COVID-19 & vaccines: “Don’t forget routine immunization”

Editorial Team

Editorial Team

May 11th, 2020

Editorial Team

‘There is no vaccine to protect against COVID-19, but experts are warning of outbreaks of measles and polio if disruption to routine immunization continues’

The COVID-19 pandemic continues to have a devastating impact on health, economies and societies around the world. The full direct impact of the disease will not be clear for months – or maybe years. But, as there is currently no cure, no natural immunity and no vaccine, it remains probably that millions more will be infected.

However, on top of those concerns, experts are also beginning to worry about indirect health impacts of the pandemic arising from cancelled surgeries, a growing reluctance to seek medical attention, and disruption to routine immunization services.

The World Economic Forum says more the COVID-19 pandemic may indirectly trigger widespread measles outbreaks. More than 117 million children globally could miss out on their MMR vaccine as immunization campaigns are suspended. The threat to polio eradication campaigns is also of concern. 

The European Centre for Disease Prevention & Control (ECDC) says 13,200 cases of measles were reported in EU/EEA countries in 2019. This led to 10 deaths last year, and two deaths in the first two months of 2020.

ECDC Director Andrea Ammon warned against complacency. ‘With the COVID-19 pandemic stretching health system capacity, there is a risk that other important health issues are being overlooked,’ she said. ‘Achieving the best possible vaccine uptake in the current circumstances is crucial to prevent measles outbreaks and other vaccine-preventable diseases. Otherwise, we risk an increase in outbreaks and a resurgence of these diseases.’

The WHO Regional Office for Europe has issued guidelines on routine immunization services during the pandemic. It emphasises the need to preserve vaccination, describing it as ‘an essential component of health services’. Measures to minimise the risk of COVID-19 infection during immunization sessions are also recommended. Mass vaccination campaigns and the introduction of new vaccines should be avoided, according to the guidance.

WHO Europe says vaccinations against measles, rubella and polio should be prioritised for children, while pneumococcal and seasonal influenza vaccines for vulnerable populations.

In the Americas, PAHO Director Carissa Etienne, has issued a similar warning. She urges health systems to prioritise diseases such as measles, which can spread very quickly if immunisation rates fall, and respiratory diseases such as flu and pneumococcus.

The Americas were declared measles-free in 2016 but have suffered recent outbreaks in Venezuela, Brazil, Colombia and in some US states. ‘History has shown us that after wars or epidemics, if we allow large gaps in immunization coverage, vaccine-preventable diseases like polio and measles can re-emerged.’

Meanwhile, Gavi, the Vaccine Alliance, is calling for the resumption of routine immunization programmes suspended due to the COVID-19 lockdown. Pointing to a study on the risks and benefits of reopening immunization clinics while the novel coronavirus is in circulation, Gavi CEO Seth Berkeley said the risk of ‘old diseases’ returning was significant. The study he cited indicates that for every death attributable to COVID-19 acquired through contact with routine immunization clinics, 101 deaths from vaccine-preventable diseases would be avoided.

‘I can’t emphasize enough [that halting routine immunization] is going to be a challenge, and we are going to see outbreaks, certainly for polio,’ Berkeley said. ‘If we don’t support those routine systems, those systems won’t be ready to move forward to roll out [existing and new] vaccines.’

He said the world will need to think about ‘catch-up’ programmes to restore the previous level of immunization. Gavi is aiming to raise $7.4 billion (€6.75 billion) from its next five-year plan for mass immunizations. The UK will host a ‘virtual replenishment’ fund-raising drive on 4 June as part of a global effort to immunize an additional 300 million children on top of the 760 million children Gavi has reached over the past two decades.  

Read the National Immunization Technical Advisory Groups (NITAG) summary of recommendations on dealing with the pandemic.