The Covid pandemic has exposed the flaws in health systems and national routine immunization programs around the world.
A recent World Health Organization (WHO) showed that the pandemic fueled the largest sustained decline in childhood vaccination coverage rates.
These declines threaten to undo exceptional efforts to prevent and control the devastating burden of vaccine-preventable diseases worldwide. Routine vaccination prevented two to three million dead annually. lives saved, 800 000 were in the Africa region.
Routine vaccination has led to a drastic reduction in diseases such as neonatal tetanus and measles. And bacterial meningitis (type A) and poliomyelitis have been virtually eliminated across the continent.
The impact of the pandemic on routine immunization programs in the African region has yet to be fully realized. What we know so far is that the pandemic has caused significant disruptions to national routine immunization programs.
As a result, the continent is experiencing an increase in the number of outbreaks of vaccine-preventable diseases.
African countries had nearly eliminated the deadly form of type A meningitis. But a four-month meningitis epidemic was reported in the Democratic Republic of Congo in 2021. It accounted for 2,665 cases, killing 205.
This resurgence has been related with the suspension of meningitis vaccination campaigns at the height of the COVID pandemic.
In February 2022, Malawi reported its first wild type 1 poliovirus case in 30 years. A second case followed in mozambique three months later. The outbreaks triggered massive polio vaccination campaigns across southern Africa.
UNICEF and WHO have warned the increased risk of measles outbreaks, given the widening immunization gaps.
Currently, Zimbabwe is in the grip of a devastating measles outbreak. In five months, there were 6,551 confirmed cases of measles and 704 related deaths.
These emerging epidemics are a matter of great concern. They call for urgent and sustained public health interventions. Unless these are put in place, the cumulative effects of the pandemic could derail regional progress towards globalization. vaccination targets that ensure the health and well-being of infants and children.
The resurgence of deadly vaccine-preventable diseases highlights the importance of maintaining high vaccination coverage rates. Children everywhere should have access to all the recommended life-saving vaccines they need.
The disruptions seen during the Covid pandemic also underscore the importance of building resilient healthcare systems. Systems must be able to withstand acute and prolonged shocks while delivering essential health services like immunization programs.
Vaccination before Covid
It is important to contextualize the performance of routine immunization programs in the African region. Even before the pandemic, the African region was already facing a precarious situation.
For one year valued 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 insufficient access to essential immunization services.
The continent’s health systems have to manage an average of 150 cases of epidemics and other public health emergencies each year.
These range from armed conflicts to climate-related disasters (including floods, droughts and famine) and epidemics. National routine immunization programs have had to operate in this context.
The pandemic has widened the gaps in vaccination
On the continent, the pandemic has significantly disrupted national routine immunization programs. In many countries, health systems have been forced to divert limited resources to fight the pandemic. This often makes 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 that have led to stock-outs.
The number of people seeking vaccination services has declined due to restrictions on public gatherings. Many people also feared being exposed to the virus in healthcare settings.
A good measure of Covid-related disruptions in immunization programs is coverage of three doses of the diphtheria-tetanus-pertussis (DTP3) vaccine. The WHO uses DTP3 coverage to monitor access to immunization services and measure the performance of broader health systems.
The WHO report shows that the Covid-19 pandemic has contributed to a general decline in DTP3 coverage around the world – regardless of economic power or income level.
In Africa, national immunization programs in several countries have maintained peak performance, achieving DTP3 coverage rates above 90%. These include Algeria, Botswana, Burkina Faso, Burundi, Ghana, Kenya, Malawi, Mauritius, Namibia, Sierra Leone, Uganda and Zambia.
However, the 29 countries that have recorded coverage below 90% are of concern, creating significant immunization gaps.
Increased misinformation and disinformation during the pandemic has also led to some decline in public trust in immunization services. This has significantly affected the demand for vaccines.
Charting a path forward
The pandemic provides useful lessons on the importance of continuously strengthening “crisis-proof” national routine immunization programs and health systems.
Covid-19 has been a catalyst for renewed political interest in vaccination programs. But this must be followed by regional solidarity to re-prioritize routine vaccination in national and regional public health agendas.
National governments will be responsible for securing and sustaining donor funding while increasing domestic financial commitments that will fill funding gaps for national immunization programs. This is in accordance with the statements they endorsed.
Most importantly, demand for vaccines and immunization programs must be intensified. This is essential to restore public confidence in vaccines and immunization services in a post-Covid world.