Robin nandy of unicef vaccination program: “it gives me sleepless nights”.

Unicef vaccinates half the world’s children against deadly diseases. Covid-19 vaccines are threatening overuse, says program director Robin Nandy.

Polio vaccination in Ethiopia: Many such programs have been halted because of the pandemic Photo: Tadesse/UNICEF

site: Mr. Nandy, in recent months Unicef has repeatedly warned of the consequences of the pandemic for children worldwide. There is a threat of a lost generation. Do we have a crisis within a crisis?

Robin Nandy: Yes, absolutely. We’ve been warning about this for a long time. At the beginning of the pandemic, there were massive disruptions to essential services of general interest, including vaccination programs. We and WHO simply recommended that mass vaccinations be temporarily suspended.

Was that already a mistake?

I don’t think so. I would make the same decision again today. When we provide health services, we do not want to do harm. Our global vaccination campaigns, by definition, involve a large part of the population from different communities, who come into contact with each other and with many of our health workers. They then move on again – and during a pandemic. It was pragmatic to interrupt that and continue to provide routine vaccinations and other health services. But many countries were overwhelmed with Covid and didn’t keep up with other health care. Sometimes people stopped visiting health facilities because they were afraid of contracting Covid.

began his career as a public health physician in Delhi, India, is also an epidemiologist and now leads Unicef’s global immunization program.

What has been missing as a result?

I am talking about vaccinations against preventable diseases. These can perhaps be delayed for a few weeks or even months, but then the number of susceptible children and the number of disease outbreaks inevitably grows. Other things cannot be delayed: prenatal care, emergency obstetrics, care for newborns and their mothers, as well as treatment for diarrheal diseases, malaria or pneumonia. Since August, September, many things have been resumed, vaccinations started again more quickly. But we have not yet recovered the lost ground – and now the vaccinations against Covid-19 are added to it.

In July, the Lancet magazine published a projection that the interruptions you’re talking about could cost the lives of between 250,000 and one million children worldwide. Did that happen?

You have to constantly check such projections. If you just extrapolate the situation in May 2020, when health care was often almost completely disrupted, you have such a prediction. But many services were functioning again later. These model calculations depend on the assumptions that you apply. But they were useful because they shed light on what happens when you interrupt health care for a longer period of time in developing countries.

Have there been outbreaks of diseases that could have been prevented because of interruptions in vaccination?

We have had such outbreaks, but you have to be careful: We can’t attribute them directly to the interruptions because of Covid. There were measles outbreaks in previous years as well. That’s a disease that’s far more contagious than Covid.

And it is very dangerous for children in developing countries.

Yes, especially where there is malnutrition and vitamin A deficiency, mortality among children increases sharply. This affects the poorest sections of the population.

Industrialized countries already vaccinate against Covid-19, what is the situation in developing countries?

So far, the vaccines are not available in almost all developing countries. That’s why we’re relying on the Gavi vaccination alliance, the World Health Organization (WHO) and Unicef to work with Covax, an entity with which developing countries jointly purchase vaccines. Currently, Gavi is finalizing final negotiations with vaccine manufacturers. We expect the first doses of vaccine to be available for low- and middle-income countries by the end of February.

Developed countries will likely be able to vaccinate 60 to 70 percent of their populations in the second half of the year. Is it unfair that developing countries get significantly fewer vaccine doses?

Historically, every vaccine has been used first in high-income countries. Sometimes it took years for developing countries to get their turn. Part of Covax is also an initiative that seeks to ensure fair access to diagnostic tools and treatment against covid. For all countries, regardless of income. And Covax aims to give 20 percent of each country’s population access to a vaccine by the end of 2021.

Is that realistic?

We are optimistic. Even if it doesn’t become exactly that amount, in most countries we could achieve that approximately. But it will be challenging. It’s not just about getting vaccines delivered, but also getting them distributed. That’s very different from what we usually do. Many developing countries have experience vaccinating children. Now we want to start with health workers, the elderly and high-risk groups. This has to be meticulously planned.

Has the international community provided you with enough material and personnel?

Most of the money has gone into vaccine development and production worldwide. Funds to prepare countries for vaccine distribution are flowing, but much more slowly. The World Bank has pledged $12 billion to help organize Covid-19 vaccines. Other development banks are following suit. It will be critical that we can deploy resources quickly. We need them now, not when the vaccines come.

Can you build global logistics for a vaccine that needs to be refrigerated at minus 70 degrees, like Pfizer’s and Biontech’s?

On a limited scale, you can. We’re working with WHO right now to identify countries that can rapidly improve their ability to deploy this vaccine. That includes cold chains. However, they will limit the large-scale use of this vaccine. But it won’t be available in such quantities in developing countries anyway. And I expect that in the next few months we will have three, four or five vaccines. Then we can match the vaccines with the capabilities of each country. With the ones that need complicated refrigeration, you can still vaccinate doctors and health workers in major cities.

In developed countries, the pandemic could be over by 2021 because of vaccination, but continue to run rampant in developing countries for lack of vaccination. Is this a threat?

The use of vaccines is not initially intended to stop the spread of the virus in developing countries. They are meant to protect healthcare workers, who bear the brunt of the pandemic. And they are meant to prevent people from dying. That is our most important message: Despite the hope and optimism surrounding vaccines, they should not lead us to sit back and do nothing. People should not think: now we have the vaccine miracle weapon, so we don’t have to wear masks, wash our hands, or keep our distance.

They seem to be very cool about the fact that developing countries can only vaccinate a fraction of their population. Although they have to organize the vaccinations in many of these countries …

… in 92 countries, to be exact. Quite a big task, yes. But I’m not serene, I’m concerned. Vaccines will not be as readily available in low-income countries as they are in rich countries, so we have to deal with that. I just very much hope that developing countries will actually get their vaccine doses, which is enough for 20 percent of their population, in 2021. And then the challenges for us really start: We have to distribute them quickly and fairly in the countries.

In many countries, Unicef is the only organization and then often vaccinates children against preventable diseases.

That really gives me sleepless nights: do we have to get so hung up on vaccinating against Covid-19 that we jeopardize vaccinations against other preventable diseases? Our Executive Director Henrietta Holsman Fore is constantly stressing, "We must not fight one health crisis at the expense of another. We must do both at the same time: address the disruption of vaccination programs against preventable diseases while planning for the efficient delivery of Covid 19 vaccines. If we do this with the same resources we’ve had in the past, we’re not going to get it done. We desperately need more resources.

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