A recently released ‘Lancet’ study notes that around 126 countries reported some level of disruption in routine immunization services due to the pandemic. South Asia seems to be the most affected region. However, the Union Health Ministry has denied poor coverage of immunization services due to the pandemic.
Childhood immunization is important to protect children from severe illnesses and potentially life-threatening diseases such as polio, measles, whooping cough, and others. Routine immunization must be undertaken as per the recommended schedule to protect infants and children by providing immunity early in life. Vaccines are known to have reduced child mortality rates to half, saving millions of lives. Delaying or not taking a vaccine has its own risks and has the potential to affect a child’s health for life.
However, since the onset of the COVID-19 pandemic in early 2020, severe disruptions in routine and essential health services including routine immunization for children were reported in many parts of the world. ‘The Lancet’ recently published a study report on the scale & extent of this disruption.
126 out of 170 countries faced some level of disruption in routine immunization due to pandemic
According to a recent study published in ‘The Lancet’, the COVID-19 pandemic resulted in the most widespread and largest global disruption to life-saving immunization programmes in recent history, putting millions of children at risk of measles, diphtheria, tetanus, and pertussis (whooping cough) in both rich and poor countries. Some level of disruption was reported by 126 of 170 countries (74%) during the earlier phase of the pandemic. Factors such as mobility restrictions, fear of contracting SARS-CoV-2, diversion of resources towards tackling the pandemic, unavailability of healthcare workers, shortages in PPE Kits, need for social distancing, have led to the disruption around the world.
The study analysed global and regional patterns in disruptions to the routine immunization through administration of diphtheria-tetanus-pertussis, third dose (DTP3) vaccine and measles-containing vaccine, first dose (MCV1) in 2020 based on data reported by countries and supplementary sources. The study involved modelling to estimate the number of doses expected to be given in 2020 had the pandemic not broken out and compared it with the actual number of doses administered to estimate the number of additional children who missed the routine vaccine doses in 2020 because of COVID-19.
8.5 million doses of DTP3 and 8.9 million doses of MCV1 were not given to children in 2020 due to pandemic
Between January to December 2020, an estimated 30 million children missed doses of DTP3, and 27.2 million children missed MCV1 doses. An estimated 8.5 million third doses of the DTP vaccine and 8.9 million first doses of the measles vaccine were not given to children worldwide in 2020 because of the pandemic. As compared to the expected coverage levels if the COVID-19 outbreak had not taken place, DTP3 vaccine coverage dropped by 7.7% while MCV1 vaccine coverage dropped by 7.9% in 2020.
The findings of the study indicated that South Asia was the most acutely affected region in 2020 with the greatest drop in vaccination coverage. An estimated 3.6 million doses of DTP3 and 2.2 million doses of MCV1 vaccine missed by eligible children due to the pandemic were in South Asia. In South Asia, DTP3 was estimated to have fallen by 13% and MCV1 by 4%, compared to expected levels, because of the pandemic. Nonetheless, between May and December 2020, vaccine delivery appeared to improve, with the monthly estimated doses administered approaching expected levels by the end of the year.
23 million children were unvaccinated or under-vaccinated in 2020, according to UNICEF
Meanwhile, data published by WHO and UNICEF showed that global coverage of the third dose of diphtheria-tetanus-pertussis (DTP3) fell from 86% in 2019 to 83% in 2020, the lowest since 2008. 90% of countries that reported 2020 data experienced stagnant or declining coverage of DTP3 compared to 2019, as per UNICEF. Further, 23 million children were unvaccinated or under-vaccinated as they missed out on basic vaccines through routine immunization services in 2020. More than 60% of these 23 million children lived in ten countries including India, Nigeria, the Democratic Republic of the Congo, Pakistan, Indonesia, Ethiopia, Brazil, Philippines, Angola, and Mexico, and 17 million of them did not receive any vaccines. South Asia witnessed the sharpest decline in DTP3 coverage- from 90% in 2019 to 84% in 2020.
Meanwhile, the coverage of DTP1 had dropped from 90% to 87% and coverage of MCV1 had dropped from 86% to 84%. Compared to 2019, 3.5 million more children did not receive the first dose of the DTP1 vaccine around the world, while 3 million more children missed their first measles dose.
Huge increase in children who did not receive the first dose of DTP vaccine in India: UNICEF
With respect to DTP1 vaccine coverage, in absolute numbers, India recorded the greatest increase in children who did not receive the first dose of the DTP vaccine. Over 3 million children in India missed out on their DTP1 vaccine in 2020. In other words, an additional 1.64 million children in India did not receive DTP1 in 2020 as compared to 2019 when over 1.4 million children missed the vaccine, according to UNICEF’s data. Countries with the largest increase in children who did not receive DTP1 is given in the following chart.
Union Health Ministry denied reports of poor immunization coverage
India’s Union Health Ministry issued a statement on 16 July 2021 stating that “there have been some media reports alleging that lakhs of Indian children may have missed their routine vaccinations due to disruptions caused by COVID-19 leading to increased risk of future outbreaks and deaths. These reports are not based on facts and do not reflect the true picture.”
Furthermore, the statement clarified that since the outbreak of COVID-19, the Health Ministry has been focused on maintaining essential services, including immunization under the Universal Immunization Programme. In the first quarter of 2021, between January and March 2021, India has achieved 99% DTP3 coverage, the highest to date. The Ministry also listed the measures taken amidst the pandemic to mitigate negative impacts of COVID-19 on vaccination services such as issuance of guidelines, training, identification of high-risk areas for risk mitigation etc.
HMIS data shows India’s vaccination coverage dropped slightly in 2020
According to the Health Management Information System (HMIS), India administered over 1.08 lakh doses of the DTP1 vaccine in 2018, which reduced to around 80,000 doses in 2019. Likewise, over 81,000 doses of the DTP3 vaccine were administered in 2018, which also reduced to less than 43,500 doses in 2019. In 2020, the year of outbreak, while the total number of doses of DTP1 administered further dropped to around 76,000 doses, the number of DTP3 doses administered increased to nearly 56,000 doses. In the first five months of 2021, more than 39,000 doses of DTP1 and 28,000 doses of DTP3 have been administered. At this rate, the doses administered in 2021 might cross the 2020 levels by the end of 2021.
Rotavirus1 administration increased in 2020
Other important vaccines administered in India are the BCG vaccine, a birth dose of Oral Polio Vaccine (OPV), Vaccine against Measles (MCV1), and the vaccine against Rotavirus. The number of doses of BCG vaccines administered in 2018 was about 23.4 million, and 24.1 million in 2019. However, in 2020, the number dropped to 22.6 million doses. A similar trend is observed with respect to the polio vaccine- from 17.7 million doses in 2018, the coverage increased to 18.6 million doses in 2019, to 17.5 million doses in 2020. In contrast, the first doses of the rotavirus vaccine increased from 8.2 million in 2018 to 22.42 million in 2020. Meanwhile, the MCV1 vaccine administration dropped slightly from 23.4 million doses in 2019 to 23 million doses in 2020. In the first five months of 2021, approximately 40% of doses administered in 2020 have been administered.
Routine immunization must continue
Routine vaccination services were disrupted during the pandemic in many countries across the world, especially the highly populated South Asian countries. Though the second half of 2020 witnessed recovery efforts, it was not enough to get back to usual levels. With new variants of COVID-19 emerging, it continues to be a threat even in 2021. While governments are focused on the administration of COVID-19 vaccines, routine immunization must also continue with adequate safety measures. The progress made in the past many years in immunization has suffered a setback due to COVID-19. Past outbreaks such as the 2014 Ebola virus epidemic in West Africa, also led to large disruptions to routine immunisation and resulted in a subsequent measles outbreak. There is a real danger of disease outbreaks if routine immunization is not taken care of alongside the administration of the COVID-19 vaccine. Such disease outbreaks during a pandemic will further burden the healthcare system and hence it is imperative that countries across the world make efforts to continue with routine immunization.
Featured Image: Disruption in Routine Immunization