COVID Lockdowns Have Sped Up the Spread of Other Diseases, a Measles Explosion Feared

As poor countries around the world struggle to beat back the coronavirus, they are unintentionally contributing to fresh explosions of illness and death from other diseases — ones that are readily prevented by vaccines.

This spring, after the World Health Organization and UNICEF warned that the pandemic could spread swiftly when children gathered for shots, many countries suspended their inoculation programs. Even in countries that tried to keep them going, cargo flights with vaccine supplies were halted by the pandemic and health workers perted to fight it.

Now, diphtheria is appearing in Pakistan, Bangladesh and Nepal.

Cholera is in South Sudan, Cameroon, Mozambique, Yemen and Bangladesh.

A mutated strain of poliovirus has been reported in more than 30 countries.

And measles is flaring around the globe, including in Bangladesh, Brazil, Cambodia, Central African Republic, Iraq, Kazakhstan, Nepal, Nigeria and Uzbekistan.

Of 29 countries that have currently suspended measles campaigns because of the pandemic, 18 are reporting outbreaks. An additional 13 countries are considering postponement. According to the Measles and Rubella Initiative, 178 million people are at risk of missing measles shots in 2020.

The risk now is “an epidemic in a few months’ time that will kill more children than Covid,” said Chibuzo Okonta, the president of Doctors Without Borders in West and Central Africa.

As the pandemic lingers, the W.H.O. and other international public health groups are now urging countries to carefully resume vaccination while contending with the coronavirus.

At stake is the future of a hard-fought, 20-year collaboration that has prevented 35 million deaths in 98 countries from vaccine-preventable diseases, and reduced mortality from them in children by 44 percent, according to a 2019 study by the Vaccine Impact Modeling Consortium, a group of public health scholars.

“Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health,” said Dr. Tedros Adhanom Ghebreyesus, director general of the W.H.O., in a statement. “Disruption to immunization programs from the Covid-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles.”

But the obstacles to restarting are considerable. Vaccine supplies are still hard to come by. Health care workers are increasingly working full time on Covid-19, the infection caused by the coronavirus. And a new wave of vaccine hesitancy [more like of Covid hesitancy] is keeping parents from clinics.

“We will have countries trying to recover from Covid and then facing measles. It would stretch their health systems further and have serious economic and humanitarian consequences,” said Dr. Robin Nandy, chief of immunization for UNICEF, which supplies vaccines to 100 countries, reaching 45 percent of children under 5.

The breakdown of vaccine delivery also has stark implications for protecting against the coronavirus itself.

At a global summit earlier this month, Gavi, the Vaccine Alliance, a health partnership founded by the Bill and Melinda Gates Foundation, announced it had received pledges of $8.8 billion for basic vaccines to children in poor and middle-income countries, and was beginning a drive to deliver Covid-19 vaccines, once they’re available.

But as services collapse under the pandemic, “they are the same ones that will be needed to send out a Covid vaccine,” warned Dr. Katherine O’Brien, the W.H.O.’s director of immunization, vaccines and biologicals, during a recent webinar on immunization challenges.

More contagious than Covid

Measles virus spreads easily by aerosol — tiny particles or droplets suspended in the air — and is far more contagious than the coronavirus, according to experts at the Centers for Disease Control and Prevention.

“If people walk into a room where a person with measles had been two hours ago and no one has been immunized, 100 percent of those people will get infected,” said Dr. Yvonne Maldonado, a pediatric infectious disease expert at Stanford University.

In poorer countries, the measles mortality rate for children under 5 ranges between 3 and 6 percent; conditions like malnutrition or an overcrowded refugee camp can increase the fatality rate. Children may succumb to complications such as pneumonia, encephalitis and severe diarrhea.

In 2018, the most recent year for which data worldwide has been compiled, there were nearly 10 million estimated cases of measles and 142,300 related deaths. And global immunization programs were more robust then.

Before the coronavirus pandemic in Ethiopia, 91 percent of children in the capital, Addis Ababa, received their first measles vaccination during routine visits, while 29 percent in rural regions got them. (To prevent an outbreak of a highly infectious disease like measles, the optimum coverage is 95 percent or higher, with two doses of vaccine.) When the pandemic struck, the country suspended its April measles campaign. But the government continues to report many new cases.

“Outbreak pathogens don’t recognize borders,” said Dr. O’Brien of the W.H.O. “Especially measles: Measles anywhere is measles everywhere.”

Wealthier countries’ immunization rates have also been plunging during the pandemic. Some American states report drops as steep as 70 percent below the same period a year earlier, for measles and other diseases.

Once people start traveling again, the risk of infection will surge. “It keeps me up at night,” said Dr. Stephen L. Cochi, a senior adviser at the global immunization pision at the C.D.C. “These vaccine-preventable diseases are just one plane ride away.”

Source: The New York Times