Focusing on Community-Based Solutions to Reverse Routine Immunization Backslide
As global health leaders during World Immunization Week largely focused due attention on addressing inequities in COVID-19 vaccination rollout, Sabin Vaccine Institute CEO Amy Finan rightly also called attention to the urgent need “to restore and maintain high rates of routine immunization against all vaccine-preventable diseases.”
Exacerbated by the COVID-19 pandemic, disjointed and siloed health programming perpetuates disparities in immunization, a critical and indispensable public health tool for preventing disease and bolstering life expectancy. The practical and logistical effects of inaccessible care, coupled with declining vaccine trust and confidence and the spread of misinformation, have triggered a backslide in routine immunization and increased the number of “zero-dose children” – children who have never received a single dose of the diphtheria, tetanus, and pertussis vaccine (DTP1). Although only one in seven children are zero-dose children, they account for nearly half of all vaccine-preventable deaths.
In 2020, most countries experienced a decrease in childhood immunization rates, as 23 million children globally did not receive routine vaccines, a 20% increase from 2019. Since the beginning of the pandemic, vaccine-preventable diseases have reappeared in some communities for the first time in years. Reported outbreaks, including the first polio case in Malawi in three decades, can be directly linked to the backslide in routine immunization.
These worrying trends put at great risk this year’s World Immunization Week theme of #LongLifeForAll and demonstrate the need for a closer look at the unique challenges of different routine immunizations, such as HPV, as well as the implementation of the most underutilized and underinvested solutions closest to communities.
HPV vaccination push needed
HPV immunization rates, already too low, suffered a concerning relapse during the pandemic as 1.6 million girls missed out on the vaccine in 2020.
Dorothy Logedi, nurse, EPI Logistician for Kenya’s Ministry of Health and guest on Immunization Advocates’s podcast Community Conversations on Vaccines, stresses that misinformation and lack of education on the routine HPV immunization regimen have stifled uptake of the vaccine and led to many pre-teens missing the second dose.
As the absence of accurate information in many communities has negatively affected HPV immunization rates, Logedi is especially concerned with the strict age bracket for HPV vaccination, age restrictions that are similarly present with other routine vaccines. In 2020, only 13% of the target population had received both HPV doses due to barriers such as supply, cost, and age restrictions. If we do not act now to address and reverse the backslide of routine immunization that occurred during the pandemic, we risk cohorts aging out and growing up without the health – and socioeconomic – benefits of routine vaccines for themselves and their communities.
Last month, the World Health Organization’s (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) reviewed all available evidence on HPV vaccination, finding a single vaccine dose effective against HPV in girls and women ages 9 to 20, a recommendation that directly addresses low two-dose HPV immunization rates. Integrating and understanding community needs in global health policy and practice to promote innovative and community-based efforts are critical to increasing HPV vaccination rates.
Reversing the backslide in routine immunization rates
Health workers delivering primary care have the ability to engage as trusted community voices and sources of vaccine information, yet they have been underinvested in and underutilized in vaccination campaigns. Communication skills, such as those reinforced through the International Pediatric Association’s Vaccine Trust Project, and immunization administration skills, such as those emphasized in the Open WHO course, need to be scaled up for health workers, particularly those working with vulnerable populations or marginalized communities.
Health workers listen, answer questions and empathize with patient concerns. We cannot overlook the trust that patients have for local health workers, trust that is essential to increase vaccine confidence among individuals and communities. Global health practice must build data-driven, locally-owned policies and immunization infrastructure and strengthen the scope and efficiency of health workers delivering primary care who have the power to improve vaccine equity and confidence.
Sabin’s Vaccine Acceptance & Demand and Immunization Advocates Initiatives, along with other Sabin programs, strive to support professionals closest to communities in low- and middle-income countries to bolster immunization rates. Most recently, Sabin’s Boost Community launched applications for the COVID-19 Recovery for Routine Immunization Programs Fellowship, an opportunity for national and sub-national immunization professionals to build capacity to strengthen, administer and manage routine immunization programs.
As other major global gatherings, including the Global COVID-19 Summit and World Health Assembly, soon commence, policymakers and global health program leaders must take action to enact systemic change to enable professionals closest to communities across sectors of expertise – from social and behavioral researchers to journalists to health workers – to address the recent backslide of routine immunization. Vaccines must reach every community to ensure a truly equitable future, free from vaccine-preventable diseases.
