ACCRA, Ghana — Vast outbreaks of diseases that mostly kill children are spreading around the world, a grim legacy of disruptions to health systems during the COVID-19 pandemic that left more than 60 million children without a single dose of standard childhood vaccines.
As of mid-year, 47 countries were reporting serious measles outbreaks, up from 16 countries in June 2020. Nigeria is currently facing the largest diphtheria outbreak in its history, with more than 17,000 suspected cases and nearly 600 deaths. nowadays. Twelve countries, from Afghanistan to Zimbabwe, are reporting the circulation of the polio virus.
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Many children who were unable to get vaccinated are now missing out on routine immunization programs. “Doseless children” account for nearly half of all child deaths from vaccine-preventable diseases, according to Gavi, the organization that helps fund immunization in low- and middle-income countries.
Due to the pandemic, 85 million more children are underimmunized – that is, they have received only part of the standard treatment of several injections required to be fully protected against a particular disease .
The cost of failing to reach these children quickly becomes evident. Measles deaths increased 43% (to 136,200) in 2022 compared to 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 the total could again be twice as high.
“The decline in immunization coverage during the COVID-19 pandemic has led directly to this situation of increasing child illness and death,” said Ephrem Lemango, associate director of immunization at UNICEF, who supports the provision of vaccines to almost half of the world’s children each year. . “With each new epidemic, the toll on vulnerable communities increases. We must act quickly now and make the investments needed to catch up with the children who missed out during the pandemic.
One of the biggest challenges is that children who did not receive their first injection between 2020 and 2022 are now older than the age range typically seen in primary health care centers and in vaccination programs normal. Reaching them and protecting them from diseases that can easily prove fatal in countries with the weakest health systems will require additional effort and new investments.
“If you were born within a certain time frame, you were forgotten, period, and you’re not going to get caught just by restoring normal services,” said Lily Caprani, UNICEF global advocacy manager .
UNICEF is asking Gavi for $350 million to buy vaccines to try to reach these children. Gavi’s board will consider the request next month.
UNICEF is urging countries to implement a catch-up vaccination campaign, an exceptional, one-time program to reach all children aged 1 to 4 who have not been vaccinated.
Many developing countries have some experience in carrying out measles catch-up campaigns, targeting children between 1 and 5 years old, or even between 1 and 15 years old, in response to epidemics. But now these countries must also deliver the other vaccines and train staff – usually community health workers who are only used to vaccinating babies – and procure and distribute the vaccines themselves.
Lemango said that despite the urgency of the situation, it had been difficult to put plans in place for such campaigns and that he hoped most could come together in 2024.
“Coming out of the pandemic, there was this hangover; no one wanted to campaign,” he said. “Everyone wants to return to normal and regularly increase vaccination. But we already had unfinished business.
In some countries, such as Brazil, Mexico and Indonesia, health systems have recovered from the severe disruptions caused by the pandemic and have returned to, or even exceeded, the vaccination coverage levels they had achieved before the pandemic. But others – mostly countries where vaccination rates were already significantly below targets set by UNICEF – have not caught up to their previously lower levels.
The countries with the highest number of children without doses are Nigeria, Ethiopia, India, Congo and Pakistan. Many with the lowest coverage levels face compounding challenges, such as civil conflicts in Syria, Ethiopia and Yemen; the growing population of climate refugees in Chad; and these two problems in Sudan.
Ghana’s experience is representative of the challenges facing many low-income countries. Parents couldn’t take their children for routine vaccinations when communities were closed to protect against COVID, and when those restrictions were lifted, many parents stayed away for fear of infection, said Priscilla Obiri, a community health nurse responsible for vaccinations. in low-income fishing communities on the outskirts of the capital, Accra.
Among the children Obiri sees these days at a typical pop-up vaccination clinic, where she sets up a table and a few chairs in the shade at an intersection, up to a third will have incomplete or sometimes no vaccinations, she says. She. said. She agrees on a plan with their mothers to close the gap.
But some parents are unwilling or unable to bring their children to a clinic. “We need to go to the community and chase them away,” she said.
As Obiri and his colleagues try to regain lost ground, they face another challenge: Disinformation campaigns and hesitancy about COVID vaccines have spread and eroded some of the urgency tradition of parents to vaccinate their children regularly, according to the Vaccine Confidence Project. , a long-standing research initiative of the London School of Hygiene and Tropical Medicine.
“Across 55 countries, there was a sharp drop between 2015 and 2022 in the number of people saying routine immunization is important for children,” said project director Heidi Larson, whose team collected what which she described as “robust global survey data”. » in more than 100 nationally representative surveys.
Even as people around the world searched for information about vaccines, there was a surge in misinformation and disinformation, she said, and people with little trust in authorities and official guidelines were particularly likely to believe alternative sources of information.
In 2015, 95% of Ghanaian parents said they believed vaccines were safe. This figure dropped to 67% of parents in 2022. It had risen to 83% in October this year.
Dr Kwame Amponsah-Achiano, who oversees Ghana’s childhood immunization programme, said he did not think confidence had dropped during the COVID pandemic. Demand remains high and has exceeded the program’s supply capacity in some areas, he said.
Caprani said UNICEF found that the two problems were occurring in parallel.
“You can have demand that exceeds not only physical supply, but also faster access – convenient, affordable and accessible access – and at the same time see some decline in confidence,” she said. “They’re not necessarily the same people.”
Last year, 22 million children did not receive routine measles vaccination in their first year of life – 2.7 million more than in 2019 – while a further 13.3 million did not have not received their second dose. To achieve herd immunity and prevent epidemics, 95% of children must receive both doses. Measles acts as an early warning system for vaccination gaps because it is highly transmissible.
“There are communities where a measles outbreak is a bad thing, and others where it is a death sentence, due to the combination of other risk factors such as poor malnutrition, limited access health care, limited access to clean water,” Caprani says.
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