Disruptions caused by the Covid-19 pandemic are likely to have a devastating impact on immunisation programmes in the world’s least-developed countries, according to analysis by public-private partnership, Gavi, the Vaccine Alliance.

Immediate delays to vaccination campaigns and routine introductions will mean at least 13.5-million people in 14 of the world’s least-developed countries will not be protected against diseases like measles, polio and human papillomavirus, with millions more likely to follow, the analysis posits.

The Vaccine Alliance and its partners are working to keep immunisation programmes running; however, at least 21 low- and middle-income countries are already reporting vaccine shortages as a result of border closures and disruptions to air travel.

So far, 14 major Gavi-supported vaccination campaigns against polio, measles, cholera, HPV, yellow fever and meningitis have been postponed, as have four national vaccine introductions.

Collectively, these would have immunised more than 13.5-million people, the organisation says.

Gavi notes that the number of people missing out on vaccines is likely to rise substantially as it expects a significant proportion of planned vaccine campaigns to be postponed in the coming months, with routine immunisation programmes also severely impacted as key staff are redeployed and communities observe physical distancing.

Gavi is redirecting 10% of its funding for health systems for immediate use, until more substantial support starts to flow, towards supporting countries’ response to Covid-19.

This includes support for personal protective equipment (PPE), diagnostics, training and communications campaigns.

Gavi says it is ready to work with alliance partners to support mass immunisation campaigns once emergency measures are lifted and, assuming successful fundraising for the 2021 to 2025 period, help repair health systems, boost vaccine coverage rates and protect the next generation against disease in the coming years.

A Gavi analysis of Imperial College modelling suggests Covid-19 could lead to 12.9-million deaths in the 73 Gavi-supported countries without any mitigation, compared with 900 000 deaths with full suppression measures.

The latter will be a huge challenge to implement in impoverished communities which cannot afford long periods at home.

Meanwhile, Gavi is also helping with the development of Covid-19 vaccine candidates, as well as supporting efforts to manufacture, buy and deliver vaccines to those that need them once they are available.

On March 30, the World Health Organisation’s Strategic Advisory Group of Experts on Immunisation recommended that all one-off preventive vaccination campaigns should cease as countries focus on Covid-19 response; however, routine immunisation should continue where possible.

The Global Polio Eradication Initiative has paused all polio vaccination campaigns.

Routine immunisation, including vaccines against polio, continues in most countries for now, though mainly in fixed facilities with strict guidelines on hygiene and physical distancing.

With the expansion of nationwide lockdowns across the developing world it is likely more and more routine immunisation programmes will close temporarily. The suspension of outreach activities, in which health workers visit communities to proactively offer routine vaccinations, is likely to have an immediate impact on vaccine coverage.

Measles outbreaks are currently ongoing in several countries, including the Democratic Republic of Congo (DRC) and Central African Republic, Gavi indicates.

The DRC outbreak is currently the world’s largest, affecting over 300 000 people since it began in 2019, with more than 6 000 deaths – nearly three times as many as from Ebola as part of the outbreak in the country, Gavi notes.