Covid pandemic created immunisation gaps in Africa. Over half a million children are at risk: WHO

These emerging outbreaks are a matter of great concern. They call for urgent and sustained public health interventions. Unless these are put in place, the compounding effects of the pandemic could derail regional progress towards the global immunisation targets that secure the health and wellbeing of infants and children. The resurgence of deadly vaccine preventable diseases underscores the importance of maintaining high vaccination coverage rates. Children everywhere must have access to all the recommended lifesaving vaccines they need. The disruptions observed during the COVID pandemic also highlight the importance of establishing resilient health systems. Systems must be able to withstand acute and prolonged shocks while delivering essential health services like immunisation programmes.

It is important to contextualise the performance of routine immunisation programmes within the African region. Even before the pandemic, the African region was already contending with a precarious situation. It is important to contextualise the performance of routine immunisation programmes within the African region.

For one, an estimated 30.7 million children under five continue to suffer from vaccine preventable diseases. These include rotavirus diarrhoea, pneumonia, pertussis and measles. Of these children, more than 520,000 die each year because of poor access to essential immunisation services. The continent's health systems have to manage on average 150 cases of disease outbreaks and other public health emergencies every year. These range from armed conflicts to climate-related disasters (including flooding, drought, and famine) and disease outbreaks. National routine immunisation programmes have had to function in this context.

On the continent the pandemic has substantially disrupted national routine immunisation programmes. In many countries health systems were forced to divert limited resources to combat the pandemic. This often left immunisation services vulnerable.

At the height of the pandemic, several countries reported having to suspend vaccination services. There were disruptions to vaccine supply chains which led to stockouts. The number of people taking up immunisation services declined due to restrictions on public gathering. Many people also feared being exposed to the virus at health facilities. A good measure of the COVID-related disruptions to immunisation programmes is the coverage of the three doses of the diphtheria-tetanus-pertussis (DTP3) vaccine. The WHO uses the coverage of DTP3 to monitor access to immunisation services and measure the performance of broader health systems.

The WHO report shows that the COVID-19 pandemic contributed to a general decline in DTP3 coverage globally irrespective of economic power or income level. In Africa, national immunisation programmes in several countries maintained optimal performance, achieving DTP3 coverage rates above 90%. These included Algeria, Botswana, Burkina Faso, Burundi, Ghana, Kenya, Malawi, Mauritius, Namibia, Sierra Leone, Uganda and Zambia.

Of concern, however, are the 29 countries that recorded coverage of less than 90%, creating substantial immunisation gaps. The increased misinformation and disinformation during the pandemic also led to some decline in public trust and confidence in immunisation services. This has significantly affected vaccine demand.

The pandemic provides useful lessons on the importance of continuously strengthening health systems and crisis-proofing national routine immunisation programmes.

COVID-19 has been a catalyst for renewed political interest in immunisation programmes. But this must be followed up with regional solidarity to re-prioritise routine immunisation in the national and regional public health agendas. National governments will have the responsibility to secure and sustain donor funding while increasing domestic financial commitments that will fill the funding gaps for national immunisation programmes. This is in line with the declarations they have endorsed.

But most importantly, there's a need to intensify demand for vaccines and immunisation programmes. This is critical to build back public confidence and trust in vaccines and immunisation services in a post-COVID world.