By Henrylito D. Tacio

Photos courtesy of WHO

Last November 6, two United Nations organizations issued an urgent call to action to avert major measles and polio epidemics as coronavirus disease 2019 (COVID-19) continues to disrupt immunization services worldwide.

As a result of the pandemic, millions of vulnerable children are “at heightened risk of preventable childhood diseases.”

“Even when available, people are unable to access services because of lockdown and transport disruptions, or unwilling due to fear of contracting (the COVID-19 virus),” said the Emergency Call to Action for Measles and Polio Outbreak Prevention and Response. “This has resulted in plummeting uptake of vaccination in many countries, falling to as low as 50% in some countries during the crisis.”

The United Nations Children’s Fund (UNICEF) and World Health Organization estimate that US$655 million (US$400 million for polio and US$255 million for measles) are needed to address dangerous immunity gaps in non-Gavi eligible countries and target age groups.

Gavi, the Vaccine Alliance, has enabled previous access to funding for outbreak response, preventive campaigns, and routine immunization strengthening, including additional support for catch-up vaccination for children who were missed due to COVID-19 disruptions in Gavi-eligible countries. 

However, significant financing gaps remain in middle-income countries that are not Gavi-eligible. This call for emergency action will go to support those middle-income countries that are not eligible for support from Gavi.

“COVID-19 has had a devastating effect on health services and in particular immunization services, worldwide,” commented Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

“But unlike with COVID,” the WHO official added, “we have the tools and knowledge to stop diseases such as polio and measles. What we need are the resources and commitments to put these tools and knowledge into action. If we do that, children’s lives will be saved.”

“We cannot allow the fight against one deadly disease to cause us to lose ground in the fight against other diseases,” said Henrietta Fore, UNICEF Executive Director. “Addressing the global COVID-19 pandemic is critical. However, other deadly diseases also threaten the lives of millions of children in some of the poorest areas of the world.”

In recent years, there has been a global resurgence of measles with ongoing outbreaks in all parts of the world. Vaccination coverage gaps were further exacerbated in 2020 by COVID-19. In 2019, measles climbed to the highest number of new infections in more than two decades.

The Philippines is one of those countries where measles and polio have staged a comeback. In February last year, the Department of Health (DOH) declared measles outbreaks in five regions: Metro Manila, Central Luzon, CALABARZON, Western Visayas, and Central Visayas.

The previous year, measles outbreaks were also declared in some cities: Davao and Zamboanga in Mindanao, Taguig in Luzon, and some areas in Negros Oriental.

“When a community has low immunization coverage, the likelihood of measles outbreak increases,” the WHO explains the Philippines’ measles outbreaks. “An immunization coverage of 95% amongst all children is needed for a community to be fully protected against measles. This includes protection for the vulnerable members of the population such as infants that are too young to receive the vaccination, people who have weakened immune systems, and older adults.”

According to the UN health agency, the Philippines has seen a decline in the first dose of measles vaccine in the past decade – from above 80% in 2008 to below 70% in 2017. Subsequent figures indicate further decrease.

“As a result, many children have become susceptible to measles infection,” the WHO deplores. 

The WHO estimates that 2.6 million Filipino children under 5 years are not protected from measles infection. “As long as routine immunization remains low in the Philippines,” the UN health agency surmises, “the country will experience periodic measles outbreaks.”

As for polio, an outbreak was declared in the country last year. “Children are at risk of lifelong paralysis because of this outbreak,” the WHO points out.

On September 19, the Department of Health confirmed the re-emergence of polio in the country and declared a national outbreak. This follows a confirmed polio case in a 3-year-old child in Lanao del Sur.

In addition, the poliovirus has also been detected in samples taken from sewage in Tondo, Manila, and waterways in Davao City as part of the regular environmental surveillance. The samples were tested by the Research Institute for Tropical Medicine and verified by the Japan National Institute for Infectious Diseases and the United States Centers for Disease Control and Prevention.

On September 20, the health department again confirmed another case, that of a 5-year-old boy from Laguna. With two children afflicted with the disease, the level was raised from outbreak to epidemic. This resulted in the country’s delisting as a polio-free nation, a distinction it held since 2000.

“Not only do we lose it, but we have an epidemic,” said Health Secretary Francisco Duque III. “It is deeply disconcerting that poliovirus has re-emerged in the Philippines after nearly two decades,” added Oyon Dendevnorov, Philippines Representative of the United Nations Children’s Fund (UNICEF).

In the early part of the 20th century, few diseases frightened parents more than polio did. “Polio struck in the warm summer months, sweeping through towns in epidemic every few years,” the website of History of Vaccines states. “Though most people recovered quickly from polio, some suffered temporary or permanent paralysis and even death. Many polio survivors were disabled for life. They were a visible, painful reminder to society of the enormous toll this disease took on young lives.”

According to the aforementioned website, polio is caused by one of three poliovirus types (types 1, 2, and 3). “These viruses spread through contact between people, by nasal and oral secretions, and by contact with contaminated feces,” it said. 

“Poliovirus enters the body through the mouth, multiplying along the way to the digestive tract, where it further multiplies,” the website continued to explain. “In about 98% of cases, polio is a mild illness, with no symptoms or with viral-like symptoms. In paralytic polio, the virus leaves the digestive tract, enters the bloodstream, and then attacks nerve cells. 

“Fewer than one percent to two percent of people who contract polio become paralyzed,” it further said. “In severe cases, the throat and chest may be paralyzed. Death may result if the patient does not receive artificial breathing support.”

As COVID-19 disrupts immunization, the WHO and UNICEF call for action and funds to protect children by vaccination.

“Left unchecked, this situation poses an increasingly high risk of explosive outbreaks and potentially further international spread of both polio and measles,” the urgent call reminded.

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