Four years ago in March 2020, the World Health Organization (WHO) officially declared coronavirus disease 2019 (COVID-19) a global pandemic. Nations scrambled to develop and secure vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – competing for supplies, intensifying political rivalries, and hoarding in the name of nationalism. As adults engaged in this frenetic scramble, millions of children were missing out on basic vaccines due to halted immunization services. The pandemic had inevitably given rise to lockdowns, social distancing measures, and economic struggles that disrupted essential healthcare services across the globe. Consequently, by the end of 2020, 23 million children had not received routine vaccinations, increasing their risk of contracting fatal, yet vaccine-preventable, diseases such as measles, polio, and diphtheria.
After birth, most infants around the world receive a standard set of vaccines that protect them from viral and bacterial infections. These vaccines target MMR (measles, mumps, rubella), DPT (diphtheria, pertussis, tetanus), rotavirus, poliovirus, pneumococcus, and more. During the first year of the COVID-19 pandemic, there were 17 million “zero-dose” children – those who had not received a single dose of any vaccine. Importantly, 98% of zero-dose children were from low- and middle-income countries. In some cases, children failed to complete all the required doses in a vaccine series. For instance, three doses of the DPT vaccine are usually administered within 12 months of birth. In 2020, the number of children who did not complete the 3-dose DPT series increased by 20% compared to the previous year – with the greatest increases in South-East Asian and Eastern Mediterranean regions.
Similarly, polio vaccination programs were significantly disrupted by the COVID-19 pandemic. In 2020, 46 poliovirus immunization campaigns were suspended in 38 countries. Coincidentally, a newly mutated strain of poliovirus was reported in more than 30 countries and polio outbreaks emerged during the same year. In Pakistan, 40 million children did not receive polio vaccines when immunization programs were suspended in April 2020. While vaccinations gradually resumed thereafter, there may be long-term consequences to face in the future – considering Pakistan is one of the few countries in the world where polio has not been eliminated.
It is undeniable that childhood vaccinations took a severe hit in 2020. In low- and middle-income countries, pre-existing challenges such as lack of infrastructure, political instability, and fragile healthcare systems, made it even more challenging to maintain immunization services during the pandemic. Additionally, vaccine hesitancy had been on the rise long before the SARS-CoV-2 outbreak, threatening childhood vaccination efforts worldwide.
In fact, the WHO had highlighted “vaccine hesitancy – the reluctance or refusal to vaccinate – despite the availability of vaccines” as one of the top 10 threats to global health in 2019. While drivers of vaccine hesitancy are multifaceted with geopolitical and cultural nuances, the dissemination of false and sensationalizing information through the Internet has certainly played a role. In 2005, a study conducted by Johns Hopkins Bloomberg School of Public Health reported that in the United States, parents who exempt their children from vaccinations were more likely to have consulted anti-vaccination websites compared to parents of vaccinated children. Supporting studies have shown these websites discuss vaccine safety concerns, alternative medicines, civil liberties, and conspiracy theories that proport collusion between doctors, pharmaceutical industries, and the government.
As a corollary to vaccine hesitancy, vaccine-preventable diseases began to re-emerge prior to 2020. For example, Centers for Disease Control and Prevention reported that measles incidence had increased in all six WHO regions during 2017-2019. In an attempt to eliminate this disease worldwide, vaccination efforts had decreased annual incidence rates by 88% from the year 2000 to 2016. The lowest incidence occurred in 2016 with 18 cases per population of 1 million. Yet by 2019, measles incidence had risen to 120 cases per million, likely due to difficulties in the vaccination campaign, improving surveillance, and closing immunity gaps.
Finally, as COVID-19 vaccines were being approved amidst the recent pandemic, vaccine hesitancy brewed among experts and parents alike. Specifically, there were doubts about the necessity and safety of COVID-19 vaccines for children under 12 years of age. Fueling such doubts were studies reporting that the risk of severe COVID-19 was significantly lower in infected, healthy children compared to adults. In addition, there were reports of rare, transient myocarditis (inflammation of the heart) occurring in adolescent and young adult males within a week of receiving their second dose of the COVID-19 vaccine that were sensationalized in the media.
As of March 2024, all children 6 months of age and older are eligible for COVID-19 vaccines in Canada. Interestingly, a recent 2023 survey conducted by the Government of Canada revealed that 44% of parents with children below 18 years of age are reluctant to vaccinate their children against SARS-CoV-2. Among the 44%, the majority (72%) stated their reluctance stemmed from lack of COVID-19 vaccine research conducted in children. Altogether, it appears that national and global strategies are required to not only improve vaccine accessibility but also educate the public on vaccine efficacy, while gaining its trust with rigorous and transparent clinical research.
Jennifer Ahn
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