Much global attention has been focused on the uneven distribution of Covid-19 vaccine doses around the world. Yet a growing body of evidence suggests that struggle some under-resourced healthcare systems face to deliver jabs without compromising on other care is being overlooked. In particular, efforts focused on vaccinating against one particular disease considered more urgent than others can lead to routine immunisations and standard healthcare functions being neglected, researchers have found.
In some developing countries with weaker healthcare systems, essential vaccines such as those against measles and polio are delivered via efforts known as supplementary immunisation activities, or SIAs. SIAs usually involve healthcare professionals and volunteers going from village to village in rural areas, knocking on doors and setting up mobile vaccination stands.
SIAs are very effective, typically reaching 90 to 95 per cent of the people they target. In Nigeria, for instance, a long campaign of SIAs eliminated polio from the country last year, leaving just two nations – Pakistan and Afghanistan – in which the virus continues to spread. Yet they can also suck resources away from the main healthcare systems, according to research.
A new paper by a team led by Marco Haenssgen, a researcher at the University of Warwick, looked at SIAs aimed at eliminating polio in Nigeria between 2000 and 2017. It found that focusing resources and personnel on eradicating polio adversely affected the healthcare system’s ability to deliver routine immunisations. Over the 17 years of the study, the paper estimates that polio campaigns left around 3.6 million children deprived of receiving the full immunisation schedule.
One worker in Kano state, in northern Nigeria, commented to researchers that: “80 per cent of the healthcare activity [stops] until the polio campaign days are over”. In addition, some residents of rural areas were suspicious of well-funded polio eradication campaigns, asking why the polio jab should be free and brought to their front doors while routine healthcare services required payment and were given in underfunded and poorly maintained hospitals.
Although the paper focused on Nigeria, “there may be good reason to believe that [the findings] hold more widely because they’re to do with the issue of a healthcare system suffering when very high-intensity campaigns are run”, Haenssgen told me.
The findings have particular relevance as poorer countries await Covid-19 vaccines. Although few doses have so far been sent to countries in the Global South, deliveries are expected to ramp up through the year. Covax, the World Health Organisation’s vaccine-sharing programme, expects to deliver up to 337 million vaccine doses to developing countries by the end of the first half of 2021, and 2 billion by the end of the year, with the figures likely to increase dramatically in 2022.
That means that in countries where SIAs are asked to deliver millions of doses of a coronavirus vaccine, other programmes, such as vaccinations against measles, could be sidelined – resulting in longer-term health costs, including a resurgence in lower-priority diseases or ailments.
Preventing these outcomes will require greater focus on the mechanisms of delivery, in addition to the doses themselves, the report concludes. This could mean rich countries offering personnel to carry out the vaccination campaigns in poorer nations, Haenssgen said.
The problem could also be mitigated if governments pay attention to ensuing that SIAs are not conducted at the expense of other healthcare, even though administration of Covid-19 vaccines will be near the top of their priorities in the months to come. The side-effects of SIAs are unlikely to outweigh the benefits of administering Covid-19 vaccines, Haenssgen said, though he stressed the importance of considering the potential downsides.
The findings underline how multifaceted dealing with Covid-19 is, especially for countries in the developing world which, having been close to abandoned as the rich world hoards vaccine doses for itself, will find administering those doses a further challenge.