Cancer Services and Routine Immunizations Backlogged – as Some Countries Anticipate Pandemic ‘Ceasefire’ – WHO
Hans Kluge, WHO European Regional Director

Cancer services remain backlogged in many parts of the world due to the effects of the two-year-long COVID pandemic – even as Europe hopes a pandemic “ceasefire that could bring us enduring peace” , said WHO’s European Regional Director Hans Kluge Thursday on the eve of World Cancer Day.  

Meanwhile, in Latin America, routine childhood immunizations are down by around 10% as a result of setbacks from the COVID-19 pandemic, leaving the region at very “high-risk” for new and re-emergent vaccine-preventable diseases, said Carissa Etienne, Regional Director of the Pan American Health Organization in a briefing Wednesday evening.

Both WHO regions, which include some of the world’s highest income countries, as well as middle income nations, alongside low-income states, continue to face striking regional imbalances in vaccine distribution, top officials in the two regions also stress – with some countries reaching 70% COVID vaccine countries or more – while others only have reached about 30% of eligible adults with jabs, both Etienne and Kluge stressed in separate press briefings. 

And that still leaves some countries disproportionately vulnerable to the ongoing effects of the Omicron variant – as well as to risks of new emerging variants. 

Cancer – knock-on effects will last for years 

Cancer services were disrupted up to 50% in the WHO Europe region.

The two-year ongoing pandemic has had “catastrophic” effects on people with cancer, said Kluge, in his remarks – “going far beyond the disease itself.”

One in four people in WHO’s European Region will receive a cancer diagnosis at some point in their lives – and cancer accounts for more than 20% of morbidity and mortality in the WHO region that extends from the Central Asian republics to the United Kingdom, he noted. 

In the European region, cancer diagnosis and treatment services saw disruptions of up to 50% in the early stages of the pandemic he noted. 

And while many EU countries have since rebounded, the picture remains uneven regionally and around the world.

The latest WHO Global Pulse survey on disruptions in essential health service found that in the last quarter of 2021, countries worldwide were still experiencing disruptions in cancer screening and treatment services of between 5-50%, Kluge said. 

“The knock-on effects of this disruption will be felt for years,” Kluge added, noting that 44% of countries worldwide were reporting backlogs in cancer screening in the second half of 2021. 

Any post-Omicron ‘respite’ must be used to restore other essential health services 

Problems are compounded, he added, by the fact that the “health workforce is overstretched and exhausted – after being repurposed to address the direct impact of the virus.  

“Any respite the widespread immunity provides, thanks to vaccination and in the wake of the less severe Omicron, together with the coming spring and summer season, must be used immediately to enable health workers to return to other important health care functions, in order to bring backlogs for chronic care services down. 

“As we go forward, maintenance of essential health services, including services along the journey of cancer care, from prevention, early detection, diagnosis, treatment and quality of care will be a component of emergency planning and response,” he said. 

Americas also struggling to overcome disruptions in routine childhood vaccinations 

A child receives a routine vaccination in Cuba, which is a world leader in childhood immunization.

Meanwhile, speaking from Washington DC, PAHO’s Etienne sounded a similar theme. 

But her message was focused around pandemic-related setbacks in childhood vaccinations across the WHO’s Americas’ region – which includes the affluent USA and Canada, alongside high, middle and low income countries of Latin America and the Caribbean. 

Routine childhood vaccinations for a third dose of diphtheria, tetanus, pertussis (DTP) vaccine has declined by 10% in the region, as a result of setbacks from the COVID-19 pandemic, leaving the region at very “high-risk” for new and re-emergent vaccine-preventable diseases because of lower immunization coverage, she said: 

“Despite the tremendous achievements of immunization programs in past decades, that progress has stalled in some countries, and has even reversed in this region.”  

Carissa Etienne, Director of the Pan American Health Organization/WHO Region of the Americas

While the goal was to fully cover at least 95% of eligible children in 2020 with the DTP vaccine, 26 countries and territories of the Americas did not reach that goal. And some 14 countries in the region had particularly low coverage with the third dose – of 10% or less. 

As in Europe, she attributed the setbacks to the reassignment of healthcare professionals from primary care centers to hospitals and intensive care units – alongside public hesitations about getting vaccinated during the pandemic.  

PAHO is currently working with Ministries of Health across the Americas to revitalize family immunization programs as one of their “highest priorities”.

“We are at a juncture where it is urgent to look at routine immunization programs,” said Etienne. 

As countries reopen – uneven vaccination coverage exacerbates future variant risks 

Both Europe and the Americas also are facing major inconsistencies in vaccine coverage rates within countries of the region, the officials also noted. 

And that poses additional risks as countries relax restrictions, Kluge stressed. 

“We in the European region have a unique situation,” Kluge said. “Once the Omicron wave has subsided, there will be a large capital of [SARS-CoV2]  immunity, due to the infection in general, and quite high vaccination rates generally.”

That offers opportunities to restore normalcy and “respond to new variants that will inevitably emerge without reinstalling the kind of disruptive measures that we needed before,” he said. 

Can the pandemic ceasefire bring enduring peace?

“This period of higher protection should be seen as a ‘ceasefire’ that could bring us enduring peace,” he said.  But he insisted that his message does not contradict those coming from Geneva, either, where WHO’s Director General Tedros Adhanom Ghebreyesus urged caution in reopening economies at a briefing earlier in the week.

“The pandemic is not over, as Dr Tedros is rightly saying.”    

In particular, vaccination rates need to be pushed higher in undercovered parts of the Europe – as well as worldwide – to expand protection against the emergence of still newer, and potentially more dangerous variants, Kluge stressed. 

“It is because we see the opportunity that the top priority is to bring all countries to a level of protection which allows them to grasp this opportunity and look ahead towards more stable days

“And that means that we need a drastic and uncompromising increase in vaccine-sharing.” 

For instance, while 66% of people across WHO’s vast European region have received a second vaccine dose, the numbers go as high as 70% in high income countries – where 40% of the population also has boosters, said Oleg Benes, another WHO European region official. 

But in the region’s lower middle income countries, rates remain much lower. “Booster courses are just starting to roll out.” Vaccine rates are as low as 30% in some countries, with only one in 3 older adults, on average protected.” That, he admitted, is also due in part to higher rates of vaccine hesitation among older people in some countries. 

Inconsistent vaccination coverage in the Americas ‘worrisome’ 

Similar inconsistencies in vaccination coverage prevail in the Americas – where average vaccination rates are also 60% or more. And that remains a “worrisome sign”, said Etienne. 

That is particularly true as the Americas region overall is still seeing rising rates of the Omicron variant – even while Europe seems to have turned the corner.

While 14 countries and territories have immunized 70% of their populations, the same number of countries have yet to protect 40% of their people. 

More than 25% of people across the region have yet to receive a single dose of protection – rising to 54% in low- and middle-income countries, PAHO officials said. 

As in other parts of the world, countries that have experienced civil conflict, unrest and natural disasters lag even further behind. 

Haiti, notably, has less than 1% of its population fully vaccinated against COVID-19. The country  began its vaccine drive late last year, having only received donations from donors such as the WHO-co sponsored COVAX initiative in July

Jamaica also is behind in its vaccinations – with only 21% of people fully vaccinated. 

Meanwhile, COVID-related deaths have increased for the fourth consecutive week in all subregions of north and south America and the Caribbean, with an increase of 33% last week over the week previous.  That, officials added, further underscores the impacts of uneven vaccination rates – which continue to leave unvaccinated older and more vulnerable groups more prone to serious disease.

Image Credits: Daily Caller/Twitter , Radio Metropolitana Cuba/Twitter .

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