COVID-19's lost generation of unvaccinated children – Authors' reply

Abstract

We thank Damian Walker and Subhash Chandir for their letter in response to our benefit–risk analysis on sustaining routine childhood immunisation in African countries during the COVID-19 pandemic.1Abbas K Procter SR van Zandvoort K et al.Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection.Lancet Glob Health. 2020; 8: e1264-e1272Summary Full Text Full Text PDF PubMed Scopus (162) Google Scholar Walker and Chandir highlight the uncertainty in our understanding of the indirect health effects due to the impact of the COVID-19 pandemic on immunisation services, and the importance of electronic immunisation registries to track under-immunised children, as evident from the case study in Pakistan's Sindh province.2Chandir S Siddiqi DA Setayesh H Khan AJ Impact of COVID-19 lockdown on routine immunisation in Karachi, Pakistan.Lancet Glob Health. 2020; 8: e1118-e1120Summary Full Text Full Text PDF PubMed Scopus (81) Google Scholar The absence of electronic immunisation registries in many African countries is a limiting factor in translating this solution to Africa. WHO issued guidance in March, 2020, on immunisation activities during the COVID-19 pandemic, which recommended a temporary suspension of mass vaccination campaigns, but continuation of routine immunisation services while maintaining physical distancing and infection control measures.3WHOGuiding principles for immunization activities during the COVID-19 pandemic: interim guidance.https://apps.who.int/iris/handle/10665/331590Date: 26 March 2020Date accessed: October 5, 2020Google Scholar The evidence on the benefits and risks of these recommendations was not extensive, but timely policy decisions were warranted despite this uncertainty. We conducted our benefit–risk analysis on sustaining routine childhood immunisation during the COVID-19 pandemic to address, in part, this evidence gap. Despite the uncertainties and conservative assumptions, we inferred that the deaths prevented by sustaining routine childhood immunisation in Africa outweigh the excess risk of COVID-19 deaths associated with vaccination clinic visits, especially for the vaccinated children. Thereby, routine immunisation services should be sustained as much as is logistically possible in a COVID-secure manner. Empirical data are being generated by countries to assess the indirect effects of the COVID-19 pandemic on regular health services, including immunisation. Masresha and colleagues4Masresha BG Luce Jr, R Shibeshi ME et al.The performance of routine immunization in selected African countries during the first six months of the COVID-19 pandemic.Pan Afr Med J. 2020; 37: 12PubMed Google Scholar reviewed administrative routine immunisation data to analyse the performance of routine immunisation in 15 African countries during the first 6 months of the COVID-19 pandemic. The strict COVID-19 control measures, redeployment of health workers and repurposing of health facilities to assist COVID-19 control efforts, and public concerns about being infected by severe acute respiratory syndrome coronavirus 2 led to a decline in use of regular health services, including immunisation. 13 of 15 countries had a decrease in immunisation service delivery, with six countries showing more than a 10% decrease in the average monthly number of vaccine doses provided. Epidemiological risk assessment using empirical data on the disruptions to immunisation services in combination with serological surveillance and social behaviour dynamics should be conducted to assess the immunity gaps and assist in planning and implementation of catch-up vaccination of under-immunised and zero-dose children to prevent vaccine-preventable disease outbreaks.5Mburu CN Ojal J Chebet R et al.The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya.medRxiv. 2020; (published online Aug 31.) (preprint)https://doi.org/10.1101/2020.08.25.20181198PubMed Google Scholar We declare no competing interests. COVID-19's lost generation of unvaccinated childrenIn their modelling study, Kaja Abbas and colleagues (October, 2020)1 state that routine childhood immunisation is “at risk of suspension” and “should be sustained in Africa as much as possible… during the COVID-19 pandemic”. It is now more than 6 months since the paper was first posted as a working paper, approximating the 6-month COVID-19 risk period modelled by the authors. We now know that immunisation programmes in Africa (and beyond) were severely disrupted.2 Full-Text PDF Open AccessImpact of COVID-19 lockdown on routine immunisation in Karachi, PakistanThe swift spread of COVID-19 has upended health systems and affected all health services. The disruption of routine immunisation services could start secondary outbreaks of vaccine-preventable diseases and also worsen the longstanding inequity in immunisation coverage, especially in rapidly urbanising cities. Karachi, the capital of Sindh province and the largest megacity in Pakistan, is home to more than 16 million people.1 Despite the city's status as the industrial hub of the country, Karachi has seen a decline in the delivery of health-care services over the past decade. Full-Text PDF Open AccessRoutine childhood immunisation during the COVID-19 pandemic in Africa: a benefit–risk analysis of health benefits versus excess risk of SARS-CoV-2 infectionThe deaths prevented by sustaining routine childhood immunisation in Africa outweigh the excess risk of COVID-19 deaths associated with vaccination clinic visits, especially for the vaccinated children. Routine childhood immunisation should be sustained in Africa as much as possible, while considering other factors such as logistical constraints, staff shortages, and reallocation of resources during the COVID-19 pandemic. Full-Text PDF Open Access