The current COVID-19 outbreak has shifted our focus on one thing, how to prevent ourselves from the disease, but we are ignoring the fact that there are many other infectious diseases waiting to seize the right opportunity to come back. Many countries are under lockdown for almost 2- 3 months and as a result of that primary health care services are disrupted. Interruption of immunization services poses a major risk for secondary outbreaks of vaccine preventable diseases (VPD). This spotlight on vaccines highlights the seriousness of routine immunization systems and calls to question the preparedness of health systems around the world.

This is not the first pandemic we are facing, many countries or regions have faced pandemics and they have battled against them and have their fair share of experience and learnings gathered till date. Organizations such as Gavi (global vaccine alliance), WHO and UNICEF etc. have many lessons learned from previous pandemics and these learnings will help to strengthen health systems and routine immunization. How we can adapt, approaches to maintain routine immunization, during the COVID-19 pandemic and identify the necessary commitments from country partners to achieve equitable access to vaccines against both known and novel pathogens will help us to overcome the coming threats.

According to a study done by Dr Timothy Roberton and colleagues on “Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries” they have predicted that an additional 1.2 million under-five children will die in just six months, due to current decrease in routine health service coverage levels,  and an increase in child wasting. They also predict coverage reductions of 9·8–18·5% and wasting increase of 10% will results in 2.5 million additional child deaths and 12 200 additional maternal deaths over the next six  months. Looking at these numbers it’s very clear we need to take prompt action in every country and leverage the collective expertise of partners and the technologies currently available.

How technology can help to overcome the burden?

It is very important to have a robust, large-scale and innovation-based global response to sustain and increase the current immunization, as hard fought gains on vaccine coverage are at risk. Not a single country in the world can face two outbreaks at the same time while the healthcare system is under attack by COVID-19. Technology driven solutions that can provide accurate and verifiable data on immunization, as well as aggregating data that can easily inter-operate with other existing systems will help to identify the problem areas. This will help organisations to independently identify beneficiaries, take timely interventions in this outbreak situation.

Introduction of cutting edge technologies and reaching more children with life-saving vaccines is the need of the hour. For example, some countries are trying to implement digital innovations such as introducing digital vaccination record keeping, which is going to track the children real time, efficient vaccine cold chain monitoring from production to the clinics to make sure the efficacy of the vaccines and also delivering vaccines to the unreachable areas using drones.

Moreover, improving vaccination monitoring and surveillance systems to ensure up-to-date data is critical to close the existing immunization gap as well as fighting post COVID-19 vaccine fallouts. Streamlining the analytics of vaccination monitoring, record keeping and outreach will help to save many lives. It is also the time for the policy makers to overlook the existing policies and take timely actions to bridge the immunization gap and make provisions to improve and accommodate newer technologies and utilize them for the benefit of every child in the country.

Making sure every child is immunized in order to avoid the fallouts from disruption to the routine immunization program is a must, if not it is going to be catastrophic in the long run. Let’s take proactive measures to maintain routine immunization services as much as possible, and prepare to scale-up in the immediate post-COVID period to make sure no child is left unattended.

Dr. Nadeera Nilupamali

Director- ImmunifyMe

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World has been challenged with an unparalleled health emergency in the form of COVID 19. (caused by Severe Acute Respiratory Syndrome corona virus 2, SARS-CoV-2). The ongoing corona virus pandemic has continually subjected the existing healthcare systems to unprecedented burdens and has shifted the entire focus of organizations and world health forums towards measurement of containment of spread of this deadly virus.

COVID-19 is an infectious disease that primarily spreads through droplets of saliva or discharge from the nose when an infected person coughs or sneezes. Henceforth, its transmission occurs either by direct contact with the infected persons or through indirect contact of the contaminated environmental surfaces. Treatment deficiencies like absence of vaccine or a recognized medicinal regimen, makes it obligatory to rely upon the recommended measures like social distancing, isolation, quarantine etc.

Potential threat to routine immunization :

Overriding burden on existing health care system along with legislative decisions like nationwide lockdown, has impacted the routine immunization services beyond anticipation. Immunization against vaccine preventable diseases (VPDs) is recognized as a life savior intervention. Continual immunization practices resulted in eradication of fatal diseases like smallpox. Ministry of Health and Family Welfare provides free vaccination against 12 vaccine preventable diseases under the umbrella of Universal Immunization Program.

In a country like India, with humongous birth group, Routine Immunization services are carried out majorly through RI sessions, by a designated ANM(vaccinator). Country conducts approximately 120 Lac RI Sessions to cover the cohort of 260 Lac of children and 290 Lac of pregnant women annually. Due to the wide spread of COVID 19 across the states, there is a potential threat that multiple routine immunization activities could be wedged partially or entirely. Apart from acknowledged contributors like healthcare encumbrance, restricted movements etc., community unwillingness and apprehension can be further associated with staggered RI activities.

The compromised immunization services, even for shorter periods, will result in increased numbers of unvaccinated cohort and create a potential of outbreak prone to vaccine preventable diseases (VPDs) such as measles and diphtheria. Such VPD outbreaks may result in increased morbidity and mortality predominantly in young infants, which may put additional strain on health workers and health systems, which is already overwrought by the COVID-19 response.

Importance of immunization during Covid-19 :

On 26th March 2020, WHO issued a guideline highlighting the importance of Immunization during Covid-19 where it was stated that “where feasible immunization delivery strategies may need to be adapted and should be conducted under safe conditions, without undue harm to health workers, caregivers and the community. The temporary suspension of mass vaccination campaigns was also suggested.

Prioritizing other health programs during an emergency situation like Covid-19 is extremely challenging for the system. Parallel incidence in Democratic Republic of Congo (DRC) has occurred in past when during Ebola outbreak in country, more children lost life due to measles (6500), than Ebola outbreaks (2264). With major focus on the rapid spread of the novel corona virus, there is a fear in health experts, that delay of scheduled vaccine doses can possibly result in heightened vulnerability towards vaccine preventable diseases outbreak.

Home confinement, fear, movement of informal migratory population towards their native places has all contributed towards the marginal coverage. A Benefit-risk analysis among routine childhood immunization and risk of SARS-CoV-2 infections during the Covid-19 pandemic in Africa was conducted by a team of researcher at the London School of Hygiene and Tropical Medicine (LSHTM) which says that for every one excess Covid-19 death attributable to SARS-CoV-2 infections acquired during routine vaccination clinic visits, there could be 140 (37 – 549) deaths in children prevented by sustaining routine childhood immunization in Africa. Also, as per another study, it was observed that the death rate was as lowered as 4.28/million in countries with BCG Immunization programs compared to 40/million in countries without such a program.

Road Ahead:

With the ongoing pandemic, as social distancing is becoming a way of life, there is a pre-requisite to plan immunization activities concerning the health of caregivers as well as the beneficiaries. We should work towards protecting our self at least from the identified diseases, while we wait for protection from the unrevealed. The need of the hour is to streamline collective efforts from both the demand as well as supply side of routine immunization.

*The views expressed in the article are author’s personal and by no means depict any endorsement from NIHFW or any associated departments or organizations

Dr. Snehil – Coordinator & Team Lead

National Cold Chain & Vaccine Management Resource Centre

The National Institute of Health & Family Welfare

Phone: +91 11 2616 5959 (Ext: 237),  Mob : +91 9690007821

Email: snehil.me@gmail.com,  snehil@nihfw.org

www.nccvmrc.org

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