Vaccinating the world's children: the post-pandemic catch up

Season 4, episode 5 

Vaccinating the world's children: the post-pandemic catch up

It’s 2023 and 1 in 5 children is still not protected against vaccine preventable diseases, according to UNICEF’s latest State of the World’s Children report. In this episode of the For Every Child podcast, we mark World Immunization Week, and look at what it would take to build back immunity following the pandemic – globally and in Canada.

Host: Saara Chaudry

Guests: Lily Caprani, Head of Global Advocacy (Health, Nutrition, Climate), UNICEF

Dr. Vinita Dubey, Associate Medical Officer of Health at Toronto Public Health

Producer: Sara Faruqi

Composed and mixed by: Chandra Bulucon

Episode Transcript: 

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[00:00:10.99] That's the sound of nurse Irwan Hakim informing villagers on the remote Indonesian island of [INAUDIBLE] Immunize your children today, his message says. He encourages parents to get their children's routine vaccinations done against preventable diseases such as measles and rubella. Last year, only 4% of the island's children were fully immunized. Today, thanks to Irwan and his team, over 73% are immunized. Children like eight-year-old [INAUDIBLE]

[00:00:42.25] She showed up with a parent at a local school to get vaccinated once they heard Irwan's call. A slide in routine vaccinations during the pandemic is a worrying statistic. With health systems pushed to their limits globally, routine immunization for children dropped significantly. Compounded by the pandemic, today, one in five children worldwide are not fully protected against vaccine preventable diseases.

[00:01:11.03] And UNICEF is raising the alarm with its latest, state of the world's children report released this month, which focuses on missed vaccinations for children worldwide. Catch up and recovery is needed urgently to vaccinate children and to avoid sliding back further, and greater effort is needed to reach children who have historically been left behind.

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[00:01:46.20] Hello, and welcome to the For Every Child podcast. I'm your host Saara Chaudry, and in this episode, we will look at how the pandemic has impacted immunization for the world's children. I'm joined today by Lilly Caprani, UNICEF's global head of advocacy for health, nutrition, and climate. Hi, Lily. Thanks for joining us. This year, the state of the world's children is focusing on vaccinations. So can you tell us some of the major challenges we're facing in 2023 in terms of getting children immunized?

[00:02:22.59] Yeah, this is the first time in many years that UNICEF has done a real global stocktake of the state of immunization across the world. It's the most comprehensive analysis that UNICEF's ever done on the state of vaccination of children, and we've done it for a number of reasons. We know that vaccination is one of the best ways to save children's lives from vaccine preventable diseases and protect them from childhoods being interrupted by illness, disability, and all of the illness impacts on their education. It's by far the best value thing we can do for children.

[00:03:01.15] Right, and how did the COVID-19 pandemic play a role in all of this. Well, over the course of the last generation, we made enormous progress around the world in reaching more and more children with life saving childhood vaccines. And in fact, 4 and 1/2 million children every year, they have their lives saved because they're immunized. So the picture for the last generation has been one of enormous progress and really positive.

[00:03:29.70] But, of course, when the pandemic struck, it caused enormous disruption to health services, and a lot of families in every country in the world were losing access to the normal health care services and clinics that they would go to. And that's had a huge knock-on impact on the number of children who got their routine childhood vaccines at the time they would have normally got them.

[00:03:49.87] So we know that over the course of that three-year period, around 67 million children missed out on all of their vaccines. That's basic stuff like measles and diphtheria and polio, and they're now unvaccinated, which means that they are very vulnerable. And, of course, it also puts at risk communities because these are really highly transmissible infectious diseases that can spread very quickly when a community isn't protected.

[00:04:18.16] So we've been seeing a lot in the headlines that COVID-19 created a gap in vaccinations and vaccine delivery. What do you think can be done to fill that gap, and what is UNICEF doing about it?

[00:04:30.00] Yeah, health services were so disrupted throughout the pandemic that obviously, the number one thing is to just fully restore all health systems and make sure that health services have the staff that they need, the money that they need, and also to get outreach back to those families that missed out. So we need to do more than simply go back to business as usual and have a concerted effort of catching up.

[00:04:53.13] That means reaching out to all of those children who missed out during the three years because they may reach the age now where they wouldn't normally be caught in the system. We're going to have to go and find them and bring them back into the system to make sure that their immunity levels are what they should be.

[00:05:09.33] We're already seeing some of the negative consequences of not doing that with vaccine preventable diseases outbreaks. Measles and polio are starting to come back, and that's a really worrying sign. So there's an urgent need to run large scale intensive catch up campaigns in all of the countries that are affected by this backsliding.

[00:05:29.19] So let's touch upon vaccine confidence. There have been worrying signs of misinformation and hesitancy even before the pandemic on vaccinations. So why is this?

[00:05:41.31] During the pandemic, the number of people who were thinking about vaccines, asking questions, doing research, and discussing what the benefits of vaccination are really increased, especially online. So in a lot of online spaces and all the social media platforms and even among those of us on WhatsApp groups or in big-text groups, the volume of the conversation, the number of discussions taking place about vaccines went much, much higher.

[00:06:10.53] And in a way, that's a good thing because knowledge and awareness was higher, but it also meant that some very organized-- a small number of highly organized anti-vaxx actors have also taken advantage of that situation. And the number of conversations where there's a lot of misinformation or sowing the seeds of doubt about what the science says about vaccines also increased. And we've seen that happening over the whole course of the pandemic, and it's continuing, and that's very worrying.

[00:06:44.19] Another thing we've observed from data that was collected asking families the extent to which they think it's important to vaccinate children, and we're not talking about COVID vaccines. We're talking about children's vaccines. Asking that question before the pandemic and after, we can see a change, and there's a worrying signal in some of the surveys that suggests even though most families, a very, very high proportion, still consider it very important. That number is coming down.

[00:07:17.89] We've seen a decline in the number of parents that say, yes, I think it's important to vaccinate my child. And we don't know exactly why that is, but it's something very concerning that we need to keep an eye on and better understand and understand the ways to make sure that those same families who have questions about vaccines are getting accurate information and making sure that they can find out what the real benefits are for their children and make informed choices.

[00:07:45.03] Speaking of the real benefits, as you just said, can you explain this a bit more in today's context?

[00:07:51.09] Yeah, of course, well, thinking about what are the benefits of vaccines is, if you-- I mean, very highly contagious illnesses like measles can spread like wildfire when you have a concentration of unvaccinated people in any one community. And I think perhaps we've forgotten how dangerous some of these illnesses are.

[00:08:14.46] There's perhaps a bit of a risk of complacency, of taking it for granted because it's so normalized that we expect our children when they're very young and they're going to start school, to receive all of these basic vaccines. It's just been the norm for a generation that we've almost forgotten what it used to be like when it was commonplace to see children in iron lungs who were suffering from polio, suffering lifelong disabilities.

[00:08:39.87] It's only a generation ago, and yet we so quickly forget just what the stakes are for children, and not only directly for their health, lives, and well-being but for the communities around them. If we don't protect children and communities against illness, and there are these large widespread outbreaks, it has a huge impact on the whole family, especially on caregivers and mothers having to take time off work to care for sick children, missing school, missing learning.

[00:09:07.71] It has these catastrophic costs beyond the immediate health of the child. And if we've learned anything from the pandemic, it should be exactly this, that it's a public health, good for everyone to vaccinate children. Because when we have large-scale epidemics and outbreaks, it can literally close down whole communities and countries. So it's in everyone's interest to tackle this problem and make sure that children get the protection they deserve and that the communities all benefit from it.

[00:09:36.96] What lies ahead when it comes to ensuring every child is immunized against vaccine preventable diseases?

[00:09:43.62] UNICEF is the world's biggest vaccinator of children. We vaccinate nearly half the world's children every single year, and that means we've got enormous infrastructure and expertise on how to get the vaccines to communities and that could be anything from helping the governments and the health systems get hold of the actual vaccines themselves through the supply chain, making sure that the cold chain works.

[00:10:07.05] And the cold chain is this system of, how do you keep a product like a vaccine refrigerated even when you've got to reach very remote places. It could be that you're going to an urban informal settlement or a refugee camp or across rivers and lakes and ravines or into desert areas and reaching these really remote communities, island states, for example. And that's part of what we do every day as our huge group of vaccinators who are out there with great expertise on how to reach these communities.

[00:10:38.71] It's also making sure those communities are aware and have knowledge and understanding of what is available to them. We find that a big part of the job is that families can understand that they have the right to ask for this for their children, that they can access these basic commodities and services and protect their children. So there's a lot of outreach involved, a lot of community engagement, and a lot of making available the kind of information they need to make those choices for their families.

[00:11:05.59] So we can use all of those tools in our toolbox to now recover the levels of vaccination of children, and we need to go a little bit further. One of the harms done by the pandemic is it really showed that some health systems that have less money in them are less-- are more fragile, less well resourced, have fewer available trained staff. They were crippled by the pandemic, and we need to help countries to invest in the basic health systems.

[00:11:35.53] The primary health care that we all rely on for the basics. So we're also working to try and strengthen that health system at the point of delivery, not just to be able to recover levels of vaccination now but also to protect against potential collapse when there's another health emergency in the future so that we can prepare for-- hopefully, there won't be another pandemic, but we need to be prepared to make sure that next time there are outbreaks and epidemics, we can contain them quickly.

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[00:12:05.52] Thank you so much for your insights, Lily. As Lily said, at UNICEF, we've been working with governments and communities to reach all children with the proper vaccinations needed to protect them. Let's travel to Ecuador and meet Maria Katakwango, a community health volunteer and one of 500 Indigenous volunteers trained by UNICEF to reach remote communities in the region.

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[00:12:36.01] [NON-ENGLISH SPEECH]

[00:12:44.62] I was born to help the people from my community, says Maria. I make home visits to children and pregnant women. When I see there are children who have missed vaccinations, I inform the local health center so they can bring them up to date with their vaccines and checkups, she explains.

[00:13:11.65] In the community of [? Kayambe, ?] UNICEF-supported volunteers have helped immunize 8,200 children under the age of five against deadly diseases. Families can now access health services quickly, making it one of Ecuador's most successful models of community outreach. Maria is just one example of so many health workers and volunteers who ensure children are fully protected against deadly diseases.

[00:13:41.72] From hearing about the global perspective on vaccine reach, let's move closer to home. I have here with me Vinita Dubey, an associate medical officer of health at Toronto Public Health. Hi, Vinita, thanks for joining us. So as we heard from Lily, routine immunization has been impacted globally due to the pandemic. Is this the case in Canada as well?

[00:14:05.10] So we absolutely know that children and parents had difficulty getting in for routine appointments during the pandemic. And in terms of how many missed immunization opportunities have occurred for childhood, I mean, it's not just childhood vaccines. It's also those school-based vaccines that actually had a very big impact. Because when we are not in schools, we actually can't offer those school-based vaccines. So there are certainly a number of reports that have come out documenting some of this.

[00:14:40.19] It's very easy to show how little of the school-based vaccines we gave through the pandemic and how much catch we need to do. Because that data is readily collected by public health, especially in Ontario. For some of those routine childhood vaccines, we don't have a registry. We don't have a national registry. We don't have a provincial registry. So it's hard really to keep track at an individual and population basis on how far behind we are. But there's no question, as with many things COVID, we have a lot of catch up to do.

[00:15:17.15] Has vaccine confidence been impacted in Canada, and if so, why is that?

[00:15:22.28] Yeah, it's something that we've actually been trying to keep an eye on because we know-- we spoke a lot about it through COVID, and we know that there was an awful lot of misinformation about COVID vaccines. There was an urgency when you were eligible to get vaccinated. We were in the midst of all of these variants spreading, and in some ways, parents felt like it was a rushed decision. They didn't get a chance to understand, well, how safe are these vaccines? How long have they been around for? Does my child need it right now? Is it better to wait?

[00:15:55.43] And so some of those conversations have led to some of the vaccine hesitancy that we saw through COVID. Now, have some of those questions then translated into vaccine hesitancy post COVID for routine immunizations? I don't have any data on that right now for where I work. But what I can tell you is, before COVID, we actually started to see hints of reduced vaccine confidence in our city.

[00:16:24.48] And so I mentioned to you that in Ontario we have the Immunization School Pupils Act, and so this is a legislative act that requires students to be vaccinated against routine childhood immunizations or have a valid exemption. And there are two kinds of exemptions you can get. One is a medical exemption, and the other is a philosophical exemption.

[00:16:47.48] And before the pandemic, we had actually shown that over a 10 plus year period, that philosophical exemption rate, while small, had a slow and steady increase to it. And so I think that's signs that even before COVID, vaccine confidence was eroded even in our own city and province, and it's to be expected. We saw, in Europe, outbreaks of measles before the pandemic because many parents there had chosen not to vaccinate their children.

[00:17:23.28] So whether the pandemic had a worsening impact on vaccine confidence or not, it's hard to say right now. But we had this occurring even before COVID, and so it's something that we actually really need to continue to keep an eye on and to address. I think the one thing that I can say, though, is because of the pandemic, we actually know how we can address it. Because I think we've been able to do a very good job through the pandemic to address misinformation, to address a lack of confidence, and get people vaccinated.

[00:18:04.40] Right, and you said that we've been able to do a good job in addressing misinformation. So can you elaborate a bit more on this?

[00:18:11.37] We know that social media was a very common way that many people were getting information, and they weren't necessarily trusting some of the health care providers or health care institutions or government. And so how can you combat that? Well, we had a very innovative approach in the city that I work in, Toronto, where we had a team of over 700 community ambassadors that were hired to literally address vaccine hesitancy at the ground level.

[00:18:43.38] And it meant talking to people in their own languages, reflecting them that they were part of their own communities, addressing their questions, steering them to proper resources, and giving them time to really be able to ask their questions and have them answered as well.

[00:19:03.69] What would a road to recovery for routine immunization look like for children in Canada?

[00:19:09.12] I think the first thing that we have to recognize is that it will take time. It took us three years of the pandemic to get to this place where we need to catch up, and so we can't expect the catch up to happen within a month or six months or even within a year. So I think that's the first point is, let's be realistic about it. We need to then also recognize that we're going to need more resources for catch up. It's not just, OK, we're back to normal now, go see your doctor, and get it.

[00:19:38.58] That may not necessarily work to get everyone caught up. And if you think about vaccines that were missed in schools, how do you get those vaccines to those individuals. We're actually facing this right now. So the students who are today in grade 9 and 10, they did not get a chance to finish or start the three vaccines that we give in grade 7 and 8, the hepatitis B, human papilloma virus, and meningococcal vaccines.

[00:20:04.92] Because of the pandemic, schools were shut down when they were in grade 7 and 8 in those years. And so we've now gone back into schools this September. Our grade 7 and 8s have had an opportunity to get the vaccines in schools, and they're coming forward. They're getting vaccinated, and so it's the grade 9 and 10 now that are lagging behind.

[00:20:26.97] But we can't just go back into school to vaccinate them because that-- we typically don't go into high schools to vaccinate these students. And even if you go to high school on one day, are you going to catch all of them on one day? And the answer to that is no. So we have to be innovative and provide many opportunities and many reminders, frankly, to these students so that they can get these missed but very important life saving vaccines.

[00:20:56.23] Thank you so much, Vinita. As we heard from both Vinita and Lily, we need to get back on track to ensure every child is vaccinated and protected from preventable diseases. As the state of the world's children report highlights, reaching the goal of vaccinating every child won't be easy. It will require commitment from governments. It will require making better use of data, improving outreach and awareness.

[00:21:22.98] It will require strengthening cold chains and conversations on building resilient health systems, and it will force societies and communities to examine fundamental values because children from marginalized communities are the least likely to be vaccinated. Achieving this goal will not be easy and getting back on track will be challenging, but the achievements of the past 80 years should give us hope. Time and time again, the world has made remarkable progress in immunization, often in the most difficult and challenging circumstances. Thank you.

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