Ahead of World Immunisation Week (24-30 April), we are looking into how the COVID-19 pandemic has disrupted routine immunisation schedules. Although immunisation rates appear to be recovering, the refugee influx from Ukraine into neighbouring countries has presented a further challenge, writes GIEDRĖ PESECKYTĖ .

If you were born before the 60s, you might remember how polio used to be a major cause of death, paralysis and lifelong disability across Europe and beyond. But polio – as well as flu, measles, pertussis and more – is now entirely preventable, thanks to vaccinations.

According to the European Centre for Disease Prevention and Control (ECDC), vaccination now stops 2.7 million worldwide from getting measles, one million from getting pertussis and two million babies from getting tetanus.

However – vaccination programmes are still met with hesitancy by some.

In 2018, approximately 527,000 children missed their first dose of a measles-containing vaccine in the World Health Organisation (WHO) European Region. One year later, immunity gaps resulted in an outbreak of the measles virus in Europe, infecting over 100,000 people across all age groups, UNICEF reported.

It is a simple calculation. When routine vaccinations are missed, the risk of disease outbreaks increases. And in recent years, routine immunisation has faced a further disrupting factor: a global pandemic that paralysed health systems worldwide.

In May 2020, a few months into the COVID-19 pandemic, the WHO announced that at least 80 million children under the age of one were at risk of missing life-saving vaccinations.

“The marked magnitude and global scale of immunisation disruption evoke the dangers of vaccine-preventable disease outbreaks in the future,“ the Lancet warned. “Children who are unvaccinated and susceptible to vaccine-preventable diseases can lead to a higher burden of disease than previously, and excess deaths.”

Particularly concerning are polio and measles.

In an interview with EURACTIV last year, the executive director of Vaccines Europe Sibilia Quilici called for a catch-up immunisation campaign to overcome the difficulties routine vaccination programmes have experienced during the pandemic.

UNICEF Regional Director for Europe and Central Asia, Afshan Khan confirmed the urgency, stating that “it is critical that routine immunisation programmes continue during this crisis.”

This includes ongoing assessment of recovery, catch-up vaccination strategy implementation for vulnerable populations, and ensuring vaccine coverage equity and health system resilience.

“Reaching the most vulnerable children who have missed routine immunisations in the past should be prioritised,” Khan added.

How are we doing?

There is still “a distance to go with countries still reporting disruptions in their essential immunisation program,” said the Director of the Department of Immunisation, Vaccines and Biologicals at the WHO, Kate O’Brien at a press briefing on 11 April following a meeting of WHO’s Strategic Advisory Group of Experts (SAGE).

The challenge is two-fold, she emphasised: advancing COVID-19 vaccine programmes, as well as the recovery of essential immunisation schedules.

“About 50 per cent of countries in our poll survey of essential health services at the end of 2021 were still reporting disruptions to the routine immunisation programme,” O’Brien said.

She urged that the main challenge is identifying children who missed their immunisation, adding that this issue is “partly a health worker issue, partly a programmatic issue of finding those children and also a planning issue of how to actually do catch up.”

“There are many opportunities to immunise children, either through campaign-style approaches or through their encounter with the health system for anything else that they are seeking care for,” she said.

“We do see in the European region, countries recovering from that disruption,” O’Brien said, adding that data on vaccination coverage for 2021 will be released on 15 July.

The recovery set back by the invasion

However, Russia’s invasion of Ukraine on February 24 has had a profound effect on vaccination recovery schedules.

“Obviously, many children are displaced, both internally and externally. And there are significant efforts and programmes to assure that those children are up to date on their vaccinations,” O’Brien said.

Again, the biggest concerns are measles and polio infections.

“The issue is the possibility that viruses that are in the environment might cause an outbreak, as they did in Ukraine if there were pockets of children who were not properly immunised against polio, in the neighbouring countries,” SAGE chair Alejandro Cravioto explained.

He said that their recommendation is to both have children in the local countries properly immunised, and offer the vaccines for refugee children that are necessary for completing immunisation schemes.

“I think everybody’s aware that the need is, as in any case for refugee children, to both protect them and protect the locals from having contact with anything that might harm them in any way,” Cravioto concluded. 

• Peseckytė is on the  EURACTIV’s Health Team