Tag: WHO

At least 80 million children at risk as COVID-19 disrupts routine vaccination effort

Measles in India
A newborn receives a routine vaccination at an immunization site, in Ghaziabad, Uttar Pradesh India.

COVID 19 is disrupting life-saving immunization services around the world, putting millions of children – in rich and poor countries alike – at risk of diseases like diphtheria, measles and polio.

This stark warning comes from the World Health Organization, UNICEF and Gavi, the Vaccine Alliance ahead of the Global Vaccine Summit on 4 June, at which world leaders will come together to help maintain immunization programmes and mitigate the impact of the pandemic in lower-income countries.

According to data collected by the World Health Organization, UNICEF, Gavi and the Sabin Vaccine Institute, provision of routine immunization services is substantially hindered in at least 68 countries and is likely to affect approximately 80 million children under the age of 1 living in these countries.

Since March 2020, routine childhood immunization services have been disrupted on a global scale that may be unprecedented since the inception of expanded programs on immunization (EPI) in the 1970s. More than half (53%) of the 129 countries where data were available reported moderate-to-severe disruptions, or a total suspension of vaccination services during March-April 2020.

“Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“Disruption to immunization programmes from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles.

“At the 4 June Global Vaccine Summit in London, donors will pledge their support to Gavi, the Vaccine Alliance, to sustain and accelerate this lifesaving work in some of the most vulnerable countries. From the bottom of my heart, I urge donors to fully fund the Alliance. These countries, these children especially, need vaccines, and they need Gavi.”

The reasons for disrupted services vary. Some parents are reluctant to leave home because of restrictions on movement, lack of information or because they fear infection with the COVID-19 virus. And many health workers are unavailable because of restrictions on travel, or redeployment to COVID response duties, as well as a lack of protective equipment.

“More children in more countries are now protected against more vaccine-preventable diseases than at any point in history,” said Dr. Seth Berkley, Gavi CEO.

“Due to COVID-19 this immense progress is now under threat, risking the resurgence of diseases like measles and polio. Not only will maintaining immunization programmes prevent more outbreaks, it will also ensure we have the infrastructure we need to roll out an eventual COVID-19 vaccine on a global scale.”

Transport delays of vaccines are exacerbating the situation. UNICEF has reported a substantial delay in planned vaccine deliveries due to the lockdown measures and the ensuing decline in commercial flights and limited availability of charters.

To help mitigate this, UNICEF is appealing to governments, the private sector, the airline industry, and others, to free up freight space at an affordable cost for these life-saving vaccines. Gavi recently signed an agreement with UNICEF to provide advance funding to cover increased freight costs for delivery of vaccines, in light of the reduced number of commercial flights available for transport.

“We cannot let our fight against one disease come at the expense of long-term progress in our fight against other diseases,” said Henrietta Fore, UNICEF Executive Director.

“We have effective vaccines against measles, polio and cholera. While circumstances may require us to temporarily pause some immunization efforts, these immunizations must restart as soon as possible, or we risk exchanging one deadly outbreak for another.”

Next week, WHO will issue new advice to countries on maintaining essential services during the pandemic, including recommendations on how to provide immunizations safely.

Mass immunization campaigns temporarily disrupted

Many countries have temporarily and justifiably suspended preventive mass vaccination campaigns against diseases like cholera, measles, meningitis, polio, tetanus, typhoid and yellow fever, due to risk of transmission and the need to maintain physical distancing during the early stages of the COVID-19 pandemic.

Measles and polio vaccination campaigns, in particular, have been badly hit, with measles campaigns suspended in 27 countries and polio campaigns put on hold in 38 countries.

At least 24 million people in 21 Gavi-supported lower-income countries are at risk of missing out on vaccines against polio, measles, typhoid, yellow fever, cholera, rotavirus, HPV, meningitis A and rubella due to postponed campaigns and introductions of new vaccines.

In late March, concerned that mass gatherings for vaccination campaigns would enflame transmission of COVID-19 WHO recommended countries to temporarily suspend preventive campaigns while assessments of risk, and effective measures for reducing COVID virus transmission were established.

WHO has since monitored the situation and has now issued advice to help countries determine how and when to resume mass vaccination campaigns. The guidance notes that countries will need to make specific risk assessments based on the local dynamics of COVID-19 transmission, the health system capacities, and the public health benefit of conducting preventive and outbreak response vaccination campaigns.

Based on this guidance, and following growing concerns about increasing transmission of polio, the  Global Polio Eradication Initiative (GPEI), is advising countries to start planning for the safe resumption of polio vaccination campaigns, especially in polio high-risk countries.

Despite the challenges, several countries are making special efforts to continue immunization. Uganda is ensuring that immunization services continue along with other essential health services, even funding transportation to ensure outreach activities. And in Lao PDR, despite a national lockdown imposed in March, routine immunization in fixed sites continued with physical distancing measures in place.

Pictures: WHO

WHO: Substantial investment needed to avert mental health crisis

The COVID-19 pandemic is highlighting the need to urgently increase investment in services for mental health or risk a massive increase in mental health conditions in the coming months, according to a policy brief on COVID-19 and mental health issued by the United Nations today.

“The impact of the pandemic on people’s mental health is already extremely concerning,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Social isolation, fear of contagion, and loss of family members is compounded by the distress caused by loss of income and often employment.”

Depression and anxiety are increasing

Reports already indicate an increase in symptoms of depression and anxiety in a number of countries. A study in Ethiopia, in April 2020, reported a 3-fold increase in the prevalence of symptoms of depression compared to estimates from Ethiopia before the epidemic.

Specific population groups are at particular risk of COVID-related psychological distress. Frontline health-care workers, faced with heavy workloads, life-or-death decisions, and risk of infection, are particularly affected. During the pandemic, in China, health-care workers have reported high rates of depression (50%), anxiety (45%), and insomnia (34%) and in Canada, 47% of health-care workers have reported a need for psychological support.

Children and adolescents are also at risk. Parents in Italy and Spain have reported that their children have had difficulties concentrating, as well as irritability, restlessness and nervousness. Stay-at-home measures have come with a heightened risk of children witnessing or suffering violence and abuse. Children with disabilities, children in crowded settings and those who live and work on the streets are particularly vulnerable.

Other groups that are at particular risk are women, particularly those who are juggling home-schooling, working from home and household tasks, older persons and people with pre-existing mental health conditions. A study carried out with young people with a history of mental health needs living in the UK reports that 32% of them agreed that the pandemic had made their mental health much worse.

An increase in alcohol consumption is another area of concern for mental health experts. Statistics from Canada report that 20% of 15-49 year-olds have increased their alcohol consumption during the pandemic.

Mental health services interrupted

The increase in people in need of mental health or psychosocial support has been compounded by the interruption to physical and mental health services in many countries. In addition to the conversion of mental health facilities into care facilities for people with COVID-19, care systems have been affected by mental health staff being infected with the virus and the closing of face-to-face services. Community services, such as self-help groups for alcohol and drug dependence, have, in many countries, been unable to meet for several months.

“It is now crystal clear that mental health needs must be treated as a core element of our response to and recovery from the COVID-19 pandemic,” said Dr Tedros Adhanom Ghebreyesus. “This is a collective responsibility of governments and civil society, with the support of the whole United Nations System. A failure to take people’s emotional well-being seriously will lead to long-term social and economic costs to society.”

Finding ways to provide services

In concrete terms, it is critical that people living with mental health conditions have continued access to treatment. Changes in approaches to provision of mental health care and  psychosocial support are showing signs of success in some countries.

In Madrid, when more than 60% of mental health beds were converted to care for people with COVID-19, where possible, people with severe conditions were moved to private clinics to ensure continuity of care. Local policy-makers identified emergency psychiatry as an essential service to enable mental health-care workers to continue outpatient services over the phone. Home visits were organized for the most serious cases.

Teams from Egypt, Kenya, Nepal, Malaysia and New Zealand, among others, have reported creating increased capacity of emergency telephone lines for mental health to reach people in need.

Support for community actions that strengthen social cohesion and reduce loneliness, particularly for the most vulnerable, such as older people, must continue. Such support is required from government, local authorities, the private sector and members of the general public, with initiatives such as provision of food parcels, regular phone check-ins with people living alone, and organization of online activities for intellective and cognitive stimulation.

An opportunity to build back better

“The scaling-up and reorganization of mental health services that is now needed on a global scale is an opportunity to build a mental health system that is fit for the future,” said Dévora Kestel, Director of the Department of Mental Health and Substance Use at WHO.

“This means developing and funding national plans that shift care away from institutions to community services, ensuring coverage for mental health conditions in health insurance packages and building the human resource capacity to deliver quality mental health and social care in the community.”