COVID-19 and the Crisis of Missed Immunizations

Season 3, episode 10 

COVID-19 and the Crisis of Missed Immunizations

In this episode we’ll explore why children are backsliding on regular immunizations, what the dire consequences could be and how you can make a difference.

Sound Mix: Chandra Bulucon

Episode Transcript: 

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[00:00:05.45] Hello, For Every Child podcast listeners, and welcome to our November episode. There's one word that's been on everyone's lips in 2021, thanks to COVID-19-- vaccines. This is so much so the case that, earlier this month, "vax" was declared the word of the year by the Oxford English Dictionary.

[00:00:29.51] Ironically, as vaccines dominated public discourse and millions of COVID-19 vaccines were put into the arms of people globally, there were some parts of the world where vaccines were absent, completely absent. And as a result, there have been devastating results for children. In this episode, we'll explore how COVID-19 created this specific crisis, what the dire consequences could be, and how you can make a difference. Here we go.

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[00:01:17.64] Earlier this year, a report was published by UNICEF and the WHO stating that a staggering 23 million children missed out on their basic vaccines through routine immunization services in 2020. Even as countries clamored to get their hands on COVID-19 vaccines, the data shows we've gone backwards on other vaccinations, leaving children at risk from devastating but totally preventable diseases, like measles, polio, meningitis.

[00:01:51.78] Multiple disease outbreaks would be catastrophic for communities and health systems already battling COVID-19, making it more urgent than ever to invest in childhood vaccination and ensure that every child is reached. To tell us more today, we have Annie Bodmer-Roy, the director of International Policy Programs at UNICEF Canada. Welcome, Annie.

[00:02:17.91] Hi, thanks so much for having me.

[00:02:20.16] Annie, before we dive into this conversation, I know you've done work in various parts of the world where you've seen the consequences of children not getting their routine vaccinations. Can you tell me a story about that?

[00:02:33.91] Yes, absolutely. I used to be based in Cote d'Ivoire, or Ivory Coast, in West Africa. And when I was living and working there, there was a conflict that erupted across the country following an election that was contested. And at that time, children and families-- and, in fact, entire communities-- were forced to flee their homes to find safe spaces away from the fighting. It was really difficult for a time there to continue to access all of our areas of operation across the country.

[00:03:07.53] For a lot of-- even our lifesaving programs like immunization, it was really challenging to ensure that there was safe access there. The level of desperation became very acute. And that was actually true for the people who had fled their homes, but also the people who were part of the armed groups and armed forces and their families. And at that time, our field offices were actually looted. And there was a storage of health supplies, including vaccines, that were looted.

[00:03:37.23] So the supplies, including the vaccine doses, which need to be kept at a certain temperature, they were stolen or damaged. And that had a direct impact on our initial ability to be able to scale-up health services as soon as it was safe to be able to do so. So even during the times where, operationally, it was very challenging, we needed to make sure that everything was in place so that as soon as we were able to negotiate access, we had all of the supplies we needed.

[00:04:01.80] And when that happened, there was a big concern there around, could we even provide immunization, even if access becomes safe? So there were a lot of different pieces interplay there. And there was a lot of risk to young children. And at the same time, we were also trying to negotiate access to one of the specific camps that I remember that had been set up for families that were forced to flee their homes. There was very little access to health services within the camp, and more young children were being born. And I remember a woman who had given birth on the side of the road trying to get to the camp.

[00:04:36.63] And we were very concerned at children's exposure to disease, including newborns and infants. That was compounded, all of that, by the lack of access to routine immunization. The good news at the end of the story, though, is that when we were able to resume our immunization campaigns, we were able to work with local radio stations to get the word out as to where families could bring their children to receive the vaccines and receive assurances that the locations were safe.

[00:05:06.51] It was a feeling of hope. And there's one woman that I met with her young child at one of our health and nutrition clinics. And I remember the smile on her face, [? at ?] [? bet. ?] When her child was given access to services and when they finally were able to secure that, it was-- from extreme desperation to hope that, wow, maybe my child will actually survive. That stayed with me.

[00:05:35.97] Well, that happened some time ago, but obviously this is still a problem. How did COVID-19 make this worse?

[00:05:44.19] One of the things that we've been afraid of as UNICEF since the beginning of the pandemic has been the risk of health systems and resources, in terms of time and funding and human capacity, being diverted to be able to support the COVID-19 response. Any country has a limited amount of capacity, and in a lot of these countries, health systems even before the pandemic were stretched.

[00:06:12.84] One of the reasons we were so scared was because we had actually seen this happen before with Ebola in West Africa. There were cases in countries that had measles outbreaks where children died from measles because the country was trying desperately to contain Ebola. We knew it had happened before, and we were very scared of it happening again. And what's been particularly devastating over the past year and a half is actually seeing your fears play out.

[00:06:44.28] It's been essential, of course, to ensure the provision of resources and capacity within national health systems to respond to COVID-19-- to stop the spread, to contain, to allow for testing, treatment and vaccines. All of that has been critical to saving lives. And it has come also at a cost, a devastating cost, to other areas of healthcare, including life-saving vaccination of children from preventable disease.

[00:07:12.32] And often I hear that children aren't directly impacted by COVID, or because children are younger, their symptoms are different, they're not as exposed to COVID-19, or when they get COVID-19, the direct health impacts aren't as devastating. And I think that only tells part of the story. What's become clear for us is that the level of resources and personnel countries have had to divert to support COVID has meant that children's health has suffered a direct consequence. And that is seen very clearly in the disruptions to immunization services.

[00:07:52.36] So what that means in practice is that, for example, vaccine clinics have had their hours reduced, or even in cases have had to completely close. And when services have, in some cases, stayed available, even at reduced hours, for example, or further locations, families may have been reluctant to seek healthcare because of the fear of transmission throughout the pandemic.

[00:08:14.29] And in other cases, families may have experienced challenging reaching services because, either some places have closed down-- they've had to go even further-- or there's been lockdown measures where they haven't been able to get to those places. And that's had a really direct impact on children. There are 23 million children who have missed out on basic vaccines in 2020 and last year. And that's an increase of 3.7 million more than the year before.

[00:08:42.43] What are the consequences of children continuing to miss out on routine vaccinations?

[00:08:48.95] Well, already so far this year we know that there have been millions of some of the world's most vulnerable children that have been, frankly, at risk of death. They've missed out on life-saving vaccines that protect them from preventable death, including DPT, but also measles, polio, tetanus-- these are all devastating and sometimes deadly diseases for children.

[00:09:10.09] And one of the areas that we're very concerned about is fragile and crisis settings with very challenging operational contexts, where even before the pandemic, it's very difficult to get vaccines to that last mile. And UNICEF has built up many years of experience in this. And we're able to successfully do that work thanks to the dedication of our teams on the ground.

[00:09:31.63] But we have analysis that shows that in countries like this, like Yemen, Venezuela, Pakistan, Chad, that countries like these that have experienced disease epidemics, that have experienced conflict, or economic shocks, or climate shocks, even for a short period of time, we have seen that many were not able to return to pre-shock immunization coverage levels without significant and urgent action. So there is really a lot of help that's required to get countries back on track-- and particularly countries, where we're already starting to see disease outbreaks, like Yemen, for example.

[00:10:09.34] What's UNICEF doing to help support vaccinations getting on track?

[00:10:14.62] So countries are working to recover lost ground from COVID-19. Health systems are working furiously around the clock to continue to respond to COVID-19 because, of course, in many, many countries, the rates are still extremely high and disruptions continue to health systems. And so UNICEF is working with our partners at global-level but also at country-level to strengthen immunization systems, helping build them back up again so that we can prevent further loss of life amongst vulnerable children.

[00:10:45.82] And I should say too that not all children are in the same situation. I spoke earlier about conflict settings and crisis settings, areas that are particularly vulnerable to outbreaks of disease and the impact that can have, particularly when it's not contained, like measles and polio, where those are the vaccine-preventable diseases that tend to re-emerge first when immunization systems are not functioning well. Those spread very, very quickly, and those can cause explosive outbreaks unless children are vaccinated.

[00:11:15.62] So there are specific diseases that we're particularly concerned about. And then I just wanted to highlight too that girls are particularly affected in a very specific way because vaccinations against human papillomavirus, HPV, protect girls against cervical cancer later in life. Those have also been affected. And they've been particularly impacted by the school closures that we've seen because schools are often a platform for immunization.

[00:11:43.18] And so across the countries that have introduced the HPV vaccine to-date, we've seen more than 1.5 million girls miss out on that vaccine in 2020. So that's a particular concern for us as well. So as we're looking to respond and help countries build up their health systems and their immunization systems, we're also really looking to ensure that those children who are at most risk because of their exclusion already in society and in the context in which they live, that those children don't fall through the cracks.

[00:12:18.15] But we're also just across the board working with our colleagues and partners in ministries of health to ensure that countries can safely deliver routine immunization programs during the COVID-19 pandemic. so ensuring that health workers are equipped with PPE, for example, so they can continue that work without putting themselves at further risk. And then also working directly with health workers at the community-level and other community leaders to communicate with parents and families so that there's a clear understanding of the importance of vaccinations.

[00:12:48.15] Of course, that's the work that we've been doing through COVID-19 in relation to the COVID-19 vaccines, but that also very much is critically important for routine immunizations for children. Mainly, we can't allow the fight against COVID-19 to come at the expense of the fight that we still have to keep going on for children, to save children's lives. If we focus all of our attention on one global pandemic and it comes at the expense of children's lives, I don't think that that's something we can live with. We can't afford for that to happen, and we can't sacrifice children's lives.

[00:13:29.43] Thank you, Annie.

[00:13:30.68] Thanks, David.

[00:13:33.62] As you just heard, children are paying the biggest price when it comes to backsliding on vaccines through no fault of their own. There's something you can do to ensure that children around the world get the immunizations they need to allow them to have what every child deserves-- a safe, healthy, and happy childhood. To find out more about how you can play a role in vaccinating children against life-threatening diseases, please visit unicef.ca and consider making a donation today. That brings us to the end of our episode. Thank you for listening.

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