The Future of Routine Immunization During COVID-19

Focusing on any one crisis today can be challenging, as new emergencies overshadow previous ones. Though the COVID-19 pandemic continues to burn, our thoughts have recently been with the people of Ukraine, where war has caused profound damage, including to health workers providing lifesaving services. We must not let the lessons learned and the increased commitments to global health spurred by COVID-19 fall victim as well.

As we mark World Immunization Week 2022, over 11 billion COVID-19 vaccine doses have been administered globally — the fastest vaccine rollout in history.

This tremendous global achievement unfortunately obscures vast inequities at multiple levels. As of April 20, just 1 in 7 people (15.21%) living in low-income countries have received at least one vaccine against SARS-CoV-2. Only 17 percent of the WHO African region’s population is even partially vaccinated. We have failed to achieve the level of vaccine equity the Sabin Vaccine Institute called for during World Immunization Week one year ago.

Inequitable vaccine distribution mirrors the impact COVID-19 has had on other health services, including routine immunizations. Since COVID’s emergence, multiple countries have reported outbreaks of vaccine-preventable diseases that can be directly linked to declining routine immunization. Malawi has reported its first polio outbreak in three decades – two years after polio was declared eradicated in Africa. As we push to end the COVID-19 pandemic, we also urgently need to restore and maintain high rates of routine immunization against all vaccine preventable diseases.

Beyond the current crisis, we must identify and address immunization system weaknesses, build trust in vaccines, and integrate immunization across the life course into primary health care. This is the strategy outlined in WHO’s Immunization Agenda 2030. We can improve and prolong lives by maximizing the potential of vaccines for all people throughout their lifetime. Supporting infrastructure for routine immunization will also help fight COVID-19 as regular boosters may be necessary to maintain protection.

Major long-term investments are needed to strengthen and integrate life course immunization with existing systems. COVAX included $1.6 billion for country-level COVID-19 vaccine readiness and delivery in its current investment case for the 92 Gavi Advanced Market Commitment (AMC) countries. This is an important step, but we must think beyond the current crisis. To maximize impact, we must integrate COVID-19 vaccination into immunization systems while simultaneously strengthening those systems. The cost will be far greater than $1.6 billion, but the investment will pay dividends.

A key part of success is investing in the people on the front lines. Last year I commented during the White House Global COVID Summit that investing in health workers is central to high vaccine uptake. Hundreds of thousands of health workers have died from COVID-19. Many others have left the profession due to the strains of the pandemic. These factors are making the shortage of health workers even worse, particularly in LMICs where health workers often lack adequate pay, vaccination, protective equipment and protection from violence. Only 75% of health workers are fully vaccinated in the 61 of the 92 Gavi AMC countries that report on their COVID-19 vaccination rates. One quarter of health workers are susceptible to the very disease they are vaccinating others against.

Rapid, decisive action is needed so the health workforce can effectively respond to emergencies. Nurses, community health workers, pharmacists, midwives and other frontline professionals must be included in these efforts, as their hard-learned lessons from the COVID-19 response must inform future strategies. Sabin applauds the United States for proposing a new Health Worker Initiative – a bold first step and catalyst for greater investment by the U.S. and other countries.

As other crises gain attention, political will for building back better from COVID-19 is already beginning to wane. For instance, the U.S. Congress has unfortunately yet to approve new global response funding even as USAID’s GlobalVax initiative other vital programs run dry. Fully funding global health accounts is not only critical for global COVID-19 response and recovery, but also for the future health and security of Americans.

At the World Health Assembly and G7 and G20 Summits, Sabin urges world leaders to commit to accelerating their COVID-19 response and pandemic-proofing the future, as outlined by the Pandemic Action Network’s Call to Action. A better future will require commitment to immunization, support for the people who deliver care, and actionable research to understand and address vaccine acceptance and demand globally. Vaccines have incredible potential to prevent crises, but only if they reach every community.