Fifty countries have not yet resumed routine immunisations disrupted by the COVID-19 pandemic, affecting 228 million people – mainly children – and there have already been serious measles outbreaks in Yemen, Pakistan and the Democratic Republic of the Congo, according to World Health Organization (WHO) director general Dr Tedros Adhanom Ghebreyusus. 

To address this, the WHO, UNICEF, and the global vaccine alliance, Gavi, launched the Immunization Agenda 2030 (IA2030) to strengthen global immunization systems at the WHO biweekly press conference on Monday. 

The main targets to be achieved by 2030 are: 

* 90% coverage for essential vaccines given in childhood and adolescence

*Halving the number of children completely missing out on vaccines  

* Completing 500 national or subnational introductions of new or under-utilized vaccines, such as those for COVID-19, rotavirus, and human papillomavirus (HPV) .

Dr Kate O’Brien, the WHO’s head of immunisations, said that if these goals are achieved, “the latest estimates show that the strategy would avert over 50 million deaths of children and adolescents”.

Over half of the 50 affected countries are in Africa, highlighting “protracted inequities in people’s access to critical immunisation services”, according to WHO.

“The pandemic has made a bad situation worse, causing millions more children to go unimmunized. Now that vaccines are at the forefront of everyone’s minds, we must sustain this energy to help every child catch up on their measles, polio and other vaccines. We have no time to waste. Lost ground means lost lives,” said Henrietta Fore, UNICEF Executive Director. 

Fore added that, due to pandemic-related disruptions, UNICEF delivered 2.01 billion vaccine doses in 2020, compared to 2.29 billion in 2019.

“We are embarking on an unprecedented global [COVID-19] immunisation campaign. But this campaign cannot come at the cost of childhood vaccinations,” said Fore.

”We cannot trade one global health crisis for another. In a year when vaccines are at the forefront of everyone’s minds, we must sustain this energy to accelerate efforts on all three fronts: providing equitable access to COVID-19 vaccines, catching up on missed vaccinations due to the pandemic lockdowns and, critically, extending immunisation efforts to all children currently missing out on vaccines entirely.”

Gavi CEO Dr Seth Berkley said that “to support the recovery from COVID-19 and to fight future pandemics, we will need to ensure routine immunization is prioritized as we also focus on reaching children who do not receive any routine vaccines, or zero-dose children”. 

COVAX Depending on Dose Donations

COVAX had expected another 90 million vaccine doses from the Serum Institute of India in March and April for low income countries but these had been kept for domestic use given the COVID-19 “crisis” in India, according to Berkley, whose organisation co-leads COVAX.

“We are in early days on discussions on dose sharing,” added Berkley. “We had an announcement last Friday from French President Macron that he would be sharing up to a half a million doses and we’ve also had an announcement from New Zealand, that they would be sharing 1.6 million doses and we’ve heard from the Spanish Prime Minister that they would be sharing doses, so we’re beginning to see engagement from many on dose sharing.”

He confirmed that COVAX was “waiting for when supplies will resume [from India], and we’re looking at other options at the same time”.

Meanwhile, on Monday the US announced that it would be releasing 60 million doses of AstraZeneca vaccines that it had ordered “as they become available”, according to Andy Slavitt, White House Senior Advisor on COVID-19.

Tedros described the situation in India as “beyond heartbreaking”.

“WHO is doing everything we can, providing critical equipment and supplies, including thousands of oxygen concentrators, prefabricated mobile and field hospitals and laboratory supplies,” said Tedros, adding that it had redeployed 2,600 staff “to support the response on the ground, providing support or surveillance, technical advice and vaccination efforts”.

Dr Maria Van Kerkhove, the WHO Lead on COVID-19, described the exponential growth in COVID-19 cases in India as “really, truly astonishing”, but warned that “this can happen in a number of countries if we let our guard down”. 

“We’re in a fragile situation, with nine weeks of case increasing, with more than 5.7 million new cases reported last week, and that is certainly an underestimate,” said Van Kerkhove.

“The situation can grow if we allow it to, and this is why it’s important that every single person on the planet knows that they have a role to play,” she added. “We need governments to continue to apply comprehensive approaches and enabling populations so that they know what they need to do to keep themselves and their loved ones safe.”

Image Credits: © UNICEF/Claudio Fauvrelle, Jaya Banerji/MMV, UNICEF.