Unvaccinated children drive disease outbreaks – 11/28/2023 – Health

Massive disease outbreaks that kill mostly children are spreading across the world, a grim legacy of the disruptions to health systems during the Covid pandemic that left more than 60 million children without a single dose of routine childhood vaccines.

By the middle of this year, 47 countries had reported serious measles outbreaks — in June 2020 there were 16. Nigeria is currently facing the largest diphtheria outbreak in its history, with more than 17,000 suspected cases and almost 600 deaths so far. Twelve countries, from Afghanistan to Zimbabwe, are reporting the circulation of the polio virus.

Many of the children who missed their vaccines are now left out of routine immunization programs. So-called “missed children” account for nearly half of all child deaths from vaccine-preventable diseases, according to Gavi, the organization that helps finance vaccinations in low- and middle-income countries.

An additional 85 million children are under-immunized as a result of the pandemic, meaning they have received only part of the standard course of multiple doses needed to be fully protected against a specific disease.

The cost of failing to reach these children is quickly becoming evident. Measles deaths rose 43% (to 136,200) in 2022 compared with the previous year, according to a new report from the World Health Organization and the Centers for Disease Control and Prevention. Figures for 2023 indicate that the total could be twice as high again.

“The drop in vaccination coverage during the Covid pandemic has led us directly to this situation of increased childhood illnesses and deaths,” said Ephrem Lemango, associate director of immunization at Unicef, which supports the delivery of vaccines to almost half of the world’s children. each year.

“With each new outbreak, the impact on vulnerable communities increases. We need to act quickly now and make the necessary investment to reach the children who have been left behind during the pandemic.”

One of the biggest challenges is that children who missed their first doses between 2020 and 2022 are now older than the age group typically seen routinely in primary health care centers and normal vaccination programs.

Reaching them and protecting them from diseases that can easily become fatal in countries with the weakest health systems will require extra effort and new investment.

“If you’re born within a certain time frame, you’ve been left behind, period, and it won’t be achieved just by restoring normal services,” said Lily Caprani, head of global advocacy at Unicef.

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

Unicef ​​calls on countries to implement a catch-up vaccination campaign, an exceptional and unique program to reach all children aged 1 to 4 who have been left behind.

Many developing countries have some experience in running measles recovery campaigns, focusing on children ages 1 to 5 years, or even ages 1 to 15 years, in response to outbreaks. But now these countries also need to deliver the other vaccines and train staff — typically community health workers who are only used to vaccinating babies — and acquire and distribute the actual vaccines.

Lemango said that despite the urgency of the situation, it has been a struggle to implement plans for such campaigns and that he hopes most can be carried out by 2024.

“Coming out of the pandemic, there was this hangover; nobody wanted to campaign,” he said. “Everyone wants to return to normality and regularly strengthen immunization. But we already had unfinished business.”

Countries with the most children without any doses include Nigeria, Ethiopia, India, Congo and Pakistan. Many with the lowest levels of coverage face additional challenges, such as civil conflicts in Syria, Ethiopia and Yemen; the growing population of climate refugees in Chad; and both of these problems in Sudan.

Ghana’s experience is representative of the challenges of many low-income countries. Parents couldn’t take their children for routine vaccinations when communities were on lockdown to protect against Covid, and when those restrictions were lifted, many parents still stayed away for fear of infection, said Priscilla Obiri, a health nurse. community responsible for vaccinations in low-income fishing communities on the outskirts of the capital, Accra.

Of the children Obiri currently sees at a typical pop-up vaccination clinic, where she sets up a table and a few chairs in the shade at a crossroads, up to a third will have incomplete or sometimes no vaccinations, she said. She agrees on a plan with the mothers to bridge the gap.

But some parents are unable to bring their children to a clinic. “We need to go out into the community and look for them,” she said. As Obiri and his colleagues try to make up this lost ground, they face another challenge: campaigns of misinformation and hesitancy toward Covid vaccines have spread and dampened some of the traditional enthusiasm that parents have had for routine immunizations. their children, according to the Vaccine Confidence Project, an ongoing research initiative at the London School of Hygiene and Tropical Medicine.

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

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

In 2015, 95% of Ghanaian parents said they believed vaccines were safe. This number dropped to 67% of parents in 2022. In October of this year, it rose to 83%.

Dr Kwame Amponsah-Achiano, head of Ghana’s childhood immunization program, said he does not believe confidence has diminished during the Covid pandemic. Demand remains high and has exceeded the program’s ability to provide vaccines in some areas, he said.

Caprani said Unicef ​​discovered both problems were occurring in parallel.

“You can have demand that outstrips not just physical supply but also access and at the same time see a decrease in confidence,” she said. “It’s not necessarily the same people.”