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Decline in routine vaccines is important talking point at 36th Meeting of the Caribbean Immunization Managers

According to the repot, immunization coverage backslid in most LAC countries during the first two years of the pandemic

The talking points at the 36th Meeting of the Caribbean Immunization Managers over the next two days is anticipated to be different from prior years, particularly as Latin America and the Caribbean (LAC) is facing a continued decline in immunization rates for regular coverage.

It means that many children in Antigua and Barbuda and regionally are unprotected against preventable, life-threatening diseases.

The recent decline, which has been described as a “crisis” by the United Nations Children’s Fund (UNICEF), is suspected to be fueled by the impacts of the covid-19 pandemic like added health system failures and vaccine hesitancy.   

On Tuesday morning, during the meetings opening ceremony, Dr Daniel Salas, the Unit Chief of Comprehensive Family Immunization at the Pan American Health Organization (PAHO), said such a drop in coverage had not been seen in the last decades.

“The region has been a leader in the world in terms of immunization but right now we’re second to the last part in the regions of the WHO [World Health Organization],” he said.

“This is a very serious situation where we will have to do our best to push ourselves to go beyond, to go further to reach what we haven’t reached before, “he added.

Dr. Terry-Ann Joseph, acting Chief Medical Officer (CMO) in the Ministry of Health, Wellness and the Environment in Antigua and Barbuda said people are becoming more apprehensive to taking “something that has been saving their lives all of this time”.

She believes that experiencing the covid pandemic at face value and seeing firsthand how vaccines are made has reduced individual’s confidence in inoculation, leading to the sharp decline in regular coverage.

Currently, the health ministry in Antigua and Barbuda is in the process of collating data to assess the impact of immunization decline locally but, in the meantime, Dr. Joseph suggested that efforts must be made to get people to trust health professionals again.

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“We want to have people in a space and in an environment where they’re safe and they’re healthy,” she said.

The Pan American Health Organization (PAHO) in collaboration with the Ministry of Health, Wellness and the Environment is hosting the “36th Meeting of the Caribbean Immunization Managers” in Antigua from December 6th to 8th, 2022. 

There, healthcare workers will share their experiences and address solutions for health service problems across LAC.

How serious is the decline?

Reversals in coverage in Latin America and the Caribbean (LAC) that started prior to and continued during the pandemic are a cause for major concern, a technical note by UNICEF released in September 2022 read.

Vaccination rates for routine vaccines have for the most part plateaued over the decades but in 2020, global health authorities recorded significant declines.

LAC’s coverage for the percentage of one-year-olds who have received three doses of the combined diphtheria, tetanus toxoid and pertussis (DTP3) vaccine in a given year dropped well-below the global average and it now lags far behind all other regions except for West and Central Africa and East and Southern Africa. The level of DTP3 is used as a marker for immunization coverage within and across countries.

The trend that highlighted the decline was noticed between 2012 and 2021, when immunization levels dropped 18% from 93% in 2012 to 75% coverage in 2021.

While multiple in-country factors contributed to this decline, UNICEF found that the COVID-19 pandemic further exacerbated already declining immunization coverage rates due to health service and supply chain disruptions, diversion of resources to the pandemic response, lockdown measures that limited access to services, and reluctance of caregivers to visit health facilities out of fear of infection.

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According to the repot, immunization coverage backslid in most LAC countries during the first two years of the pandemic. Only two countries in the region (Costa Rica and Trinidad and Tobago) experienced an increase in DTP3 coverage between 2019 and 2021, and only three countries (Cuba, Haiti and Saint Vincent and the Grenadines) sustained coverage at a constant level over this period.

The remaining 28 LAC countries experienced declines in DTP3 coverage, ranging from a drop of 1 to 20 percentage points. The three countries with the largest drops in DTP3 coverage were Grenada (dropping 20 percentage points), Paraguay (dropping 16 percentage points) and Belize (dropping 15 percentage points).

Globally, 25 million children missed out on one or more doses of DTP through routine immunization services in 2021 alone. This is two million more than those who missed out in 2020 and six million more than in 2019, according to the World Health Organisation (WHO).

What are routine vaccines?

Routine vaccines are a group of vaccines that have proven to significantly reduced an individual’s chances of contracting life-threatening disease. They are recommended for everyone and include:

  • Chickenpox (Varicella)
  • Diphtheria, tetanus, and whooping cough (pertussis) (DTaP)
  • Haemophilus influenzae type b (Hib)
  • Measles, mumps, rubella (MMR)
  • Polio (IPV) (between 6 through 18 months)
  • Pneumococcal (PCV)
  • Hepatitis A (HepA)
  • Hepatitis B (HepB)

Consequences of declining immunization coverage in LAC *UNICEF technical note*

  • Since vaccination rates have fallen, many countries in LAC including Brazil, Colombia, and Venezuela (Bolivarian Republic of) have experienced outbreaks of vaccine-preventable diseases including measles.
  • Low vaccination rates along with high levels of cross-border mobility for work and emigration to escape political and economic crises have spurred wide-spread transmission of vaccine-preventable diseases.
  • Re-emergence of diphtheria cases and outbreaks of yellow fever have also occurred throughout the region.
  • Boosting vaccination rates is critical for stopping the transmission of disease within and between countries and to reduce the negative impacts of vaccine-preventable diseases on children and communities.
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