COVID-19: Impacts

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COVID-19: Impacts

At least 80 million children under one at risk of diseases such as diphtheria, measles and polio as COVID-19 disrupts routine vaccination efforts, warn Gavi, WHO and UNICEF
Agencies call for joint effort to safely deliver routine immunization and proceed with vaccination campaigns against deadly vaccine-preventable diseases.
GENEVA/NEW YORK, 22 May 2020 – COVID 19 is disrupting life-saving immunization services around the world, putting millions of children – in rich and poor countries alike – at risk of diseases like diphtheria, measles and polio. This stark warning comes from the World Health Organization, UNICEF and Gavi, the Vaccine Alliance ahead of the Global Vaccine Summit on 4 June, at which world leaders will come together to help maintain immunization programmes and mitigate the impact of the pandemic in lower-income countries.

According to data collected by the World Health Organization, UNICEF, Gavi and the Sabin Vaccine Institute, provision of routine immunization services is substantially hindered in at least 68 countries and is likely to affect approximately 80 million children under the age of 1 living in these countries.

ROUTINE IMMUNIZATION OF CHILDREN DISRUPTED 
Since March 2020, routine childhood immunization services have been disrupted on a global scale that may be unprecedented since the inception of expanded programs on immunization (EPI) in the 1970s. More than half (53%) of the 129 countries where data were available reported moderate-to-severe disruptions, or a total suspension of vaccination services during March-April 2020.

“Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Disruption to immunization programmes from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles.”

“At the 4 June Global Vaccine Summit in London, donors will pledge 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.”

The reasons for 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 response duties, as well as a lack of protective equipment.

“More children in more countries are now protected against more vaccine-preventable diseases than at any point in history,” said Dr. Seth Berkley, Gavi CEO. “Due to COVID-19 this immense progress is now under threat, risking the resurgence of diseases like measles and polio. Not only will maintaining immunization 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.”

Transport delays of vaccines are exacerbating the situation. UNICEF 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, UNICEF 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. 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.

“We cannot let our fight against one disease come at the expense of long-term progress in our fight against other diseases,” said Henrietta Fore, UNICEF Executive Director. “We have effective vaccines against measles, polio and cholera. While circumstances may require us to temporarily pause some immunization efforts, these immunizations must restart as soon as possible, or we risk exchanging one deadly outbreak for another.”

Next week, WHO will issue new advice to countries on maintaining essential services during the pandemic, including recommendations on how to provide immunizations safely.

MASS IMMUNIZATION CAMPAIGNS TEMPORARILY DISRUPTED
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 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 immunization. Uganda is ensuring that immunization 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 immunization in fixed sites continued with physical distancing measures in place.

Vaccination campaigns 
Total # of  countries with postponed campaigns as of 15 May*
Measles/ Measles Rubella/ Measles Mumps Rubella (M/MR/MMR)
27
Polio (IPV)
7
Bivalent oral poliovirus vaccine (bOPV)
26
Monovalent Oral Poliovirus Type 2 (mOPV2)
13
Meningitis A (MenA)
2
Yellow Fever (YF)
4
Typhoid (TCV)
2
Cholera (OCV)
5
Tetanus (Td)
7

 

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Statement
Remarks by Henrietta Fore UNICEF Executive Director at joint press briefing on immunization with WHO and Gavi, 22 May
22/05/2020
…And there have been serious disruptions in supply chains and transport services. UNICEF has reported a substantial delay in planned vaccine deliveries due to the lockdown measures and the resulting decline in commercial flights and limited availability of charters.

However, we cannot let our fight against one disease come at the expense of long-term progress in our fight against other diseases.

We cannot exchange one deadly outbreak for another. We cannot afford to lose the decades of health gains that everyone has worked so hard to achieve.

We need joint, concerted efforts to put vaccinations back on track. And there are many ways we can do this:

First, countries need to intensify their efforts to track unvaccinated children, so that the most vulnerable populations are vaccinated as soon as it becomes possible to do so.

Second, we need to address gaps in vaccine delivery. UNICEF is working with our offices around the world, freight forwarders and partner organisations to prioritise shipments and arrange charter operations as required for delivery of emergency and critical supplies. We have also appealed to governments, the private sector, the airline industry, and others, to free up freight space at an affordable cost for humanitarian supplies including life-saving vaccines. A special thanks to Gavi who made at least US$ 40 million available to UNICEF to secure vital supplies, including vaccines and personal protective equipment on behalf of 58 low and lower-middle-income countries as they respond to the COVID-19 pandemic.

Third, we need to look for innovative solutions to keep vaccinations going. And some countries are already leading the way. Uganda, for example, is ensuring that immunization services continue along with other essential health services, even funding transportation to ensure outreach activities…

 

Fourth, vaccines need to be affordable and accessible to those who need them the most.

And last, we need to make sure we have the resources to do all of this. This is a significant undertaking that requires generosity and commitment. We know only too well that when it comes to some of these diseases, no child is safe until every child is safe. Ahead of the Gavi replenishment conference in June, the call for additional funding cannot be timelier.

 

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Framework for decision-making: implementation of mass vaccination campaigns in the context of COVID-19
WHO Interim guidance
22 May 2020
Background
Mass vaccination campaigns to prevent or respond to outbreaks of vaccine-preventable diseases and high impact diseases (VPD/HID) are effective strategies to reduce deaths and disease. Yet many countries have had to postpone such vaccination campaigns due to the physical distancing measures implemented to reduce COVID-19 transmission.

For countries affected by both VPD/HID and COVID-19 outbreaks, determining the best course of action may be challenging. Weighing the benefits of a safe and effective intervention that reduces mortality and morbidity against the risks of increasing transmission of a new disease that may burden essential health services can be complex. The starting point for such considerations is a risk-benefit analysis that reviews in detail the epidemiological evidence and weighs the short- and medium-term public health consequences of implementing or postponing mass vaccination campaigns, weighed against a potential increase in COVID-19 transmission.1

 

In the context of the COVID-19 pandemic, this document:
I. outlines a common framework for decision-making for the conduct of preventive and outbreak response campaigns;

 

II. offers principles to consider when deliberating the implementation of mass vaccination campaigns for prevention of increased risk of VPD/HID among susceptible populations; and

III. details the risks and benefits of conducting vaccination campaigns to respond to VPD/HID outbreaks.

This document is complemented by an annex (Annex 1) that provides guidance on how to safely organize a mass vaccination campaign, and is supplemented by a range of technical materials on prevention, response and control measures for COVID-19, including the”
:: Guiding principles for immunization activities during the COVID-19 pandemic: Interim guidance,2
:: the Frequently Asked Questions: Immunization in the context of COVID-19 pandemic,3 and
:: the Polio eradication programme continuity: implementation in the context of the COVID-19 pandemic.4 This interim guidance should also be used in conjunction with existing disease-specific WHO prevention and control guidelines.

Audience
This interim guidance is to be used by national health authorities (and subnational where appropriate), together with immunization programme partners…