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For many developing countries across the globe, the Covid-19 pandemic is a small concern as they face the battle against other viral diseases, such as poliomyelitis (polio), measles, meningitis, human papillomavirus, and cholera. However, the majority of mass vaccination campaigns around the world have now stopped, public health leaders announced earlier this week, placing more than 100 million children globally at risk for these diseases.
Seth Berkley, head of GAVI, the Vaccine Alliance described the predicament as “a devil's choice”, reports Science Magazine, as global health organisations had to make the decision to either continue with their vaccination campaigns and risk spreading the Covid-19 virus in the process, or suspend them, potentially triggering a rise in other infectious diseases.
The suspensions started on 24 March after Global Polio Eradication Initiative (GPEI) leaders advised countries to postpone campaigns until the second half of the year.
Public health leaders explain
These mass vaccination campaigns are the only chance for millions of children to be protected against infectious diseases. Annually, the vaccines reach up to 450 million people, but Michel Zaffran of the World Health Organization (WHO), who heads GPEI, explained that they had no choice, as continuing it would risk communities and health workers contracting the new coronavirus.
“Everyone was uncomfortable” with these suspensions, Zaffran said. However, the WHO's Strategic Advisory Group of Experts on Immunization (SAGE) explained: “Any mass campaigns would go against the idea of physical distancing,” Alejandro Cravioto of the National Autonomous University of Mexico's Faculty of Medicine, who chairs SAGE, said on 26 March.
It’s a tough balance and there’s no clear answer, Dr Robin Nandy, the chief of immunisation for UNICEF, told the New York Times: “In our quest to vaccinate kids, we shouldn’t contribute to the spread of Covid-19,” adding: “But we don’t want a country that is recovering from an outbreak of it to then be dealing with a measles or diphtheria outbreak.”
The decision will be reassessed every two weeks.
Routine immunisations should continue
According to the New York Times, 24 low- and middle-income countries have pressed the pause button on these campaigns. Countries include Mexico and Nigeria. For 78 million children, this means no measles vaccine.
The measles virus can kill 3% to 6% of those it infects, and malnourished children are particularly at risk, notes the WHO. In 2018 alone, it infected an estimated 10 million people and killed 140 000. What is especially concerning is that it is incredibly contagious, which could see numbers quickly rise following the campaign suspensions.
Polio cases have decreased by over 99% since 1988, according to stats by the WHO. Currently, only three countries – Pakistan, Nigeria and Afghanistan – have not managed to stop transmission of polio. The WHO states that failure to eradicate this viral disease could result in as many as 200 000 new cases every year, within 10 years, across the globe.
As far as routine immunisations at clinics go, WHO, GAVI, and other health organisations urge for these to continue, but this is challenging due to health systems stretched thin and having very limited protective gear. Berkley fears that if health workers are diverted to Covid-19 or fall ill or die, it could pose severe disruptions of routine immunisation in hundreds of communities.
WHO says countries should continue surveillance
As the fight against Covid-19 continues, the WHO has urged countries to continue surveillance for vaccine-preventable diseases so that there can be continuous insight into where pathogens are circulating, and which children are most at risk.
Once the pandemic passes, the aim is to quickly pick up where the programmes left off. Nandy has also strongly encouraged countries to ensure they have availability of vaccines and syringes when the Covid-19 pandemic comes to an end.
Berkley is hopeful after the 2014–15 Ebola outbreak in West Africa, although the epidemic didn’t affect the world:
“We did campaigns once Ebola was over and strengthened routine immunisation. We not only recovered coverage levels, but exceeded them.”
And if outbreaks of these infectious diseases do occur, with physical distancing measures in places, transmission of the highly contagious ones, such as measles, will be limited, Dr Melinda Wharton, director of the CDC’s Immunization Services division told the New York Times.
