whose team collected what she described as “robust global polling data.” ” in more than 100 nationally representative surveys.

Even as people around the world looked for information about vaccines, there was a rise in misinformation and disinformation, she said, and people with low trust in officials and official guidance were particularly vulnerable to believing alternative sources of information.

Dr. Kwame Amponsah-Achiano, who oversees Ghana’s child immunization programme, said he did not believe confidence had dropped during the Covid pandemic. Demand remains high and has exceeded the program’s supply in some areas, he said.

Ms Caprani said UNICEF had discovered that both problems were occurring in parallel.

“You can see that demand is not only outpacing physical supply, but also outpacing access – easy, affordable, accessible access – and at the same time seeing declining confidence,” she said. “They’re not necessarily the same people.”

Last year, 22 million children missed the routine measles vaccination given in their first year of life – 2.7 million more than in 2019 – while another 13.3 million did not receive their second dose. To achieve herd immunity and prevent outbreaks, 95 percent of children must receive both doses. Measles acts as an early warning system for immunization gaps because measles is highly transmissible.

“There are communities where a measles outbreak is a bad thing, and there are communities where it is a death sentence, due to the combination of other risk factors such as poor malnutrition, poor access to healthcare and poor access to clean water.” Mrs. Caprani said.