Are we Paving the Way for Another Epidemic?

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As COVID-19 continues to spread globally, over 117 million children in 37 countries may miss out on receiving a life-saving measles vaccine. Measles immunization campaigns in 24 countries have already been delayed and  more will be postponed.

COVID-19 is raging across the world like a forest fire out of control, and despite that measles is increasingly becoming a topic of concern for most countries. This is why we need to shift some of the spotlight towards measles.

Theoretically, for a population to have herd immunity against measles, upward of 90% of the population must be vaccinated. This number doesn’t take into account the imperfect efficacy of a vaccine. A very high number of people in the community need to be vaccinated against measles to ensure decrease of  disease spread.

Photo: Village on Congo Side of Lake Kivu

Due to COVID-19, most governments urged people to stay at home, making it difficult to get routine immunization. Some parents are scared to visit health care facilities, some are limited by transportation while other places have suspended routine immunization facilities until the COVID-19 outbreak is under control. Other issues include non-availability of healthcare staff for delivery of immunization services. WHO has advised against suspending immunization programs in countries where vaccine-preventable outbreaks are occurring. In other parts of the world, they stand in favor of continuing vaccination programs, provided the safety of healthcare workers and communities can be ensured.

Stopping immunization all together will usher several problems in future when we start paying attention to non-COVID related issues. Even before we diverted attention towards COVID-19, the immunization rates had flat-lined to a level slightly below the required critical minimum. A report by World Economic Forum shows that the global rate for childhood vaccinations including diphtheria, tetanus, pertussis (the DTP3 vaccine) and measles has also flat-lined at around 86% since 2010. A immunization level of 95% is needed to prevent outbreaks. The world was already at risk before this pandemic, and stopping immunization is going to increase the gap even more. It will put both developing and developed countries at a greater risk of these preventable diseases. 

Some countries already had issues with measles epidemics, like the Democratic Republic of Congo and the Central African Republic.

Photo: A problem most villages experience across Africa, access to drinkable water.

Even if most countries around the world try to restart immunization programs soon, there will be a backlog of about 2 to 3 months. Sadly, catching up immunization may not be possible for all. In poor countries, the already burdened health systems may not be able to cope with the demand of tracking all children and providing them with vaccines. On the other hand, problems may arise in some rich countries because people refuse to vaccinate their children.

This problem is not exclusive to measles. A recent news release by WHO warns that at least 80 million children below the age of 1 are at risk of measles, diphtheria and polio. Up until now, 68 countries report moderate to total suspension of immunization services.

The Global Polio Eradication Initiative (GPEI) has asked all countries to postpone, until at least second half of 2020, mass campaigns and targeted campaigns for polio outbreaks.  One of the reasons towards suspending polio immunization was the requirement of door to door delivery of oral polio vaccines in some places and the close contact while delivering the oral vaccine drops.

 

Photo: Polio vaccination team in Nigeria.

While the number of COVID-19 cases rise, we need to be cognizant of the need of vaccination. Vaccines help to prevent diseases like measles, polio, diphtheria, hepatitis-B, typhoid, meningitis and many others. These diseases can have long lasting effects like permanent paralysis from polio, respiratory failure from diphtheria, neurological effects from measles. Just to name a few. A recent benefit risk analysis compared the health benefits from routine immunization against the excess risk of SARS-CoV-2 infections in Africa. It suggested that the health benefits of deaths prevented by sustaining routine childhood immunization in Africa far outweighs the excess risk of COVID-19 deaths associated with vaccination clinic visits.

A statement by Henrietta Fore, UNICEF Executive Director, truly explains the need of the hour. She says, “We cannot let our fight against one disease come at the expense of long-term progress in our fight against other diseases.” Next week, WHO will issue new advice to countries on maintaining essential services during the pandemic, including recommendations on how to provide immunization safely. We hope the countries soon restart their immunization programs so that the little ones who hold the future of the world are free of these deadly but vaccine-preventable diseases!

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