EDITORIAL: Global Catastrophe

The disruption from the COVID-19 response on screening, care delivery, and prevention has been catastrophic for almost all disease areas in nearly all nations on earth.

Today, many wealthy nations are finally quite close to pre-pandemic levels of medical care and public health service provision. Still, other parts of the world await vaccination availability or other metrics to get to that point. However, several major failures or missteps in the COVID-19 response translated to a global reduction in routine childhood vaccinations on the broader level. Consideration of these failures should inform strategies to right the course of routine childhood immunizations to avoid such actions in the future.

“Restrictions amounted to the weeks- or months-long closure of community clinics and stoppage of outpatient services at larger health facilities across the globe.”

The first among these failures is poor messaging that caused confusion and fear among the general public out of proportion to the relative risk in many groups, discouraging caregivers and guardians from seeking out routine care for fear of infection with SARS-CoV-2. By encouraging the general public to avoid seeking care in order to protect health system generally from theoretical collapse, most public health messaging discouraged actual necessary service utilization while oddly placing responsibility for safeguarding the wellbeing of the health system on the average citizen (Saxena, Skirrow, & Bedford, 2020). Under more common circumstances, it would be expected that the health system would conversely seek to safeguard the wellbeing of the average citizen, including the youngest of these, due for routine immunizations.

Beyond the failure of public health communications, actual restrictions in the provision of care further limited the number of people able to secure routine services even if they calculated the relative risk appropriately. Such restrictions, which do not even include restrictions in individual mobility that likely complicated health seeking behaviors, amounted to the weeks- or months-long closure of community clinics and stoppage of outpatient services at larger health facilities across the globe. In some government clinics where our organization works, we were informed that no admittance was allowed at all unless it was for a COVID-19 positive person, for extended periods of time. The impact was horrifying for those suffering with acute effects of TB, diabetes, and accidents, and for childhood vaccination the damage will be similar—both short- and long-term damage are sure to follow from children unprotected from infections that drive mortality among them in poorer settings.

“Closing the gaps in care delivery via catch-up campaigns across high-income and low-income settings alike will require infusions of resources to identify children whose immunizations were missed, provide a trust-based path to receive the most critical shots, and to extend care into communities in ways that increase likelihood of understanding.”

Finally, perhaps one of the most concerning and direct failures of the COVID-19 response was the redirection of resources to COVID-19 above all else, and the cessation of vaccination campaigns and related resources that extended access to remote and rural areas, particularly in low- and middle-income countries (Khatiwada, Shrestha, & Shrestha, 2021). For example, Mission Indradhanush, one of India’s immunization programs responsible for administering vaccinations to 26 million children 29 million pregnant women every year, saw its community-based delivery activities levelled. A 40% increase in child mortality due to vaccine-preventable illness is expected if its course is not righted (Shet et al., 2021).

In overcoming these failures, global efforts must focus their resources not just on the restoration of business-as-usual proceedings for routine childhood vaccinations. Rather, it is likely that increased investments and new communications strategies will be needed to overcome the loss of trust in the health system resulting from more than a year of fear-based messaging that placed the duty of health system protection on those whom the system is meant to serve, while also imposing restrictions on access to these services. Moreover, closing the gaps in care delivery via catch-up campaigns across high-income and low-income settings alike will require infusions of resources to identify children whose immunizations were missed, provide a trust-based path to receive the most critical shots, and to extend care into communities in ways that increase likelihood of understanding and uptake of these health services (MacDonald, Comeau, Dube, & Bucci, 2020). A simple return to pre-pandemic levels of provision is unlikely to prevent the alarming increases in preventable mortality expected in the coming years due to halted immunizations for children. An extraordinary breakdown in provision must be matched by equally remarkable corrective action.

References

Khatiwada, A. P., Shrestha, N., & Shrestha, S. (2021). Will COVID-19 Lead to a Resurgence of Vaccine-Preventable Diseases? Infection and Drug Resistance, 14, 119–124.

MacDonald, N. E., Comeau, J. L., Dube, E., & Bucci, L. M. (2020). COVID-19 and missed routine immunisations: Designing for effective catch-up in Canada. Canadian Journal of Public Health, 111, 469–472.

Saxena, S., Skirrow, H., & Bedford, H. (2020). Routine vaccination during covid-19 pandemic response. BMJ, 369(m2392).

Shet, A., Dhaliwal, B., Banerjee, P., DeLuca, A., Carr, K., Britto, C., … Gupta, P. (2021). Childhood immunisations in India during the COVID-19 pandemic. BMJ Paediatrics Open, 5.

Amanda Brumwell is Managing Director of Advance Access & Delivery, a global health non-profit working to build community-based health delivery programs across the world and to drive rapid reductions in mortality from diseases of poverty. She holds a master’s degree from Johns Hopkins Bloomberg School of Public Health, and a BS in Biology and BA in Global Health from Duke University. <amandab@aadglobal.org>

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