Milestones :: Perspectives :: Research
COVID-19 & Immunization
Vaccines work at all ages, everywhere – WHO
23 April 2020
Zsuzsanna Jakab, Deputy Director-General, WHO
There’s no question that immunization is one of the greatest success stories in global health, saving millions of lives every year from vaccine-preventable diseases. Every year more than 116 million, or 86% of all infants born are vaccinated – a number than has been holding firm for a decade.
More than 20 life-threatening diseases can now be prevented by immunization, and new vaccines for major killers like diarrhoea, cervical cancer, cholera and meningitis are quickly being introduced in countries that did not use them previously. While, vaccination has routinely prioritized children in the past, today it is increasingly protecting health among people of all ages.
Commitment to research and development has led to developing new vaccines to protect against malaria, typhoid and Ebola, and many more vaccines are under development for emerging diseases, like COVID-19.
All of this is good news. But it also shows the challenges we’re facing as we try to ensure no one misses out on life-saving vaccines.
Children still missing out on vaccines
Globally, there are still more than 13 million children who never receive any vaccination. These un-vaccinated children, and millions more under-vaccinated children, are found in all countries but the large majority of them live in a small number of countries which are affected by conflict, poverty and fragility.
It’s difficult to reach these children in normal times and intensive work continues to figure out the most effective ways to find them and assure they are receiving immunization and other essential health services. But now COVID-19 is making it even harder.
Immunization services are being scaled back and, in many cases, shut down. Even when the services are still operating parents and caregivers are forgoing taking their children to routine health visits including for immunization out of concern for risk of COVID-19. When vaccination coverage goes down, inevitably more outbreaks will occur, including of life-threatening diseases like measles and polio.
Our challenge now is to ensure we don’t slide backwards on vaccination coverage in the midst of the pandemic, but instead move beyond 86% coverage and reach everyone, everywhere. This will not only protect the health of children and their communities but will protect the health services from a second wave of diseases for which we have vaccines to prevent.
A new vison of immunization
At last year’s Global Vaccine Summit, WHO, the European Commission, governments and partners recognized that to sustain vaccination’s hard-won gains, we need to ensure our health systems are more equitable in their delivery of services.
The new Immunization Agenda 2030 (IA2030) which sets the vision and strategy for 2021-2030, co-created with community organizations, government ministries, partner organizations, academia, vaccine makers, and with non-immunization partners, recognizes universal health coverage (UHC) as essential to immunization success. To improve coverage, IA2030 outlines strategies that are relevant for all countries to break through on stagnation in reaching children not vaccinated and fight against vaccine hesitancy.
It also aims to build stronger surveillance systems for vaccine-preventable diseases, particularly for identifying, tracking, and monitoring disease outbreaks and sustaining research to ensure we are poised to meet the challenges around the corner on outbreaks, antimicrobial resistance, infections for which our vaccines are inadequate; and seize opportunities to tackle diseases for which there are as yet no vaccines.
And, for the first time the new vision expands the global focus for immunization to all age groups, not just children. While this will shift immunization programmes, it will allow us to rethink and strengthen people-centred care to ensure vaccines are taken up by older age groups.
Reaching more people with immunization requires investment
As we set new priorities for 2021 and beyond with the vaccine community, we also need to ensure we have sound investment in immunization. Every year, almost 80 million infants require vaccinations in 68 Gavi-supported countries and this is growing.
Gavi has set an ambitious goal to immunize 300 million more children with 18 vaccines by 2025. In order to reach this goal, it will require US$7.4 billion. Gavi’s replenishment is essential towards reaching the hardest to reach, and ensuring vaccination services are equitable. WHO remains committed to ensuring Gavi’s success.
As we mark World Immunization Week, we must continue to champion the message that #VaccinesWork for All, and not let the COVID-19 pandemic compromise hard won immunization gains in the past decades.
Today’s crisis further highlights the need for new vaccine breakthroughs, like we’ve saw in Ebola, to become the norm. Investments in research and development must be escalated with great intensity to fight new and emerging diseases like COVID-19.
Let’s continue to scale-up, not scale-down our immunization services through primary health care and universal health coverage so that everyone, everywhere has access to life-saving vaccines by 2030. #VaccinesWork for All.
Over 13 million children did not receive any vaccines at all even before COVID-19 disrupted global immunization – UNICEF
NEW YORK, 25 April 2020 – As the world waits desperately for a vaccine, the COVID-19 pandemic is continuing to surge across the globe. Millions of children are in danger of missing life-saving vaccines against measles, diphtheria and polio due to disruptions in immunization services. At last count, most countries had suspended mass polio campaigns and 25 countries had postponed mass measles campaigns, as per recommended guidance.
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. Over 13 million children below the age of one globally did not receive any vaccines at all in 2018, many of whom live in countries with weak health systems. Given the current disruptions, this could create pathways to disastrous outbreaks in 2020 and well beyond.
“The stakes have never been higher. As COVID-19 continues to spread globally, our life-saving work to provide children with vaccines is critical,” said Robin Nandy, UNICEF Principal Adviser and Chief of Immunization. “With disruptions in immunization services due to the COVID-19 pandemic, the fates of millions of young lives hang in the balance.”
An estimated 182 million children missed out on the first dose of the measles vaccine between 2010 and 2018, or 20.3 million children a year on average, according to a UNICEF analysis. This is because the global coverage of the first dose of measles stands only at 86 per cent, well below the 95 per cent needed to prevent measles outbreaks.
Widening pockets of unvaccinated children led to alarming measles outbreaks in 2019, including in high-income countries like the US, UK and France.
Among low-income countries, the gaps in measles coverage before COVID-19 were already alarming. Between 2010 and 2018, Ethiopia had the highest number of children under one year of age who missed out on the first dose of measles, at nearly 10.9 million. It was followed by the Democratic Republic of the Congo (6.2 million), Afghanistan (3.8 million), Chad, Madagascar and Uganda with about 2.7 million each.
Beyond measles, the immunization gaps were already quite dire, according to new regional profiles developed by UNICEF. In Africa, more children have missed out on vaccines over the past years due to rising number of births and a stagnation in immunization services. For example, in West and Central Africa, coverage has stagnated at 70 per cent for DTP3 – which is the lowest among all regions – at 70 per cent for polio, and at 71 per cent for measles. This has led to repeated outbreaks of measles and polio in countries such as the Democratic Republic of the Congo. Meanwhile, in South Asia, an estimated 3.2 million children did not receive any vaccines in 2018. In Eastern and Southern Africa, the number of unvaccinated children has remained almost the same for the last decade, at around 2 million. All regions are now also battling COVID-19 outbreaks.
UNICEF is sending critical vaccine supplies to immunize children, where possible, in areas with outbreaks and to replenish their routine supplies.In the Democratic Republic of the Congo, for example, UNICEF is supporting the Government with vaccine supplies and protective equipment to continue immunization activities in North Kivu province, where over 3,000 cases of measles were reported since January 1. And in Uganda, UNICEF procured 3,842,000 doses of bivalent oral polio vaccine (bOPV) to immunize 900,000 children below the age of one year. Children receive three doses of the polio vaccine before they celebrate their first birthday.
As the world races to develop and test a new COVID-19 vaccine, UNICEF and partners in the Measles & Rubella Initiative and Gavi, the Vaccine Alliance are calling on governments and donors to:
:: Sustain immunization services while keeping health workers and communities safe;
:: Start planning to ramp up vaccinations for every missed child when the pandemic ends;
: Fully replenish Gavi, as the alliance supports immunization programmes in the future;
:: Ensure that when the COVID-19 vaccine is available, it reaches those most in need.
“Children missing out now on vaccines must not go their whole lives without protection from disease,” said Dr. Seth Berkley, CEO, Gavi, the Vaccine Alliance “The legacy of COVID-19 must not include the global resurgence of other killers like measles and polio.”
Statement – Vaccination must be maintained during COVID-19 pandemic to be effective
Statement by Dr Hans Henri P. Kluge, WHO Regional Director for Europe, on the occasion of European Immunization Week 2020
20 April 2020, Copenhagen, Denmark
We are living through an exceptional time, when every one of us has been called upon to prevent the spread of COVID-19. The COVID-19 situation in the European Region remains very concerning.
I want to take the opportunity of European Immunization Week to reiterate that we must not, especially now, let down our guard on immunizations. Access to vaccines for all has transformed our societies, but it is a public good that must be maintained to be effective, even in difficult times. Our overstretched health systems cannot bear any outbreaks of vaccine-preventable diseases.
The health and/or economic consequences of this pandemic are affecting everyone. The most vulnerable, who are often left behind by immunization services, should not suffer the added burden of vaccine-preventable diseases.
Measles affected over 100 000 young and old in this Region last year. This virus has not gone. It will resurge again if we do not do everything in our power to stop it.
As 1 of my 4 flagship areas, prioritizing immunization is central to WHO/Europe’s vision for health in the new European Programme of Work. Immunization is crucial to achieving universal health care and the Sustainable Development Goals, as well as being a vital component of our society that assures health security across the Region.
I therefore take this opportunity to also commend all the ministries of health in this Region for heeding our call and doing everything possible to prioritize routine immunization as part of essential health services during this pandemic. And I thank our tireless health-care professionals, dedicated to leaving no one behind in providing health care and delivering vaccination services.
Vaccination is a right and a responsibility, and it is up to all of us to ensure that we are protected together.