Q&A with Gabriele Fontana

UNICEF Eastern and Southern Africa Regional Advisor for Health

By Gabriele Fontana
A child is vaccinated against measles at the DFID and UNICEF-supported Nutrition Health Centre in Hargeisa, Somaliland on 3rd February 2021.
30 April 2021

How are childhood routine immunization programmes doing generally across Eastern and Southern Africa?

Vaccinating children is the most effective way to protect them and to save lives. Yet, 1 in 5 African children do not receive all the necessary and basic vaccines. As a result, more than 30 million children under five still suffer from vaccine-preventable diseases every year in Africa. Over half a million children die from these diseases annually.

Given the region has seen 2.5 per cent population growth every year over the last few years, the number of children needing to be vaccinated has been growing year on year. Resources have not kept pace though, and the same number of health professionals are expected to vaccinate growing numbers of children. The result is increasing numbers of unimmunized children every year. For diseases that spread quickly, like measles, that results in outbreaks among children and deaths. We need to sustain vaccination efforts in countries, to make sure no child is left behind.

Has COVID made a big difference?

The COVID-19 pandemic has complicated the situation. Many countries rely on vaccination campaigns to cope with weak health systems and poor routine immunization. Vaccine campaigns have been delayed due to the pandemic, and some children are still waiting to get their vaccines. Sadly, some get sick, and some children have died.

We can prevent this. We can run immunization campaigns safely: after more than one year into the pandemic we know how to do it. There is no reason to wait.

In 2020, it became very difficult to ship vaccines to countries: planes were not flying, and even when airspace opened-up, flights have been few and far apart. UNICEF came up with new strategies to deliver vaccines and Gavi made additional funding available. We still managed to deliver 2.1 billion doses of vaccines, but that is less than the year before.

We have seen disruptions of essential services for children, including immunization, across the board. As a result, more children are getting sick and dying. Immunization services in many countries are slowly catching up, but we need to accelerate.

In South Asia, where countries started being affected by COVID before Africa, we calculated that more than 800,000 children died of preventable causes due to the impact of COVID and its containment measures. We are now doing a similar assessment for Africa. We fear the numbers will also be scary.

We hear talk about reopening economies. Let’s at the same time improve access to health services, including immunization.

We are making every effort to get COVID vaccines in countries to protect people, especially the elderly and people with health conditions. It’s crucial that we keep protecting our children at the same time.

What are the main challenges that childhood vaccination programmes face today?

It is concerning that the most vulnerable and hard to reach children are the ones often left out. Sometimes we use immunization programmes as an early warning: if children are not reached with vaccines, they are also likely to miss out on other essential health services.

It is the families that live far from health facilities, that are poor, that are marginalized. It is their children who are the ones left behind due to weak and underfunded routine immunization services.

Even when vaccines are available, we sometimes see some hesitancy. We have eliminated a deadly disease like smallpox through vaccination, and we are eliminating polio in the same way. We have seen the number of children dying from vaccine preventable diseases drop to almost none, thanks to vaccination. And still, unfounded rumours and fear continue to circulate.

Which countries are of greatest concern?

All countries have been impacted. But what is more concerning is that the most vulnerable and hard to reach groups in each country have been disproportionately affected.

These are people who rely mostly on services provided at community level, outreach activities, campaigns. People who live far from health facilities, the poor or marginalized, their children are the one left behind.

We need governments, donors and implementing agencies to double their efforts, to protect national and aid budgets to sustain delivery of health services, and vaccination in particular. We must remember that diseases do not respect borders.

Countries with stronger health systems and immunization progammes did better. It’s a clear indication of what works: strengthening delivery of health interventions pays off.

Is there vaccine hesitancy and if so where is it worst?

People are familiar with traditional vaccines. We eradicated smallpox, we are eradicating polio, we have seen deaths from measles decrease, and we see new cases and deaths every time we stop or slow vaccination. Vaccines work and we know it.

Rumours around COVID vaccines have created confusion. We have seen countries suspending the use of vaccines, to reintroduce them few days or weeks later, when reassured of their safety and effectiveness.

This can also bring hesitancy around traditional vaccines. Fortunately, we have many leaders, religious figures, politicians who are sharing good information on vaccines, who are promoting them and letting people know that they are safe and effective in saving lives.

What can people at home do, to support the vaccination of children?

We can all do our part: governments, health professionals, financing institutions, care givers. Together, we can help ensure that all children are vaccinated and protected.

Governments can prioritize resources to ensure that vaccines are available and used. Donors can support health systems strengthening with long term initiatives, so that vaccines and other essential health services are provided to children.

There are already many leaders, religious figures, politicians, celebrities who are sharing good information on vaccines, who are promoting them, who let people know that vaccines are safe and effective in preventing children from dying.