Countries across the WHO European Region are utilizing guidance from WHO/Europe to include immunization against vaccine-preventable diseases (VPDs) as an essential health service during the current COVID-19 pandemic. WHO has called on countries to ensure that immunization is maintained wherever possible and surveillance for VPDs remains undisrupted during the ongoing pandemic.
Immunization is a right and a responsibility. Ensuring that everyone is fully vaccinated not only saves lives but also prevents outbreaks of diseases, including measles, which could burden economies and health-care systems already strained by COVID-19.
“Access to vaccines for all has transformed our societies, but it is a public good that must be maintained to be effective, even in difficult times,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. “The forthcoming 2030 European regional immunization agenda, which will embrace the principle of equitable access to immunization, is one of the flagship initiatives in the European Programme of Work (EPW),” he added.
Prioritization of immunization in Italy
Italy, one of the countries hardest hit by COVID-19 in the European Region, was forced to repurpose much of its health-care personnel as COVID-19 cases mounted starting in late February 2020, particularly those working in infectious diseases, including immunization. Dr Antonietta Filia, public health physician and researcher working at the Infectious Diseases Department of the Italian National Institute of Health and an expert member of the European Technical Advisory Group of Experts on Immunization explained that the regions in Italy have tailored their immunization services based on the local COVID-19 epidemiology and the mitigation measures in place. “In the Lombardy region, the country’s epicentre of the COVID-19 pandemic, regional authorities advised temporary suspension of routine vaccinations on 24 February. However, the immunization services were partially reopened on 11 March, and full services resumed from 14 April. The authorities also reiterated the importance of putting in place a mechanism to register the children who had missed their routine doses and to prioritize these children as soon as services were available again,” she explained.
Wherever possible, regions and provinces have maintained childhood immunization as part of the essential health services, prioritizing primary vaccine doses, while ensuring strict infection prevention and control measures, such as time slots and physical distancing in waiting rooms. The Ministry of Health and Italian National Institute of Health have reiterated that routine immunization services should remain a priority, as far as possible. Dr Filia added, “As highlighted in the new WHO/Europe guidelines, it is crucial to continue providing life-saving vaccines, as feasible, in order to prevent any outbreaks of preventable diseases, such as measles. This is particularly important, as even brief disruptions of immunization services will result in an increased number of susceptible individuals in the population and increase the possibility of outbreaks.”
Emergency health system support
Maintaining continuity of service delivery during a pandemic in core service areas, including essential prevention of communicable diseases, particularly with vaccines, requires a robust health system. The WHO European Office for Investment for Health and Development based in Venice, Italy, has been geared up to provide on-the-ground, direct emergency support to the COVID-19 response in Italy. The field emergency team has provided targeted capacity-building for relevant health-care professionals of the regions in Italy and supported implementation of WHO guidance on how health systems can respond to the pandemic.
Considerations in maintaining immunization services
The current COVID-19 situation and health system capacities vary widely across the European Region, and this situation is rapidly evolving. Approaches to sustaining high levels of routine immunization coverage will also vary among countries. WHO/Europe’s guidance stresses that all possible efforts should be made by ministries of health to equitably sustain high population immunity.
When assessing the options for immunization services during the COVID-19 pandemic, ministries should consider: What is the potential risk of an increase in VPDs? What is the transmission scenario of COVID-19? Will immunization programme staff be needed to help manage the COVID-19 situation? Are routine vaccines available in sufficient quantities to continue with routine immunization? The impact and appropriateness of the chosen options for immunization services should be monitored and periodically reassessed as the COVID-19 situation evolves.
Throughout the COVID-19 pandemic, it is vital that authorities maintain the trust of the population in immunization and the health system. This includes keeping health-care providers and the general public informed of the continuation of immunization services or of any changes, and reassuring parents that all necessary infection prevention and control measures are being taken to create a safe environment for vaccination during the COVID-19 pandemic. In addition, it is important to monitor the uptake of vaccines and, if applicable, seek to understand the reasons for any drop in coverage, including barriers to vaccination.
In the case of a temporary interruption of routine immunization, countries are urged to develop solid plans for catch-up vaccination and create comprehensive lists of all children who have missed their scheduled vaccine doses. At the earliest opportunity, countries should reinvigorate and resume services to close any immunity gaps and prevent occurrence of any outbreaks of VPDs.