By Saeed Shah in Islamabad and Joe Parkinson in Johannesburg
Wall Street Journal, April 13: The coronavirus threat has suspended vaccination campaigns against many other diseases in the developing world, raising fears that other epidemics could surge in the poorest nations.
With developing nations now engaged in commercial shutdowns and enforced social distancing measures, health services are pausing mass vaccination drives for polio, measles and other deadly diseases. Such campaigns risk spreading the new coronavirus, the World Health Organization warns.
All polio vaccination drives—part of a decades long effort to wipe out the disease—have now been suspended by the Global Polio Eradication Initiative. Even routine immunization programs, often carried out in hospitals and clinics, have been disrupted or halted. Experts worry the lockdowns, while saving lives from Covid-19, could multiply death and suffering from other diseases in developing countries.
“When people are unprotected through vaccines, diseases like measles, cholera, meningitis, yellow fever and polio can cause devastating epidemics,” said Katherine O’Brien, Director of Immunization, Vaccines and Biologicals at WHO.
“This would not only be catastrophic for those who become ill, but also for health systems—especially those already battling Covid-19. The worst impacts will be felt in the poorest countries, where children are most at risk from these diseases.”
The highest-profile vaccination effort to suffer could be polio, where a 40-year-long effort to wipe the disease from the face of the earth had come close to success. Pakistan and Afghanistan were the last major hurdles. Measles has also been dramatically reduced by years of vaccination drives.
Outbreaks of those two diseases in particular could spiral into epidemics while vaccination efforts pause, experts warn.
Health workers often go door to door, or call large numbers to hospitals and clinics to receive vaccines, both of which risk spreading the coronavirus. School closures have disrupted school-based vaccinations, such as the HPV inoculation given to girls to protect against cervical cancer. Between 2 and 3 million lives are saved annually from vaccinations, the WHO says, which has urged countries to continue routine immunizations where possible.
In countries across Africa, from Burkina Faso to Uganda, health officials are sounding the alarm as social and economic investments deployed to fight Covid-19 divert resources from nationwide vaccination campaigns.
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Health professionals are particularly worried about countries fighting a measles epidemic, such as the Democratic Republic of Congo, where the world’s largest outbreak has so far killed an estimated 6,500 children—far more than a continuing Ebola outbreak—and sickened 340,000.
Edouard Biegbeder, Unicef representative in the country, said the response to coronavirus must be carefully calibrated to prevent it having a punishing effect on children.
“The knock-on effects are very worrying. Because COVID appears to be targeting the elderly, we may have more children dying of preventable disease than of COVID,” Mr. Biegbeder said.
Among the top causes of death in Africa are many illnesses that can be prevented by vaccines, such as tuberculosis, pneumonia and rotaviruses—the most common cause of severe diarrheal disease in young children.
The predicted surge of coronavirus cases across Africa, where the number of confirmed infections and deaths significantly lags behind Asia and Europe, reveals the agonizing choice for the region’s policy makers. Lockdowns across the continent are already sharply reducing the number of children attending clinics for vaccines.
Already, postponements and interruptions in vaccination shipments mean at least 13.5 million people in 14 of the world’s least-developed countries won’t be protected against diseases like measles, polio and human papillomavirus (HPV), with millions more likely to follow, according to the Vaccine Alliance.
“These diseases were major killers in the past,” said Seth Berkley, chief executive of Gavi, the Vaccine Alliance, which unites developing countries and donors. “If we had a prolonged period of not giving vaccines, you might see these diseases coming roaring back.”
The effects are being felt in Uganda, where a lockdown on public transport has already sharply disrupted vaccinations. Some clinics around the capital of Kampala say they have registered a drop of between 60% and 80% in the number of children arriving up for weekly vaccination appointments.
Uganda has one of the world’s most stringent lockdown measures. It bans private cars, motorcycles and public vans from transporting people, including children and even expectant mothers unless they have a government exemption permit.
“Just a few mothers are showing up to immunize children,” said Stella Nanteza, a nurse at Kira health center, near the Ugandan capital. “Those coming are mainly mothers with children less than three months.”
Even when the coronavirus crisis relents, systems for tracking and catching up with missed children are much less robust in developing countries. And many health workers could die battling coronavirus.
The polio campaign has come tantalizingly close to achieving its aim, with polio cases down 99.9% since the drive started in 1988, when the disease was paralyzing 1,000 children a day in 125 countries. Success would make polio only the second disease to be eliminated, after smallpox back in 1980. Billions of dollars have been invested internationally in the effort, including by the United Nations, Rotary International and the Bill and Melinda Gates Foundation.
There were just 175 cases of wild polio virus in 2019, mostly in Pakistan but also in Afghanistan, the only two countries where it remains endemic. And that was after Pakistan had suffered local setbacks in its polio fight last year—mostly due to fierce propaganda against the vaccine—but the country had been hoping to fight back in 2020.
A quarter of a million health workers in Pakistan go door to door to vaccinate children against this crippling disease, which requires the delivery of many doses to children over their first five years to build their immunity as malnourishment makes them more particularly vulnerable.
While on this mission, dozens of polio workers have been killed over the last decade by Islamic militants, who see them as spies and the vaccine as a conspiracy to sterilize Muslims.
Continuing the campaign now would place vaccinators and the communities at risk from coronavirus, said Rana Safdar, who heads Pakistan’s polio program. The polio infrastructure has been redirected to battling coronavirus, including for disease surveillance, data management and public information.
“Our polio battle is very important to us as a nation and for the entire globe,” Dr. Safdar. “We have suffered a blow.”