Updated: Nov 25
In this blog post, I will talk about how different countries have managed to vaccinate against infectious illnesses like smallpox and measles despite the challenges posed by the COVID-19 pandemic; various sources inspired me to write about this critical topic.
The first source of inspiration for me was the recently published " 2023 State of the World's Children" report published annually by UNICEF, in which the topic of focus is the world's progress in immunizing children against infectious diseases, such as polio and measles. I was intrigued by the content and wanted to learn more about it.
Another source of inspiration in writing about this topic was my work as a former community navigator in a community health center. My role involved a lot of community outreach to provide resources, namely health insurance literature, to underserved communities to fulfill their medical needs.
I fully acknowledge that vaccination can be a touchy and politically fraught subject for many people. This post aims to provide evidence-based information with an objective lens. A second goal in writing this blog is to highlight the vast success stories of immunization campaign efforts in vaccinating children in different countries.
I want to open up the discussion by laying out some alarming stats on where we are as a society in our immunization efforts to keep our children healthy and safe. According to UNICEF, about 67 million children globally missed the optimal window to receive their routine immunizations between 2019 and 2021. During the same period, 48 million children missed the opportunity to get immunizations(zero-dose children). Another astounding stat I'd like to share is that about 1/5, or roughly 20% of children in mainly low-income countries, are not immunized against measles, a lethal disease. The reason I mention this statistic is because measles is a deadly viral disease that attacks the respiratory and immune systems. It is typically transmitted via air particles and through close, direct contact with infected people. According to the World Health Organization (WHO), the measles vaccine impressively averted about 24 million deaths from 2000 to 2018, making routine immunization important.
The effects of children missing out on their immunizations due to the rippling effects of COVID-19 are ubiquitous and palpable.
a. Latin America and the Caribbean
The UNICEF 2023 State of the World's Children (SWOC) report from 2019 to 2021 revealed that only 6.8 million children were either not vaccinated (zero-dose) or partially immunized. The decrease in the administration of diphtheria, tetanus, and pertussis (whopping cough) vaccinations has led to more children being unvaccinated or partially immunized. In 2021, only 75% of children received the DTP3 vaccine, compared to 86% in 2017. Overall, 25% of children in the region are not fully vaccinated, compared to 11% in 2016. Brazil and Mexico have the highest number of unvaccinated children, with nearly 1 million children in Mexico being zero-dose, which is a prevalence rate of 26%. Brazil has a high prevalence rate of 17%, with around 1.5 million nonimmunized children. On the other hand, Saint Kitts and Nevis and St Vincent and the Grenadines in the Caribbean have the lowest number of zero-dose children, with 17 and 13, respectively.
b. West Africa and Central Africa
Between 2019 and 2021, approximately 19.5 million children in West Africa and Central Africa were unvaccinated. Nigeria, Chad, Cameroon, and the Democratic Republic of the Congo have the highest number of unvaccinated children, with approximately 2.5 million, 0.5 million, 1 million, and 1.5 million, respectively. The prevalence rates of unvaccinated children in these countries are 30%, 27%, 24%, and 19%, respectively. However, Cabo Verde, Sao Tome, and Principe have the lowest number of unvaccinated children, with only 691 and 188, respectively.
c. East Africa and Southern Africa
From 2019 to 2021, 12 million children did not receive necessary vaccinations during the critical period. The highest numbers of unvaccinated children, close to 1 million to 1.5 million, are found in Somalia, Angola, Madagascar, Mozambique, Ethiopia, and Tanzania. The percentage of unvaccinated children in these countries ranges from 18% to 4 %. In contrast, Seychelles has the lowest number of unvaccinated children, with only 16 remaining unvaccinated.
d. East Asia and the Pacific
Between 2019 and 2021, there were 8.3 million children who did not receive complete vaccinations. The countries with the highest numbers of unvaccinated children are Korea (Republic), Myanmar, The Philippines, Indonesia, and Vietnam, with a total of 0.5 million, 1 million, 2 million, 2 million, and 0.5 million children. The prevalence rates of children without vaccinations range from 13% to 5%. In contrast, the Pacific islands have the lowest rates of unvaccinated children. In 2021 alone, there were 3.9 million children who were either unvaccinated or only partially vaccinated.
e. South Asia
From 2019 to 2021, approximately 13 million children were either wholly unvaccinated or did not receive the full recommended vaccines. The countries with the highest number of entirely unvaccinated children are Afghanistan, India, and Pakistan, with a combined total of 1 million, 2.5 million, and 1.5 million children, respectively. The percentage of unvaccinated children in these countries is 26%, 12%, and 10%, respectively. In contrast, Bhutan has the lowest number of unvaccinated children, with only 95 reported cases. In 2021 alone, there were 5 million unvaccinated children.
f. Middle East and North Africa
From 2019 to 2021, 3.8 million children did not receive their scheduled immunizations. In 2021, Yemen, Syria, Iraq, and Sudan had the highest number of children who did not receive vaccinations. In this year alone, there were 1.4 million children who were either unvaccinated or under-vaccinated.
From 2019 to 2021, nearly 931,000 children did not receive vaccines. Although the prevalence of children with zero doses is generally low, typically ranging from single digits to low teens, this situation is not entirely positive. In 2021, 327,400 children in Europe were either unimmunized or partially immunized.
There's no question that the COVID-19 pandemic has significantly wreaked havoc on every facet of society; the healthcare system was no exception. COVID-19 and the subsequent lockdown measures can be considered an easy scapegoat and a source of the blame on why many children forgo receiving their routine immunizations so they can be on track developmentally. However, we must look beyond the pandemic and consider other systemic factors that have caused the abysmally low immunization coverage.
Reading the SWOC 2023 report has significantly opened my eyes to how inequity and inequality are constantly at play here. Westside Family Healthcare utilizes the social determinants of health framework to examine environmental factors that shape individuals' health behaviors. The framework examines risk and protective factors influencing our behaviors and practices. Receiving vaccinations to protect yourself against infectious illnesses is an example of healthy living. Systemic factors, such as limited access to healthcare and the proliferation of vaccine misinformation on social media, can deter people from getting immunized.
Reading about various countries' different immunization campaign initiatives greatly inspired me. Take, for example, Haiti; solar power electricity has been established in a local health center to sustain continuous solar power. This achievement has enabled the storage of vaccines through the availability of solar refrigerators. Subsequently, this initiative helped to uptick the vaccine coverage rate of 88% among children. Another successful vaccination campaign was in Nicaragua, where a team of nurses provided medical care to a local indigenous community on the country's coast. An impressive feat is that the indigenous community maintained a very high COVID-19 vaccination rate of about 98% during the early onset of the pandemic and in the eye of the storm of two major hurricanes- Eta and Iota. Another awe-inspiring immunization campaign I want to highlight is in India, in the Northeast area. Using innovative approaches, healthcare workers regularly deliver vaccines to children living in the most extreme remote locations by trekking through rugged mountains and hills and across bridges. This goes to show that nothing is impossible to achieve. There was a measles outbreak in the Middle Eastern country of Yemen. In response, healthcare workers established a vaccination campaign initiative to immunize about 1.2 million children between 6 months old and 10 years old against measles and rubella, which they accomplished.
Community outreach was my main line of work as a former community navigator. It was gratifying to me. An enjoyable aspect of the job was connecting with people from all walks of life to empower them with knowledge and resources. I was blessed to be in a helping position to enroll folks in health insurance, which was second to none. Life is priceless, and being protected against all health catastrophes is something that you cannot put a price tag on. Security, good health, and peace of mind are golden, and that's something that money and material wealth can never replace.
There are immense benefits to receiving regular vaccinations. Without a shadow of a doubt, they help to shield us from deadly infectious illnesses. Another advantage of immunizing is that it can avert unnecessary deaths and eliminate pain and suffering. According to the UNICEF SWOC 2023 report, vaccines could help to eliminate over 4 million deaths and, in turn, save precious lives. Vaccinations have an economic value. If all countries spent a portion of their fiscal budgets on securing immunizations, the world could be a safer, healthier place to live. According to the UNICEF 2023 SWOC report, every $1 spent on securing immunizations can deliver a return on investment of about $US 26.
If there was one thing that our healthcare system dropped the ball on during the COVID-19 pandemic, it was to adequately prepare for massive catastrophic shocks, such as the pandemic and the subsequent tragic deaths. If healthcare systems had considered the future and adopted a disaster reduction approach to tackling problems, they could have handled the COVID-19 pandemic more effectively. Without question, the COVID-19 pandemic significantly impacted every facet of the medical field, namely the discontinuation of other health services that were sorely needed, such as maternal care. The pandemic also laid bare the many shortcomings our medical field is teemed with, such as disjointed and fragmented structures.
Healthcare is a complex ecosystem with various moving parts. It needs to be more coordinated and integrated. Working in silos is not an effective approach If there's one thing my former job has opened my eyes to, it is the importance of collaborative partnerships. As a former community navigator, I established relationships with various local organizations to provide Delaware residents health insurance information. I had the pleasure of participating in community outreach events throughout Delaware. I loved connecting with different types of people. Each time I participated in a community event, my overall goal remained consistent: to equip people with knowledge of health insurance to live empowering, meaningful, and dignified lives. That gave me immense joy and pleasure! :)
While the pandemic was a massive tragedy within itself, I feel it unduly caused a huge inconvenience because the lockdown measures hugely deprived of the care and attention they needed to attend to other pressing health concerns, which will be an aftereffect felt for subsequent years to come as the world is slowly recovering from the pandemic.
Another unfortunate repercussion of the pandemic is the proliferation of misinformation/disinformation and conspiracy theories about vaccines and the origin of the COVID-19 virus. Social media has made it easy for folks to use their online platforms to spew their harmful, vitriolic viewpoints about the virus and subsequent targeting/ scapegoating of the Asian community. Social media access is the most significant contributing factor perpetuating the risk of vaccine hesitancy felt primarily among young adults rather than older adults.
In closing, there are a few actionable steps one can take to combat misinformation/disinformation and vaccine hesitancy.
To ensure accuracy, verify your sources and fact-check information. For the most up-to-date and scientifically-supported research and guidelines on immunization, consult legitimate sources like the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), which base their information on clinical research.
Encourage open and honest discussions about the significance of vaccines. Create a safe environment where individuals can share their viewpoints without fear of judgment. Keep communication lines open and respectful.
Get involved in your community and educate others about the advantages of vaccinating.