The coronavirus outbreak could lead to a resurgence of childhood diseases such as measles and polio, as the pandemic has shut down routine vaccination schedules and disrupted supply chains, experts have warned.
While the unprecedented interventions introduced to stem the Covid-19 pandemic should prevent other disease outbreaks in the short term there is a real concern about a potential explosion of infectious, preventable illnesses when life returns to “normal”.
Across the globe, planned efforts to vaccinate children against childhood diseases, including measles and polio, have already been suspended.
Dr Robin Nandy, global chief of immunisation at Unicef, told the Telegraph that the UN agency has paused all routine and emergency vaccinations because of concerns that they could further the spread of the coronavirus.
“We do not want to contribute to the Covid problem through immunisation programmes, so we are recommending that all campaigns are temporarily suspended as they bring a lot of people together. We don’t want to do any harm.”
“It would be inappropriate for us to recommend a campaign when the government is ordering a shut down as it would be impossible to conduct it at the right time,” he added.
Already, about 20 million children a year miss out on vital vaccinations according to Unicef and the World Health Organization. A report last year showed that global coverage for childhood vaccines including diphtheria, tetanus and pertussis and measles has stagnated at roughly 86 per cent since 2010, well below the 95 per cent required to avert outbreaks.
At his daily press briefing on Monday Dr Tedros Adhanom Ghebreyesus, director general of the WHO, said that essential health services must not fall victim to the coronavirus epidemic.
“Previous outbreaks have demonstrated that when health systems are overwhelmed, deaths due to vaccine-preventable and treatable conditions increase dramatically.
“Even though we're in the midst of a crisis, essential health services must continue. Babies are still being born, vaccines must still be delivered, and people still need life-saving treatment for a range of other diseases,” he said.
In Pakistan, Afghanistan and Nigeria polio vaccination campaigns have stopped as workers have been redeployed to Covid-19 prevention. These countries are the last reservoirs of the disease in the world and Dr Kate O'Brien, WHO's director of immunisation, acknowledges suspension will have harm global polio eradication efforts.
“We do expect a rise in polio cases as a result of the impact of Covid-19. WHO is resolved to finish the job [of eradication]. We want to make sure the programme is able to not only lend support to protecting communities from Covid-19 but build on that and resume when the outbreak is over,” she said.
Dr O'Brien added that WHO did not have systematic surveillance of which countries had suspended vaccination programmes.
“Our concern is global - for every child, everywhere. Vaccines are for the life course and it's not just infants and children. Adolescents, pregnant women and older people all need vaccines. Our concerns are for every country and every person who needs a vaccine.”
There is particular concern about measles as there has been a huge resurgence of this highly contagious disease in the last few years due to falling vaccination rates.
In 2018 there were 9.7m million cases of measles and 142,300 deaths – the vast majority of which were in children under the age of five. Experts believe that the figures for 2019 will be even higher after the widespread outbreaks in the Democratic Republic of Congo (DRC), where 6,000 children died, and Samoa.
Dr O'Brien said: “Measles anywhere is measles everywhere. We have very high concern about maintaining immunisation coverage and protecting people everywhere from diseases that will come roaring back if communities are not vaccinated.”
But with around a fifth of the global population under lockdown Dr Nandy said that social distancing measures introduced for the coronavirus may have a positive - albeit temporary - impact on other infectious diseases.
But he added that the real danger is when restrictions are lifted - unless vaccine campaigns are ramped up at this point, then the coronavirus pandemic could be shortly followed by other outbreaks, putting further pressure on already stretched health services.
“Measures introduced to limit the spread of Covid will contribute to limiting the spread of other diseases too - but once life starts going on as usual and people mingle once again, we do not want another outbreak of a vaccine preventable disease.
“And so we are saying that countries need to be mindful of this and start planning how to catch up on missed vaccine doses as soon as possible after disruption,” he said.
Dr Nandy added that supply chains and the manufacture of vaccines had been hit by staff absence and border closures.
“We are monitoring the situation on an hourly basis and doing all we can when we have a window of opportunity to supply vaccines to countries, even overstock them in some areas, so they are able to deal with the short term interruptions later.”
Dr O'Brien added that some programmes may struggle to resume after a suspension of operation.
“A pause is predicated on the assumption there could be an immediate catch up in the response whenever it is lifted. That presumes that programmes are ready to set up and people know they have to come immediately,” she said.
Yet some aid agencies are already warning that countries with weak health systems and those that have been affected by conflict will struggle to impose the type of lockdown that could stem the coronavirus outbreak and prevent a resurgence of other infectious diseases.
Countries that have reported Covid-19 cases now include Venezuela, whose health system has collapsed due to an ongoing economic crisis, and the DRC, which has been battered by a nearly two-year Ebola outbreak.
According to a new Unicef report published today, without urgent help the country's battered healthcare system will not only struggle to tackle the coronavirus, but also to contain existing measles and cholera epidemics.
Dr Esperanza Martinez, head of health at the International Committee of the Red Cross, said countries like this were completely unprepared for mounting threat of Covid-19.
“There’s no testing and there’s also a lack of supplies. We don’t have gowns, gloves, masks or any protective gear,” she told the Telegraph. “To control the outbreak we need to test, we need to isolate, we need to put in practice basic infection prevention and control but these are extremely hard in many of the countries that are starting to show cases.”
Dr Martinez added that the virus would thrive in an environment such as an urban slum or a refugee camp where people were living in cramped conditions and social distancing and isolation would be impossible.
And without routine vaccinations, other infectious diseases could also flourish, she said.
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