What happens to children when they miss their shots? As the world worries about a COVID-19 vaccine, what is happening to the thousands of infants and children who have missed their regular vaccination because of the pandemic?

Immunisation and the Pandemic

India came to a standstill when the lockdown was announced on 24 March, 2020. Life as we knew it stopped, and many healthcare services were badly hit. Dr Dhiren Gupta, a senior paediatrician at Gangaram Hospital, New Delhi. told FIT, “Many children missed their shots, and then were forced to come in with preventable infections and diseases.”

A report by Bill and Melinda Gates Foundation found that globally the number of children vaccinated this year against infections like diphtheria, tetanus, tuberculosis, polio, measles and other preventable diseases has fallen to levels not seen since the 1990s.

Disruptions are caused by a lack of services offered, a reluctance and fear to leave home even if services are available, transport issues and economic problems among others. This could cause further outbreaks of diseases, they warned.

Further, hard won milestones might get reversed. According to the WHO report, the regional coverage of the third dose of DTP in South Asia - notably across India, Nepal and Pakistan, “ increased by 12 percentage points over the last 10 years.”

India and Immunisation

India has been working hard at our immunisation programs and the Universal Immunization Programme (UIP) targets around 2.67 crore newborns and 2.9 crore pregnant women annually. Immunisation is an essential part of public health, and protects pregnant mothers and children from vaccine preventable diseases (VPD).

Under the UIP, vaccination is given to prevent 7 diseases, namely:

• Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B, Hiaemophilus influenza type b (Hib) and Diarrhea

The Government’s National Health Mission website has a detailed chart of the vaccination timeline from the time of birth till the child is up to 16 years of age.

Vaccines for VPDs are divided into two sets -

• primary: to be given right after delivery,

• secondary: top-up vaccines to be given a few months after birth until the child is 16 years old

Dr Jayant Pandharikar, president of the Maharashtra chapter of Indian Academy of Pediatrics told the Mid-day that while the secondary vaccines can be delayed by a few months, it is not advisable to skip the primary injection.

COVID, Children and Vaccination

FIT had earlier reported that children - globally and in India - are less at risk of contracting or dying from COVID-19, but some are showing signs of a rare inflammatory disease weeks after they recover. Dr Gupta had told me that, “So far, pediatric patients had a 54 per cent less chance of getting infected with COVID-19, and out of these only 1 per cent were becoming critical, especially among less than one-year-olds.”

But in some children, they start to develop inflammation around 2-4 weeks after they recover. “In fact, around 90 per cent of the pediatric patients who are showing these symptoms are testing COVID-19 negative (in the RT-PCR tests),” adds Dr Gupta. This means that they were showing these symptoms once they recovered,

While much is still to be learned about the disease, some studies suggest that childhood immunisation programs, especially the MMR vaccine, could have protected children from the virus. This was hypothesised to be done by providing “a broad neutralising antibody against numbers of diseases, including COVID-19.” While the data suggests a link, more experimental data is required to conclusively prove the hypothesis.

Another study in The Lancet on immunisation and COVID-19 risk in children in Africa found that, “the deaths prevented by sustaining routine childhood immunisation in Africa outweigh the excess risk of COVID-19 deaths associated with vaccination clinic visits, especially for the vaccinated children.” Of course, country-wide studies need to be undertaken to determine the specific risk.

How Did India Begin Vaccinating Children?

The Ministry of Home Affairs issued an order on 15 April to resume to resume essential health services - including immunisation - across the country. However, it was up to the state and districts to determine the COVID-19 risk before commencing with the outreach. For example, containment and buffer zones (and red zones) were advised to stop all outreach and health-facility related services.

The MHA issued guidelines for outreach on green and buffer zones - including social distancing rules, a staggered approach, limiting the number of patients and faculty and increasing hand washing facilities. These were then adapted for urban areas, villages and districts based on the facilities available and population size.

Dr Gupta adds that the next 6 months will be crucial in determining the effect of the missed shots, and if the catch-up shots were able to offset the damage.