It’s been four months since the first country began vaccinating against COVID-19. Since then, more than a billion doses have been delivered in a historic and monumental scale-up of the global vaccine system. However, as the world commemorates World Immunization Week this week, huge gaps still exist in vaccine equity, and there is growing concern about a resurgence of other life-threatening diseases as many routine immunizations have been disrupted.

According to Kate O’Brien, the World Health Organization’s (WHO) Director of Immunization, Vaccines and Biologicals, the world pre-COVID was delivering around 4 billion doses of vaccine on an annual basis. Now, the world is being asked to go from that to at least double, possibly triple, that number of additional doses in less than one year. It’s a “huge scale-up” of manufacturing and programs that also requires reaching age-groups who are not usually reached with routine vaccinations, she said in a media briefing last Thursday. At the time, 944 million doses had been administered globally. Over the weekend, that number surpassed 1 billion.

“That accomplishment is really worth pausing on and appreciating what it has taken and what it will continue to take to get the additional doses even beyond that,” O’Brien said. “This is just the beginning.”

On the bright side, O’Brien reported that virtually every country in the world has begun their COVID vaccination campaign; only 15 haven’t started vaccinating at all.

Of the doses that have been administered, 77 percent are being given in just 10 countries, and one country – the U.S. – is absorbing 23 percent of all global doses.

The disparity of vaccine coverage among countries is revealing as well. According to O’Brien, in high income countries 35 doses have been administered for every 100 inhabitants. In low-income countries, that rate is 100 times less – only 0.3 doses have been administered for every 100 people.

As of April 22, COVAX – the global dose-sharing facility designed to ensure equitable access to COVID-19 vaccines particularly for low-income countries – has delivered more than 40 million doses to 117 countries, according to Gian Gandhi, UNICEF’s COVAX Coordinator for Supply. Reaching the facility’s goal of delivering at least 2 billion doses around the world will require increased production but also dose donations from countries, particularly wealthy countries, like the US, that have been hoarding vaccine supply.

On Friday, France became the first country to donate vaccine doses from its domestic supply to COVAX, with an initial commitment of 500,000 doses.

While vaccine skepticism tends to be more prevalent in wealthier countries, hesitancy around the vaccine is also being fueled by misinformation and uncertainty in low- and middle-income countries. It certainly didn’t help that several wealthy countries suspended the use of certain brands, like AstraZeneca and Johnson & Johnson, after a handful of reports of blood clotting, said Sibusiso Hlatjwako, PATH’s South Africa Advocacy and Partnerships Manager, in Thursday’s media briefing.

“They did not do the efforts to counter vaccine hesitancy any favors,” said Hlatjwako. “Actually, they moved our efforts backwards, because when…wealthy countries said, ‘This vaccine isn’t good enough,’ and in some countries, that’s the only vaccine that’s available, then people tended to be very hesitant to take that vaccine.”

Some of that hesitancy has been overcome purely by the urgency of skyrocketing COVID cases, like in Brazil, said Cristina Toledo-Cornell, Public Health Director and Director of Education at the Lummi Tribal Health Center. But global health organizations and agencies are working hard to counter vaccine hesitancy through various information-sharing and community outreach efforts.

They’re also urgently trying to get other routine and mass immunization campaigns back online after widespread disruptions last year.

“If we’re to avoid multiple outbreaks of life-threatening diseases like measles, yellow fever and diphtheria, we must ensure routine vaccination services are protected in every country in the world,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus in a press release Monday.

COVID is Disrupting Routine Childhood Vaccinations Around the World

Despite progress compared to 2020, a WHO survey found that 37 percent of respondent countries are still experiencing disruptions to their routine immunization services. Sixty mass immunization campaigns against diseases like measles, yellow fever and polio, are also currently postponed in 50 countries, putting 228 million people – mostly children – at risk.

Measles campaigns have been particularly affected – accounting for 23 percent of postponed campaigns and affecting 140 million people. And it’s had devastating results, with serious outbreaks occurring in the Democratic Republic of Congo, Pakistan and Yemen so far – places that are already struggling with conflict and other service disruptions due to COVID-19.

On Monday, the WHO, UNICEF, Gavi and other partners launched a new Immunization Agenda 2030, which will aim to achieve 90 percent coverage for essential childhood and adolescence vaccines, halve the number of children completely missing out on vaccines, and complete 500 national or subnational introductions of new or under-utilized vaccines, such as those for COVID-19, rotavirus and HPV. If this agenda is fully implemented, the WHO says it will avert 50 million deaths, 75 percent of them in low- and lower-middle income countries.

According to UNICEF’s Executive Director Henrietta Fore, even before the pandemic, 20 million children were missing out on critical vaccinations. COVID-19 made a bad situation worse, she said in a press release.

“Now that vaccines are at the forefront of everyone’s minds, we must sustain this energy to help every child catch up on their measles, polio and other vaccines,” Fore said. “We have no time to waste. Lost ground means lost lives.”

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