Coronavirus: Polio and measles set to surge as pandemic forces suspension of mass vaccination campaigns
The coronavirus pandemic has dealt a massive blow to efforts meant at tackling other deadly diseases such as polio, measles and yellow fever, among others. The reason: global bodies have called for a suspension of mass vaccination campaigns to help stop the spread of the novel coronavirus. This could impact millions of children and result in a surge in many of these diseases, which are preventable.
“Based on the current understanding of the transmission modes of the COVID-19 virus and the recommended prevention measures of physical distancing, it is advised to temporarily suspend the conduct of mass vaccination campaigns due to the increased risk of promoting community circulation. Countries should monitor and re-evaluate at regular intervals the necessity for the delay of mass vaccination campaigns,” says the World Health Organization (WHO) in a March 26 interim guidance.
The document, endorsed by the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE), explains that due to the global circulation of the virus causing COVID-19 and the current pandemic, there is a risk of disruption to routine immunization activities due to both COVID-19 related burden on the health system and decreased demand for vaccination because of physical distancing requirements or community reluctance.
The experts acknowledge that disruption of immunization services, even for brief periods, will result in increased numbers of susceptible individuals and raise the likelihood of “outbreak-prone vaccine-preventable diseases” such as measles. Such outbreaks may result in increased diseases and deaths, predominantly in young infants and other vulnerable groups, resulting in a greater burden on health systems already strained by the COVID-19 response. This, say experts, underscores the importance of continuing immunization services wherever they can be conducted under safe conditions.
For routine immunization, the WHO says “where health system capacity is intact and essential health services are operational, fixed-site immunization services and surveillance should be executed while maintaining physical distancing measures and appropriate infection control precautions.”
“If the provision of immunization services is negatively impacted by COVID-19, countries will need to design strategies for catch-up vaccination for the period post-COVID-19 outbreak and make plans which anticipate a gradual recovery. Implementation of catch-up will require strategies to track and follow-up with individuals who missed vaccinations, assess immunity gaps and re-establish community demand. Innovation and creativity will be required,” say experts.
The Global Polio Eradication Initiative (GPEI), has also announced that its Polio Oversight Board (POB) has recommended that all polio eradication country programs prioritize support for the response to COVID-19. Accordingly, all preventive polio campaigns should be postponed until the second half of 2020, says an advisory. This implies that all polio activities, which contradict global guidance on physical distancing such as house-to-house or other immunization activities using oral or injectable vaccines, should be suspended to avoid placing communities and frontline workers at unnecessary risk, says the statement.
Countries that were planning to conduct poliovirus outbreak response campaigns have been asked to postpone these campaigns until June 1, 2020, and then reevaluate them based on the status of the COVID-19 pandemic.
These measures imply that for the next four to six months, GPEI assets — technical expertise, surveillance and community networks, and logistics capacity — will be made available to support the global response to COVID-19. Critical polio functions, such as surveillance and global vaccine supply management, will, however, be maintained.
Experts acknowledge the grim fact such suspension could be devastating for children and result in increased spread of disease and the number of children paralyzed by “wild and circulating vaccine-derived polioviruses.” This will require a scale-up of polio eradication efforts once the COVID-19 situation has stabilized, say experts.
“We take this decision with deep regret, knowing more children may be paralyzed by polio as a result. Nonetheless, GPEI believes it is the correct decision, given the imperative to save lives in the current emergency and not contribute to the further spread of COVID-19,” says the statement.
The experts say the final decision to proceed with outbreak response rests with countries, who will need to evaluate the risks of a delayed response to the detection of poliovirus against the risks of an immediate response, which could contribute to further spread of SARS-CoV-2 and more cases of COVID-19.
Both WHO and GPEI emphasize that if vaccination campaigns are pursued, countries must ensure that stringent measures are in place to protect health workers and safeguard the public.
Meanwhile, multiple companies and academic institutions are currently racing to develop a vaccine against COVID-19, which has killed over 108,990 globally, according to the John Hopkins tracker. Over 1,781,120 cases of the new coronavirus have been reported worldwide.
According to an analysis by Gavi, the Vaccine Alliance, immediate delays to vaccination campaigns and routine introductions will mean at least 13.5 million people in 13 of the world’s least-developed countries will not be protected against diseases like measles, polio and human papillomavirus (HPV), with millions more likely to follow.
“The Vaccine Alliance and its partners are urgently working to keep immunization programs running, however at least 21 low- and middle-income countries are already reporting vaccine shortages as a result of border closures and disruptions to air travel,” says Gavi.
Currently, 14 major Gavi-supported vaccination campaigns against polio, measles, cholera, HPV, yellow fever and meningitis have been postponed, as have four national vaccine introductions. Collectively these would have immunized over 13.5 million people.
“The world’s poorest countries need the help of the international community more than ever to help mitigate the worst impacts of the COVID-19 pandemic and to ensure that they are not hit by an even higher death toll from preventable diseases which can further overwhelm the health systems. Children missing out now must not go their whole lives without protection from disease. The legacy of COVID-19 must not include the global resurgence of other killers like measles and polio,” says Dr Seth Berkley, CEO of Gavi, in a statement.