Wilmot James is a Senior Research Scholar, Lawrence Stanberry a Professor of Pediatrics and Jeffray Tsai a research assistant at Columbia University. James is also an Honorary Professor of Public Health at the University of the Witwatersrand

In April 2020, the World Health Organization warned that postponing vaccinations due to the imposing urgency of the Covid-19 pandemic will result in children dying from utterly preventable diseases. The world’s focus on Covid-19 is understandable, but the tragic result is the neglect of many other health challenges officials have laboured on for years. 

Vaccination is a mainstay of preventing illness and reducing mortality in low- and middle-income countries, particularly in children under five years of age, but, regrettably, routine childhood vaccinations have fallen behind since the beginning of the pandemic, making children more susceptible to preventable diseases such as measles and tetanus.

In 2020, 23 million children were not able to meet their routine immunisation services, 3.7 million more than in 2019. On specific vaccinations, when comparing numbers to 2019, 3.5 million more children missed their DTP-1 vaccine and three million their first measles shot. This is a significant number of children that missed their routine vaccinations in 2020. 

United States data indicated that childhood and adolescent vaccinations were substantially lower during March-May 2020 compared with the average administered during the same period in the previous two years. Although the number of children and adolescents vaccinated between June and September 2020 rebounded and approached pre-pandemic levels, the increase was not enough to achieve the catch-up vaccinations needed, leaving large numbers of children still susceptible to vaccine preventable diseases.

Most countries reported at least some disruptions to essential health services, with routine immunisation interference among the most frequent. Reasons for disruptions included restrictions placed on movement and travel; the closure of facilities due to the redeployment of health workers to Covid-19 wards; inadequate supply of personal protective equipment and the postponement of non-urgent medical care because of concerns about viral exposure. 

In parts of the United States, increasing Covid-19 vaccine hesitancy has spilled over to impact attitudes about the safe and effective vaccines that have been used for decades in routine immunisation programmes. Countries have been placed on alert for this insidious vaccine hesitancy creep that could undo years of progress in driving down childhood mortality.

The numbers are concerning, but they did not drop as much as initially assumed. 

The CEO of the Bill and Melinda Gates Foundation, Mark Suzman, has said that vaccination rates did not drop as low as the 14% predicted by the Institute for Health Metrics and Evaluation. Still, that is still enough to backtrack on years of progress. 

High-income countries are able to make progress despite the backtracking, but middle-income countries may not be as fortunate. Middle-income countries have an increasing number of children unvaccinated against preventable diseases. Similar to Covid-19 vaccine accessibility, there needs to be equal access to vaccines in general to be able to prevent all diseases. 

With the more concerning variants of SARS-CoV-2, there is likely to be continued disruption of childhood vaccinations.

Countries need to develop strategies to reestablish routine childhood vaccination programmes and develop catch-up programmes for those children who have missed receiving their routine childhood vaccines. These include:

• Ensuring the safety of all vaccine workers by placing them among the top tier of people receiving the Covid-19 vaccines. 
• Restoring vaccination campaigns with special emphasis on catch-up vaccinations and identifying communities that are under-vaccinated.
• Ensuring all routine vaccination sites are open and adequately staffed.
• Providing transportation fees to ensure parents can take children to vaccination appointments.
• Redoubling efforts to reduce vaccine hesitancy.

Children’s health delayed may well become children’s health denied, which, given the capability of today’s medicine and public health, is simply unforgivable. DM/MC

James is a Senior Research Scholar, Stanberry a Professor of Pediatrics and Tsai a research assistant at Columbia University. James is also an Honorary Professor of Public Health at the University of the Witwatersrand.

Next week, daily between 27 September and 1 October, Columbia University and the University of the Witwatersrand will host a virtual symposium on “Effective ways to Increase Vaccination Rates”. You can find the daily programme and registration details here.