Covid has created vaccination gaps in Africa. It has helped over a million children at risk

The Covid pandemic has exposed fault lines in health systems and routine national immunization programs around the world.

A recent report from the World Health Organization (WHO) showed that the pandemic fueled the largest sustained decline in childhood vaccine coverage rates.

These declines threaten to undo the exceptional efforts being made to prevent and control the devastating burden of vaccine-preventable diseases globally. Routine immunization prevented two to three million deaths a year. Of the lives saved, 800,000 were in the Africa region.

Routine immunization has led to a dramatic reduction in diseases such as neonatal tetanus and measles. And bacterial meningitis (type A) and polio have been virtually eliminated across the continent.

The repercussions of the pandemic on routine immunization programs in the African region have yet to be fully realized. What we know so far is that the pandemic has resulted in substantial disruptions to routine national immunization programs.

As a result, the continent is seeing an increasing number of vaccine-preventable disease outbreaks.

African countries had nearly eliminated the deadly form of type A meningitis. But a four-month outbreak of meningitis was reported in the Democratic Republic of the Congo in 2021. It accounted for 2,665 cases, resulting in 205 deaths.

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This recovery has been linked to the suspension of meningitis vaccination campaigns at the height of the COVID pandemic.

In February 2022, Malawi reported its first wild case of type 1 poliovirus in 30 years. A second case followed in Mozambique three months later. The outbreaks have triggered mass polio vaccination campaigns across southern Africa.

UNICEF and WHO have warned of the increased risk of measles outbreaks given the widening immunization gaps.

Currently, Zimbabwe is in the throes of a devastating measles epidemic. In five months, there were 6,551 confirmed measles cases and 704 related deaths.

These emerging outbreaks are a matter of great concern. They require urgent and lasting public health interventions. Unless implemented, the aggravating effects of the pandemic could derail regional progress towards global immunization goals that ensure the health and well-being of infants and children.

The resurgence of vaccine-preventable deadly diseases underscores the importance of maintaining high vaccination coverage rates. Children around the world must have access to all recommended life-saving vaccines they need.

The disruptions observed during the Covid pandemic also underscore the importance of establishing resilient health systems. Systems must be able to withstand acute and prolonged shocks while providing essential health services such as immunization programs.

Immunization before Covid

It is important to contextualize the performance of routine immunization programs within the African region. Even before the pandemic, the African region was struggling with a precarious situation.

For one, about 30.7 million children under five continue to suffer from vaccine-preventable diseases. These include rotavirus diarrhea, pneumonia, whooping cough, and measles.

Of these children, more than 520,000 die each year due to poor access to essential immunization services.

The continent’s health systems have to handle an average of 150 cases of disease outbreaks and other public health emergencies each year.

These range from armed conflict to climate-related disasters (including floods, droughts and famines) and epidemics. National routine immunization programs had to work in this context.

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The pandemic has widened the immunization gaps

On the continent, the pandemic has essentially disrupted routine national immunization programs. In many countries, health systems have been forced to divert limited resources to fight the pandemic. This often left the immunization services vulnerable.

At the height of the pandemic, several countries reported having to suspend vaccination services. There have been disruptions in vaccine supply chains which have led to stockouts.

The number of people accepting vaccination services has decreased due to restrictions on public gatherings. Many people also feared being exposed to the virus in health care facilities.

A good measure of Covid-related disruptions to immunization programs is coverage of the three doses of the diphtheria-tetanus-pertussis (DTP3) vaccine. WHO uses DTP3 coverage to monitor access to immunization services and measure the performance of larger health systems.

The WHO report shows that the Covid-19 pandemic has contributed to an overall decline in DTP3 coverage globally, regardless of economic power or income level.

In Africa, national immunization programs in several countries have maintained optimal performance, reaching DTP3 coverage rates of over 90%. These included Algeria, Botswana, Burkina Faso, Burundi, Ghana, Kenya, Malawi, Mauritius, Namibia, Sierra Leone, Uganda, and Zambia.

However, the 29 countries that experienced less than 90% coverage, creating substantial vaccination gaps, are of concern.

DTP vaccine coverage in many African countries was below the WHO threshold of 90%. Data source: WHO,

The increased misinformation and disinformation during the pandemic has also led to some decline in public trust and confidence in immunization services. This significantly affected the demand for vaccines.

Plot a way forward

The pandemic provides useful lessons on the importance of continually strengthening health systems and routine national “crisis-proof” immunization programs.

Covid-19 has been a catalyst for renewed political interest in immunization programs. But this needs to be followed up with regional solidarity to redefine the priority of routine immunization in national and regional public health agendas.

National governments will have a responsibility to secure and support donor funding, while increasing national financial commitments that will fill funding gaps for national immunization programs. This is in line with the statements they endorsed.

Above all, demand for vaccines and immunization programs needs to be stepped up. This is critical to rebuilding public trust and confidence in vaccines and immunization services in a post-Covid world.

This article was republished by The Conversation under a Creative Commons license. Read the original article here.