“The legacy of COVID-19 must not include the global resurgence of other killers like measles and polio.”Dr. Seth Berkley, GAVI
“We know that children are missing out on critical vaccines. Vaccination campaigns have been postponed following social distancing measures, increasing the risk of disease outbreaks.”Dr. Kunihiko Hirabayashi, UNICEF
One of the less publicised consequences of the pandemic is its impact on the delivery of important health services, including immunisations, to populations residing in low-and-middle income countries, says The Lancet. It is critical and very worrying.
Multiple research groups indicate that COVID-19 has had a massive impact on lower income countries as the threat of other disease outbreaks becomes reality. ReAct Group published that the COVID-19 pandemic has meant that vaccination efforts that help control other diseases may be put on hold. And this may lead to increased strain on health systems, morbidity and mortality due to vaccine-preventable disease and increases in antibiotic resistance.
In South Africa alone, 28,000 healthcare workers have been deployed to vulnerable communities for COVID-19 screening, swabbing and testing, leaving immunisation clinics short of staff. Vaccine programmes are virtually coming to a halt. In addition, families afraid of the novel virus are uncertain and unclear about exposure and have in their hesitation avoided frequenting health clinics for routine vaccinations. Follow-up programmes are desperately necessary, in order for those immunisations which have been disrupted, to be implemented so that they can start again when the COVID-19 pandemic reduces workload on healthcare workers.
“As a result of lockdown restrictions, children are suffering increasingly from preventable infectious diseases, including TB and measles, due to missed vaccinations”, say several infectious disease, public health specialists and demographers at the University of Cape Town.
HIV & Tuberculosis
In South Africa, close to 200,000 people of all ages die every year from TB and HIV. The Stop TB Partnership estimates that a three-month lockdown could cause an additional 1.4 million TB deaths globally from 2020 to 2025. If we extrapolate to South Africa, this could result in an additional 60,000 deaths due to TB alone. In the past two months, thousands of patients whose chronic conditions would have been managed electively in clinics and with planned interventions have now started presenting acutely with more severe organ failure because of a lack of elective clinical services.
Researchers have warned that missing treatments could lead to people developing resistance to medications and set back treatment campaigns by years. Surveys by the healthcare organisation Right to Care and the Africa Health Research Institute (AHRI) show declines of about 50% in medication collection during lockdown. Right to Care CEO professor Ian Sanne said only between 30% and 50% of patients are collecting medication during the lockdown.
He said the lockdown could lead to people becoming resistant to HIV medication, and in the long term developing complications. One of the main reasons patients miss appointments is that they are afraid of being exposed to Covid-19. “We need to carefully reopen certain portions of the healthcare system, where the correct Covid-19 screening and protection takes place, so routine health services can continue.
The United Nations World Food Programme (WFP) estimates that the number of young children suffering from this life-threatening form of under-nutrition could increase by 20 percent as a result of the COVID-19 pandemic. That is an additional 10 million of the world’s children that may become acutely malnourished.
Children, whose rights should be prioritised, are suffering increasingly from malnutrition and preventable infectious diseases, including TB and measles, due to missed vaccinations. We must consider the possibility that the continued economic lockdown, increased poverty, decreased access to health services and diversion of public health resources to focus on Covid-19, may cause greater loss of life.
Zimbabwe to Central African Republic
The Vaccination Alliance reports that 14 of their vaccination campaigns against polio, measles, cholera, HPV, yellow fever and meningitis have been postponed, as have four national vaccine introductions. Collectively, these would have immunised more than 13.5 million people. And this figure is expected to rise substantially.
Measles outbreaks are currently ongoing in several countries, including the Democratic Republic of the Congo (DRC) and the Central African Republic. The DRC outbreak is currently the world’s largest, affecting over 300,000 people since it started in 2019, with more than 6,000 deaths – nearly three times as many as resulted from the Ebola outbreak in the country.
The partial lockdown in the main urban areas in countries such as Ghana and Zimbabwe has triggered an exodus of people, especially those living in informal settlements, back to their hometowns and other rural areas. As a result, their children are likely to miss their scheduled immunisations, resulting in reduced coverage. The large number of people returning to more rural areas has also put a strain on local health facilities that are less well-equipped to handle an influx of people.
The temporary interruptions in immunisation services while not ideal, are unavoidable, as we must contain the spread of Covid-19. It will be important to seek immunization for children as soon as services resume. Currently there is no vaccine for available for Covid-19 – research is ongoing.