Large outbreaks of diseases that mainly kill children are spreading around the world, a grim legacy of disruptions to health systems during the Covid-19 pandemic that have left more than 60m children without a single dose of standard childhood vaccines.
By June this year, 47 countries were reporting serious measles outbreaks, compared with 16 countries in June 2020. Nigeria is facing the largest diphtheria outbreak in its history, with more than 17 000 suspected cases and nearly 600 deaths so far, while 12 countries, from Afghanistan to Zimbabwe, are reporting circulating poliovirus.
The New York Times reports that many of the children who missed their shots have now aged-out of routine immunisation programmes.
So-called “zero-dose children” account for nearly half of all child deaths from vaccine-preventable illnesses, according to Gavi, the organisation that helps fund vaccination in low and middle-income countries.
An additional 85m children are under-immunised as a result of the pandemic – that is, they received only part of the standard course of several shots required to be fully protected from a particular disease.
The cost of the failure to reach those children is swiftly becoming clear. Deaths from measles rose 43% (to 136 200) in 2022, compared with the previous year, according to the WHO and the US Centres for Disease Control and Prevention (CDC). The figures for 2023 indicate that the total could be twice as high again.
“The decline in vaccination coverage during pandemic led us directly to this situation of rising diseases and child deaths,” said Ephrem Lemango, associate director of immunisation for Unicef, which supports delivery of vaccines to almost half of the world’s children every year.
“With each new outbreak, the toll on vulnerable communities rises. We need to move fast now and make the investment needed to catch up the children who were missed during the pandemic.”
One of the biggest challenges is that the youngsters who missed their first shots between 2020 and 2022 are now older than the age group typically seen routinely at primary healthcare centres and in normal vaccination programmes.
Reaching and protecting them from diseases that can easily turn fatal in countries with the most fragile health systems will require an extra push and new investment.
“If you were born within a certain period of time, you were missed, full stop, and you’re not going to get caught just by restoring normal services,” said Lily Caprani, Unicef’s chief of global advocacy.
Unicef is asking Gavi for $350m to buy vaccines to try to reach those children. Gavi’s governing board will consider the request next month.
Unicef is also urging countries to implement a catch-up vaccination blitz, an exceptional, one-time programme to reach all children aged between one and four who were missed.
Many developing countries have some experience of carrying out catch-up campaigns for measles, targeting children aged from one to five, or even one to 15, in response to outbreaks.
But now those countries also need to deliver the other vaccines and train personnel – typically, community health workers who are only accustomed to vaccinating babies – and to procure and distribute the actual vaccines.
Lemango said that despite the urgency of the situation, it had been a struggle to institute such plans but that he hoped most could come together in 2024.
“Coming out of the pandemic, there was this hangover; no one wanted to do campaigns,” he said. “Everyone wants to return to normalcy and do regular strengthening of immunisation. But we already had unfinished business.”
The countries with the most zero-dose children include Nigeria, Ethiopia, India, Congo and Pakistan. Many with the lowest levels of coverage are facing compounding challenges, such as the civil conflicts in Syria, Ethiopia and Yemen; the growing population of climate refugees in Chad; and both of those problems in Sudan.
Ghana’s experience is representative of the challenges of many lower-income countries. Parents couldn’t take their children for routine shots when communities were locked down to protect against Covid, and when those restrictions were lifted, many parents still stayed away because of fear of infection, said Priscilla Obiri, a community health nurse in charge of vaccinations in low-income fishing communities on the edge of the capital, Accra.
Of 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 a crossroads, as many as one-third will have incomplete vaccinations or sometimes none at all, she said. She agrees on a plan with their mothers to make up the gap.
But some parents don’t or can’t bring their children to a clinic. “We must go out to the community and hunt for them,” she said.
See more from MedicalBrief archives:
WHO, Unicef flag worst decline in childhood immunisations in 30 years
Africa: Benefits of childhood vaccination programmes far outweigh risks of COVID-19 transmission
NICD alert after two cases of diphtheria in SA