by Mahaa Ahmed
figures by Tal Scully
The COVID-19 pandemic has brought many corners of the world to a standstill. While researchers and scientists race to develop and distribute a vaccine, many places are still subject to a host of restrictions on daily life designed to keep people safe. Unfortunately, this may actually lead to endangerment of children’s health in other critical ways. More than just pressing pause, the World Health Organization and UNICEF jointly warned that the disruption to vaccination campaigns and routine immunizations could actually reverse years of progress made in public health. The 2020 Bill and Melinda Gates Foundation Goalkeepers Report confirmed this by finding that the number of children vaccinated against infectious diseases such as diphtheria, tetanus, pertussis, and measles this year has declined to levels last observed in the 1990s.
Global vaccination campaigns on pause
Global health organizations have been faced with an impossible choice: 1) continue vaccination campaigns while putting frontline health workers and families at risk of spreading and contracting COVID-19, or 2) halt mass vaccination campaigns in their entirety, leaving countless children at risk of vaccine-preventable diseases. Many global vaccination campaigns chose the second option. On March 24, 2020, the Global Polio Eradication Initiative (GPEI) recommended suspension of their polio vaccination campaigns across the world and committed to making its programmatic and operational assets and emergency operation centers available to respond to the COVID-19 crisis.
COVID-19 has put pressure on already-struggling immunization services in various countries, and potential outbreaks of vaccine-preventable diseases would only further strain health systems. Vaccination not only protects the child that is vaccinated but also protects those in the community around them through herd immunity — once a large percentage of people receive vaccines against a disease, few people can get the disease and spread it to others. (Fig. 1)
While cessation of mass vaccination campaigns that often lead to hundreds of children and frontline health workers congregating closely together may have minimized the spread of COVID-19, it might have actually endangered more lives than it protected. A study conducted by scientists at the London School of Hygiene and Tropical Medicine found that the benefits associated with continuing routine immunization of infants outweigh the risks of COVID-19 infections in Africa. For each excess death from COVID-19 that would be contracted during a vaccination visit to households, approximately 29-347 deaths among children could be prevented by continuing to administer vaccines. Although only preliminary data, it echoes other findings that similarly warn that abandoning childhood vaccination campaigns will lead to the preventable death of children. Researchers from the University of Washington have further shared that the pandemic has had a detrimental impact on vaccinations across all countries.
Resuming vaccination campaigns
Global vaccination campaigns began to lift their suspensions because of ground lost to other diseases in July. The eradication of polio, which is still endemic in Afghanistan and Pakistan, has been threatened by the pandemic. The four-month suspension from March to June 2020 was lifted in late-July as vaccinators resumed polio vaccination campaigns in Afghanistan, Angola, Burkina Faso, and Pakistan. Vaccinators now balance the need to provide children with life-saving vaccines while remaining compliant with strict safety and hygiene measures.
The GPEI’s strict COVID-19 prevention measures include frequent hand-washing, wearing gloves and masks, screening health workers for COVID-19, and using a ‘no-touch’ method that ensures a physical distance between the vaccinator and child when administering a vaccine. In Pakistan, vaccinators ask parents to hold their child while administering oral polio drops in order to minimize contact. Pakistan kicked off a nationwide polio vaccination campaign involving approximately 270,000 frontline health workers on September 21, 2020 with hopes to vaccinate 40 million children under the age of five.
Similar COVID-19 prevention measures were implemented during a measles vaccination campaign in Addis Ababa, Ethiopia. The campaign, which was initially scheduled to be held in April 2020 but was postponed due to the pandemic, has vaccinated approximately 15 million children between 9-59 months during a ten-day immunization drive in late-July. Both of these campaigns are testaments to the ability to safely provide children with necessary vaccines while taking measures to minimize the risk of COVID-19.
In the United States, the COVID-19 pandemic has led children’s vaccination rates to decline, thereby increasing the risk of other vaccine-preventable disease outbreaks in the coming months. The U.S. Centers for Disease Control and Prevention reported a substantial decrease in the number of children who received critical immunizations during March-April 2020 when many areas of the U.S. implemented stay-at-home orders. During this time, there was a 22% decline in vaccinations among children under two. Although thousands of school districts are providing virtual rather than in-person instruction, some are still requiring up-to-date immunizations. For instance, the New York State Department of Health is still enforcing its policy that students lacking immunizations two weeks after the beginning of the school year can no longer attend classes even if they are remote.
Focusing on every missed child
If child immunization rates continue to decline or fail to catch up to prior rates of high coverage not only in the U.S. but in countries around the world, the risk of other vaccine-preventable disease outbreaks is increased. A poll conducted in May 2020 by GlaxoSmithKline suggests that parents are anxious about getting their child vaccinated due to potential exposure to COVID-19. 45% of the 2,511 respondents reported that they believe vaccinations are now “more essential” to protect their child’s health than they were before the pandemic. 73% of respondents indicated that they would be happy for their child to receive vaccines during the COVID-19 crisis but only 27% felt comfortable visiting a medical facility to do so. (Fig. 2) This is alarming, given that 91% of respondents reported feeling comfortable doing so prior to the COVID-19 pandemic. Some parents may also be worried about the risk of their child developing multisystem inflammatory syndrome, a rare but serious effect observed in children who have had COVID-19.
Notably, of the 73% of parents who want to have their child vaccinated but are afraid to do so, alternatives, such as nurse home visits, drive-through facilities, and mobile medical clinics, are places they would feel comfortable having their child vaccinated. (Fig. 3) Pediatricians are assuring their patients that they will be safe by scheduling appointments at different times throughout the day to make sure their offices are not densely populated, setting up tents in their office parking lots, visiting patients’ homes, and more.
Ultimately, the present pandemic is a reminder of the threat posed by infectious diseases and is an opportunity to strengthen public trust in public health and vaccination, which will be immensely important when a COVID-19 vaccine becomes available. At least 68 countries and 80 million children under the age of one from those countries have been adversely affected by COVID-19 due to the disruption to vaccination campaigns. Vaccines are one of the best tools to prevent infectious diseases and have the unique potential to control, eliminate, and eradicate them. To this end, awareness about the efficacy and necessity of vaccines have never been more essential. The success of campaigns that have vaccinated millions of children while simultaneously safeguarding all from COVID-19, such as the ones held in Pakistan and Ethiopia, is a tremendous feat that provides lessons for the U.S. and other countries grappling with declining child vaccination rates. Children with greater access to health services may be able to catch up on missed vaccinations whereas those in developing areas may not be able to do so and remain vulnerable to vaccine-preventable diseases, COVID-19, and other public health emergencies. Making sure that children safely receive vaccines, even during the COVID-19 crisis, enables parents to secure healthier lives and futures for their children not only at the present moment but also for the remainder of their lives.
Mahaa M. Ahmed is an Environmental Health Masters student at the Harvard T.H. Chan School of Public Health.
Tal Scully is a third year Ph.D. student in the Systems, Synthetic, and Quantitative Biology program at Harvard University, where she studies zebrafish development. You can find her on Twitter as @TalScully.
For More Information:
- Read the 2020 Bill and Melinda Gates Foundation Goalkeepers Report
- Read more here about how COVID-19 has disrupted childhood immunizations across Africa
- See this article about the estimated indirect effects of COVID-19 on child mortality