In a number of African countries, development agencies are in a dash to ensure that vaccinations around the continent can be sustained amidst the growing difficulties on health services provision posed by the Covid-19 pandemic restrictions. These restrictions make it harder to move vaccines to areas where they are needed, they curtail the movement of individuals that need vaccination, and they expose health workers to greater safety and health risks.
Entities such as the United Nations Children’s Fund (Unicef), the vaccine alliance Gavi, the World Health Organization (WHO), and Doctors Without borders (MSF), as well as some national governments, are scrambling amidst these challenges to maintain the momentum of vaccination. However, as they admit, the challenges are numerous amidst the emergency caused by the pandemic – and sometimes by the increasing number of competing health and humanitarian needs.
It is essential to maintain the vaccination efforts amidst the Covid-19 crisis because, with the attention of governments and humanitarian agencies largely focused on the pandemic, it is easy to ignore the immunisation arm of public health provision. That would reverse gains made by several countries to reduce mortality and fatality from vaccine-preventable diseases such as cholera, measles, pneumonia, and polio. And it might give these diseases the opportunity to break out in large numbers that would be too strenuous for health authorities to manage.
There are indeed some worrying cases of such disease incidents rising currently – even as there are also shining examples of how international agencies are joining forces with governments to deliver badly-needed vaccines amidst the Covid-19 emergency. According to MSF, while much of the world’s attention is on battling the Covid-19 pandemic, measles continues to silently kill large numbers of mostly children in the Democratic Republic of Congo (DRC), the Central African Republic (CAR) and Chad.
According to the agency, since January, the DRC has registered more than 50,000 cases and 600 deaths from measles. Its teams are providing outbreak response vaccination, treating children for the disease, and for other illnesses such as malnutrition. In the CAR, the agency is working with national health authorities on a campaign to vaccinate more than 340,000 children for measles in seven health zones across the country.
Similarly, Chad is experiencing a measles outbreak, in response to which a vaccination campaign by the health ministry, in partnership with Unicef and Gavi is planned for this year but fears of a large Covid-19 outbreak may threaten it. As noted by Seidina Ousseini, who heads the MSF office in Chad, “Despite the fact that Covid-19 is the emergency situation attracting the full attention of the country and donors, the response to the measles epidemic remains our main priority. We must focus and push for a mass vaccination campaign.”
Indeed, health experts say Africa is experiencing a resurgence of measles, yet Covid-19 has prompted the suspension of measles preventive mass vaccination campaigns in Chad, Ethiopia, Nigeria and South Sudan. This has left about 21 million children “unprotected” yet they would have been vaccinated, according to the WHO.
As Dr. Matshidiso Moeti, head of the WHO in Africa states, “While the complexity and breadth of the Covid-19 response is unprecedented, we must continue to protect African children against vaccine-preventable diseases. Let us not be blind-sided by Covid-19 and let down our guard against measles and other childhood threats.”
Cathrine Ntabadde, spokesperson for Unicef in Uganda, told this writer that over the last month they have delivered to Uganda 3.8 million does of the oral polio vaccine to support ongoing routine immunisation services, as well as 810,500 doses of the pentavalent vaccine – a combination of five vaccines in one: diphtheria, tetanus, whooping cough, hepatitis B and haemophilus influenza type b (the bacteria that causes meningitis, pneumonia and otitis).
According to Noreen Prendiville, Unicef’s deputy representative in Uganda, the United Nations agency is committed to continue supporting the Uganda government to deliver the much-needed life-saving services, including protecting children from vaccine-preventable diseases especially during pandemics.
Prendiville said: “As scientists work hard to accelerate vaccine development for Covid-19, we must also ensure children are protected against those diseases for which vaccines already exist, including polio, measles, rubella and tuberculosis. Immunisation is one of the most effective public health interventions and is key to end vaccine-preventable child deaths and giving children a chance to grow up healthy and reach their full potential.”
While this year’s Africa Vaccination Week was underway at the end of last month, the Africa office of WHO noted that the Covid-19 pandemic was causing significant disruption to vaccination efforts and to the surveillance of vaccine-preventable diseases on the continent.
It said prior disease outbreaks and humanitarian emergencies have underscored the importance of maintaining essential health services such as immunisation, because even brief interruptions of vaccination activities make outbreaks more likely to occur, putting children and other vulnerable groups at greater risk of life-threatening diseases.
Meanwhile, Gavi officials told this writer that since Covid-19 cases had been registered in virtually all countries eligible to receive support from Gavi, the Vaccine Alliance is providing immediate funding to health systems, enabling countries to protect health care workers, perform vital surveillance and training, and purchase diagnostic tests. Moreover, the Alliance is working with several countries to maintain ongoing immunisation programmes, thereby avoiding future deaths resulting from various preventable diseases such as diarrhoea, measles, meningitis, pneumonia, polio, and yellow fever.
According to Gavi, the immunisation infrastructure that it has helped to build over the past two decades is also being used to help fight the Covid-19 pandemic. In a statement, it stated that across the world, staff in health ministries and partner organisations trained and funded with Gavi support are now forming part of the Covid-19 response effort. It cited the example of technology funded by Gavi to monitor immunisation that is now being used to monitor and track Covid-19 cases.
In Uganda, 1.5 million school-going children missed the Human Papillomavirus Vaccine last month due to the coronavirus lockdown. Similarly, a planned yellow fever mass vaccination campaign in four districts that reported yellow fever cases between late 2019 and early this year was called off due to the risk posed by a mass immunisation campaign, according to Dr. Alfred Driwale, who heads the country’s immunisation programme.
The WHO has developed new guidelines on immunisation in the context of Covid-19, which stress the need for a dynamic approach. The guidelines recommend that countries temporarily pause preventive mass vaccination campaigns but urge them to prioritise the continuation of routine immunisation of children as an essential service delivery, as well as adult vaccinations such as influenza for groups most at risk.
In this vein, Dr. Driwale says that whereas there are ongoing difficulties resulting from Covid-19 pandemic, health authorities are encouraging parents to ensure that their children receive their routine immunisation while following guidelines from health authorities on how to continue accessing health services while protecting themselves from Covid-19 infection.