Immunisation is one of the most powerful and fundamental disease prevention tools in the history of public health, these were the opening lines of Dr Tedros Adhanom Ghebreyesus, WHO Director-General at a press briefing last week.

However, since March 2020, routine childhood immunisation services have been disrupted on a global scale which may be unprecedented since the inception of expanded programs on immunisation.

Many countries, temporarily and justifiably, suspended preventive mass vaccination campaigns against diseases due to risk of transmission and the need to maintain physical distancing during the early stages of the COVID-19 pandemic.

More than half (53 percent) of the 129 countries where data were available reported moderate-to-severe disruptions, or a total suspension of vaccination services during March-April 2020. Measles and polio vaccination campaigns, in particular, have been badly hit.

In Pakistan there are increasing reports of absenteeism due to travel restrictions, sickness, self-isolation, and even where health facilities were open, there was a major slowdown in routine immunisation with reduced footfall at facilities.

Apprehensive of taking their children to the health facility for essential immunisation, parents were reluctant to leave home because of restrictions on movement, lack of information or because they fear infection from the virus.

Experts feel that childhood immunisation, significantly affected during lockdown in the past two months threatens to unwind decades of progress against vaccine-preventable diseases.

Even the Prime Minister highlighted that, “there has been a 50 percent drop in routine immunisation coverage and that two important Polio campaigns have been missed due to the lockdown in the past two months” amid COVID-19. He also shared data of areas where there has been a 55 percent drop in children visiting health facilities for vaccination.

As lockdown relaxes and immunisation resumes, there will be a need to create more awareness and build parents’ trust and urge them to complete their children’s immunisation schedule to avoid any disease outbreak.

Parents will also be assured that immunisation will take place amid strict compliance to the WHO guidelines and standard operating procedures issued by the Expanded Programme on Immunisation.

However, business as usual will not be an option. The ‘new normal’ will have to see immunisation drives following the necessary precautions. It may mean smaller, more frequent sessions, enforcement of social distancing and every vaccinator armed with personal protection equipment. All of which will require additional resources.

In this time of crisis, the timeliness of response is critical, especially in countries with limited resources and challenged health systems to prevent and respond while ensuring continued availability of essential health services.

Today, (June, 4 2020) UK Prime Minister Boris Johnson will be hosting heads of state and global health leaders in a virtual Global Vaccine Summit in London. World leaders will come together to pledge their support to build long-term sustainability and vaccine supply security to reduce disease inequality. The aim is to unite the international community to raise funds ($7.4 billion) for Gavi, the Vaccine Alliance.

Since its inception in 2000, Gavi has supported vaccinations in 68 of the world’s poorest countries including Pakistan. Success of the summit will help maintain immunisation in developing countries, and by 2025, more than 1.1 billion children will be immunised and 22 million lives saved.

It will also help mitigate the impact of the pandemic and to sustain health systems and ensure the distribution of COVID-19 vaccines if and when available.

Pakistan’s Expanded Programme on Immunisation (EPI) immunises around 7.8 million children every year. Completing the schedule protects children under 23 months from 11 vaccine preventable diseases like tuberculosis, polio, diphtheria, pertussis (whooping cough), tetanus, Haemophilus influenza type b, hepatitis B, diarrhoea, pneumonia, typhoid and measles.

The set of inoculations, given from birth to 15 months is provided for free by the Programme which could not have been possible without support from Gavi.

Pakistan is the largest recipient of funds from Gavi. Over the past 20 years, Gavi has provided a value of USD 1,400 million (USD 1.4 billion) to Pakistan to improve routine immunisation coverage. While the Alliance is urgently providing support to countries for COVID-19 response, its CEO, Dr Seth Berkley has stressed that the legacy of COVID-19 must not include the global resurgence of other killers like measles and polio.

On a positive side, disruption also provides a chance to challenge and change ineffective practice. It will be imperative to ensure that country response plans prioritise immunisation with a particular focus on missed communities with large numbers of zero dose and under immunised children, whose number will likely increase as a consequence of the pandemic.

While the longer-term trajectory of the pandemic remains uncertain, it is already clear that millions of people in Gavi-supported countries will miss out on immunisation, risking a resurgence of VPDs and outbreaks, exacerbating existing inequities and putting the most marginalised poorest communities at greatest risk.

It is therefore vital for both, the parents and the immunisation programme to ensure continuity while observing all social distancing measures recommended by authorities as the risks evolve to ensure the essential immunisation of children.

The positive thing with immunisation is that its success is quantifiable, and the results are tangible. Let us collectively work to make these numbers climb for Pakistani children deserve it, after all, their lives are at stake.