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Maintaining commitment to immunization in Africa through COVID-19 and beyond

May 14, 2020

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Photo: Bill & Melinda Gates Foundation/Riccardo Gangale. A nurse administers vaccines to children at the Ngarenaro Health Center in Arusha, Tanzania.

The COVID-19 pandemic is putting a strain on health systems worldwide. The increasing demand on health facilities and health care workers has dramatically shifted resources from essential routine health services—such as immunization—to COVID-19 response as countries put in place measures to control the infection and limit the impact on health systems and economies. However, the world has learned from past outbreaks of diseases like Ebola that disruption of immunization services—even for brief periods—can result in outbreaks and unnecessary deaths.

The World Health Organization has released guiding principles for immunization activities during the COVID-19 pandemic that countries around the world are translating into national-level plans. Meanwhile, the Africa Union has rolled out a continental strategy focused on containment and aggressive preventive measures including restrictions on movement, ranging from moderate voluntary stay-at-home measures to more severe mandatory curfews and total lockdowns. While these preventative activities are commendable, targeted actions and response strategies are needed to safeguard the millions of lives at stake if delivery and uptake of critical services, such as immunization, are disrupted.

It is against this background and with the upcoming replenishment conference for Gavi, the Vaccine Alliance, that PATH partnered with the BID Learning Network and Gavi to host an online conversation about maintaining commitment for immunization in Africa through COVID-19 and beyond. During the event, participants heard from Dr. Alfred Driwale, National Expanded Programme on Immunization Manager, Uganda; Fred Njobvu, Health Systems Innovation and Delivery Manager, from the Better Immunization Data (BID) Initiative, Zambia; and Dr. Marthe Essengue, Regional Head for Francophone Africa, Gavi, the Vaccine Alliance.

The conversation focused on understanding the challenges presented by the COVID-19 pandemic to existing immunization efforts in the region, approaches to sustaining vaccine delivery, and maintaining political commitment and civil society actions for immunization during COVID-19 and beyond. Below are a few key takeaways:

Maintaining immunization systems is essential during and beyond the COVID-19 pandemic.

Recent modeling in low- and middle-income countries shows that even brief disruptions of immunization services will result in an increased number of vaccine preventable deaths, Dr. Essengue remarked. She stressed the need to increase investment in immunization services to both prevent these disruptions and ensure immunization platforms can cope with introduction of a COVID-19 vaccine when one becomes available. To this point, Gavi has pivoted its focus to reach missed communities and ensure routine immunization continues and vaccine stockouts are avoided, a risk that 80% of Gavi-eligible countries currently face. Since there is no one-size-fits-all approach to immunization, Gavi is customizing its approach by country to ensure everyone, everywhere is reached through immunization programs.

It is more important than ever to replenish funding for Gavi to mitigate the potentially grievous impact of COVID- 19 on immunization. This is especially true as countries divert resources toward responding to the pandemic while battling economic downturns, which make it difficult for countries to pay co-financing commitments to Gavi. Dr. Essengue noted that the Alliance is currently reviewing country transition plans so they remain flexible. This will allow them to maintain robust vaccination programs in countries that can no longer afford their co-financing, or those transitioning out of Gavi support.

Dr. Essengue also warned that once a vaccine against COVID-19 becomes available, it is vital that the funding and infrastructure be in place to ensure it is equitably rolled out.  “All people in the world need to be protected by vaccines—not only those who can pay. This is about saving lives,” she said.

Ensuring the continuation of routine immunization must be a joint effort across all sectors and at all levels.

All speakers echoed the value of collaboration among governments, NGOs, and the private sector in developing effective strategies and tools to educate policymakers, frontline health workers, health care champions, and members of the public on the continued need for immunization despite the ongoing pandemic.

Dr. Driwale explained that in Uganda, President Yoweri Museveni is a strong champion for immunization, with a history of committing to increasing the immunization budget—almost doubling funds for immunization in the 2019-2020 budget. Uganda’s leadership demonstrates the importance of political will and commitment to sustaining vaccine programs and coverage. However, despite this leadership, Uganda has seen a decline in the use of health services as many people wrongly assume the national stay-at-home orders prevent health care facilities from remaining operational for routine services such as immunization and antenatal care. Leaders at all levels, and both within and outside of the government, have an important role to play in championing the continuation of health services during the pandemic and combating the spread of false information surrounding it. Ensuring these champions are equipped with the right information and that they are successful in reaching the public is more important than ever.

“We need to allay the public’s fears around COVID-19 so that they continue accessing immunization services as they are being provided,” said Dr. Driwale.

Relevant, timely data is needed to strengthen and maintain immunization systems during and post pandemic.

Digital and data tools and approaches first introduced to strengthen immunization services are now being used to understand and curb the impacts of COVID-19, explained Njobvu. In Zambia, the data made available by digital systems, such as the electronic immunization registries introduced under the BID Initiative, can help track trends in immunization. This allows officials to help shape immunization policy and decisions during the pandemic. It will also help target missed populations once the pandemic subsides. These electronic immunization systems can also be used to spread messages of health promotion by mobile phone when paired with patients’ digital vaccine records.

Use of data and information systems also enables planning and forecasting to minimize disruption of immunization services during COVID-19 and beyond. Dr. Driwale said that in advance of the lockdown, Uganda was able to quickly assess its vaccine stock and procure additional vaccines before supply chains were significantly impacted. Additionally, Uganda is already making data-informed plans for rolling out and resourcing catch-up immunization campaigns during the post-COVID period, based on enumeration of cohorts of children who may have missed vaccine doses.

With this proven success of digital tools, Njobvu conveyed the importance of increased investment in digital health services to ensure missed populations can be targeted through immunization services once the pandemic is over.

A full recording of the conversation is available here.


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