The writer Annie Dillard noted in her essay Seeing that “a greater light extinguishes a lesser as thought it didn’t exist.”
COVID-19 lit ablaze life as we knew it, and sucked the oxygen out of our attention towards many other issues.
We’re not only dealing with a novel virus that has killed over 4 lakh people in India, but also reeling under the effects of the measures used to curb its spread, which have had a deleterious impact on some aspects of pediatric healthcare.
In the matter of causing this kind of inadvertent damage, COVID is hardly novel.
Notably, during the 2014-2016 Ebola virus epidemic in West Africa, twice as many children are reported to have died from measles, a vaccine preventable disease(VPD) than of Ebola itself.
The doses of routine childhood vaccines administered has considerably reduced since the onset of the pandemic.
Why The Fall in Vaccine Uptake?
People fear contracting COVID- a disease children in India can’t yet be vaccinated against- at vaccination sites. Travel, especially by public transportation, has been curtailed.
This has meant that people face challenges showing up to vaccination centers, which themselves have reduced because of paucity of healthcare workers and other resources.
Schools, another important site for routine immunization, have largely remained shut for a year and a half.
Mass vaccination and other supplemental immunisation activities vital to wide coverage were disrupted and postponed.
A further spanner was thrown into the supply chain of vaccines by an alarming backlog in shipments, which have even caused some countries to start using their reserve stocks, some even fearing eventually running out of stock.
Why Is This Concerning?
These unfavorable conditions have been brewing the perfect storm away from the glare of the public eye.
Disruption of immunisation services is estimated to put 80 million infants globally at risk of contracting a VPD.
A mathematical model in 2020 estimated that disruption to health services would cause 27million children will miss out on diphtheria tetanuspertussis (DPT) vaccines, among otherhealth services, resulting in a 40% increase inchild mortality over the year.
Public health officials are concerned with the burden potential outbreaks of vaccine preventable diseases would have on a healthcare infrastructure already fraying at the edges. Of particular concerns are measles and polio.
Measles is a notoriously transmissible disease with outbreak potential even with the most infinitesimal drops in herd immunity.
India has been certified polio-free since 2014, yet we cannot relax on continued vaccination and disease surveillance, especially since erstwhile polio free countries like Niger reported fresh outbreaks of cases in 2020.
The threat of potential damage that disrupted routine immunisation can do looms even more ominously on low-middle-income-countries (LMICs) like India than on high-income-countries (HICs).
This is because the comorbidities which cause poorer outcomes in the pediatric population- such as nutritional anemia, malnutrition and HIV infection- are far more prevalent in LMICs, along with the healthcare structure itself being weaker.
Even within India, which has ways to go before attaining universal coverage (latestevidence suggests only 62% of children between the ages 12-23 months are fully immunized), uptake of immunisation is divided by socioeconomic demographics.
Factors like higher socioeconomic status and maternal education are associated with increased uptake of routine vaccines.
The pandemic has only widened this schism. MoHFW (The Ministry of Health and Family Welfare) has considered immunisation an essential health service since April 2020, and certain healthcare facilities in India have been designing interventions to minimise disruption of immunisation, such as a dedicated space for immunisation away from unwell patients.
Catch-up campaigns to minimise the number of children vulnerable to VPD’s designed keeping in mind ongoing safety measures are vitally important.
Further, it is imperative that these immunization outreach campaigns address the existing vaccine inequity in order to be effective.
There is evidence to make it clear that the benefits of continuing vaccination services, even during a pandemic, outweigh the risks.
For every death from SARS-CoV-2 acquired from a routine immunization visit, 84 deaths from VPD’s could be prevented. Given this statistic, the issue of routine immunization during a pandemic needs oxygen, stat.
(Dr Sumedha Sircar is a physician, and works as an Associate Head in Health Communication and Content Curation at Immunise India.)
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