News and Opinions  –  2020

Impact of COVID-19 on vaccine-preventable diseases and antibiotic resistance

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One of the consequences of the COVID-19 pandemic is that vaccination efforts that help control other diseases may be put on hold. This may lead to increased strain on health systems, morbidity and mortality due to vaccine-preventable disease and increases in antibiotic resistance.

Pregnant woman receiving an influenza vaccination at the Maternal and Child Hospital in Vientiane, Laos. Photo: CDC at Unsplash.

In a response to the impending risk for disruption of vaccination activities, the WHO and its Strategic Advisory Group of Experts on Immunization has provided an interim guidance for vaccinations. The guidance clearly states that routine immunization is a core health service that should be prioritized in order to prevent an upsurge of vaccine-preventable diseases. However, immunization campaigns not part of routine immunizations in areas where there is no active outbreak of a vaccine-preventable disease, are recommended to be paused to minimize the spread of COVID-19.

In addition to health services being strained due to an increased need for healthcare as well as healthcare workers falling ill in the wake of the pandemic, vaccine manufacturing and distribution may be impacted, leading to short supply. Where immunization programs and campaigns are negatively affected, the recommendations implore the relevant authorities to keep track of those who are not reached either due to disruptions so that they are not lost to follow-up once vaccination campaigns can start again.

Potential consequences

If immunizations are ceased, or if people do not show up for scheduled immunizations due to fear of COVID-19, we might see an upsurge of vaccine-preventable diseases. Many of these diseases, like measles and polio, may even be more severe than COVID-19, especially to the children would have otherwise been vaccinated. GAVI estimates that at least 13.5 million people in 13 of the world’s least developed countries will not be vaccinated against measles, polio and human papillomavirus (HPV) in the short term, and in the long-term, millions more will follow. The resulting disease burden has potential to be devastating, not only to the people suffering from disease and their families, but also to whole health systems that are likely to already be weak.

In addition to the burden of the diseases themselves and their complications, antibiotic use can be expected to increase thereby increasing the risk of development of antibiotic resistance. Many viral infections are treated with antibiotics for a multitude of reasons, from antibiotics being perceived as universal anti-fever drugs, lack of access to healthcare and diagnostics for targeted and well-informed treatment or prophylaxis for possible secondary bacterial infections. Also, if pneumococcal (PCV) vaccinations are reduced, there is a risk for increased morbidity and mortality in pneumococcal pneumonia, but also a risk in associated increases for antibiotic use in infections that could otherwise be prevented with PCV.

Tough decisions

For healthcare professionals and policymakers, deciding against vaccinating – and thus protecting – a vulnerable part of their population is a difficult choice due to the many competing priorities and additional strain on the health system caused by COVID-19. In settings and regions where immunizations can be continued safely, it is important for healthcare authorities and facilities to do so and encourage people to get vaccinated by clear communication and outreach. And where vaccinations need to be out on hold, it is imperative that those who should have been vaccinated are reached once vaccinations can be performed safely.

How do vaccines work?

Vaccines are medicines that work by evoking an immune system response to components, antigens, of the virus or bacterium from which it is designed to protect. The immune response creates antibodies and memory B-cells that can be mobilized quickly to counter an infection at an early phase – commonly before the disease is manifested clinically. . To create a strong and long-lasting protection, more than one dose is often required initially, along with booster doses after some years.

Examples of vaccines

Virus Bacteria
Measles Pneumococci
Polio Diphtheria
Rubella Tetanus
Influenza Haemophilus influenzae type B (HiB)
Varicella (Chicken pox) Pertussis

Currently, there is no vaccine available for COVID-19, but research is ongoing and some candidates are in development.

Further reading

WHO-SAGE: Guiding principles for immunization activities during the COVID-19 pandemic

GAVI: COVID-19: massive impact on lower-income countries threatens more disease outbreaks

WHO/UNICEF joint statement – Maintaining routine immunization services vital during the COVID-19 pandemic

WHO: More than 117 million children at risk of missing out on measles vaccines, as COVID-19 surges