Doctors seeing delay in routine childhood vaccinations
Fewer parents presenting children for MMR shots since COVID-19Sunday, September 12, 2021
BY ROMARDO LYONS
THE Paediatric Association of Jamaica is fearing that a noticeable reduction in the number of children being presented for their scheduled routine childhood vaccines since the start of the novel coronavirus pandemic could trigger an increase in vaccine-preventable diseases among infants.
“Anecdotally, especially last year, we did notice some delay in vaccine-seeking behaviour. We had children who should've gotten their one-year-old shots — which would have been for measles, mumps and rubella — showing up even six to eight months after they should've gotten the shots because of the pandemic, and because people are afraid to seek healthcare. When you ask the parents, it's really just fear of the crowds at the health centres and just the fear of COVID-19,” Dr Toni-Ann Fulford Ramdial, vice-president of the association, told the Jamaica Observer.
Dr Adella Campbell, associate professor and head of Caribbean School of Nursing, agreed.
“I believe that the current debate and misinformation about the COVID-19 vaccines incited some level of fear among parents or caregivers whose children are to be vaccinated against childhood diseases. It appears also that we are a society driven by fear and as such, fear may motivate parents to believe that contact with health centres, other health facilities, and health practitioners — private and public — may place them and their children at a higher risk for contracting the virus, so they shy away,” Dr Campbell related.
While the Sunday Observer was unable to get data from the Paediatric Association or the Ministry of Health and Wellness on the reduction in the number of measles, mumps and rubella (MMR) vaccines administered, the World Health Organization and United Nations Children's Fund (UNICEF) had reported in July this year that at least 23 million children missed routine vaccinations in 2020 because of the disruption in health services. This was 3.7 million more than in 2019.
“This evidence should be a clear warning — the COVID-19 pandemic and related disruptions cost us valuable ground we cannot afford to lose — and the consequences will be paid in the lives and well-being of the most vulnerable,” UNICEF's Executive Director Henrietta Fore is reported as saying.
With measles still a threat to child health, Dr Fulford Ramdial said the delay in routine paediatric immunisation is very concerning.
“The big concern — especially with measles, mumps and rubella — is that there have been measles outbreaks in places in Europe and in the United States, especially in some countries where the vaccines are a choice because in some First World countries parents will choose not to vaccinate their children, whereas in Jamaica the Public Health Act says our children need to be vaccinated to enter school,” she said.
“And parents who want to travel with their young ones tend to prefer the children to have the MMR vaccine before going away, just because of the fact that measles is still out there,” she added.
Dr Fulford Ramdial, who is also a consultant paediatrician at Bustamante Hospital for Children, told the Sunday Observer that parents need to be encouraged to bring their young children to get their routine vaccines as they are extremely essential.
“They are very important. They helped us to eradicate diseases like smallpox. Even polio… in some areas of the world there is still polio but we haven't seen it in Jamaica in a while, and we don't want to go backwards. Our health system needs to move forward and at a faster pace because we are still pretty behind than some parts of the world.”
Occupational and public health specialist Dr Alverston Bailey told the Sunday Observer that more public health campaigns to reinforce the value of routine childhood vaccinations, similar to what is being done for the COVID-19 vaccine, are necessary.
“Paediatricians and family physicians have been shown worldwide to be the best persons to be asked to communicate with parents to encourage them to accept vaccination as an important public health tool. So what the Government needs to do is to get more paediatricians and family physicians on board with the messaging, and I think we will see a significant decrease in vaccine hesitancy in the population,” Dr Bailey said.
Dr Campbell agreed, saying: “Once it can be ascertained that there is a fallout with childhood immunisation, a robust sensitisation or education campaign needs to be embarked on.”
Dr Fulford Ramdial said she hopes the paediatric vaccination numbers will return to pre-COVID levels to facilitate schooling.
“As everyone knows, for that sixth birthday, when you're going to primary school, they want to see your vaccination card — so that's that. And when we do see them in hospitals and they're not vaccinated, we try and counsel the parents and find out why they are not vaccinated,” she said.
Babies are supposed to get their MMR vaccine near their first birthday, and for those who have missed out, Dr Fulford Ramdial explained that they are now in the process of making up for that disruption.
“Really and truly, we can just catch them up, so that's what we're doing. In Jamaica what we tend to do is give the measles, mumps and rubella at a year and then we give a booster at 18 months. If they present to us at two years we'll give the first one to them, and at least a month later or so we will just give them the second shot if they are delayed,” she said.
Dr Fulford Ramdial warned that should the delay in routine childhood vaccinations persist, there could be a potential proliferation of diseases which may coincide with further stress on an already pressured health-care system.
“The worse thing I think can happen is that we might start seeing outbreaks of other things that we would not have seen previously. It would just take one person coming into the island with, say, measles, and a cluster of children who are not vaccinated could be affected,” Dr Fulford Ramdial reasoned.
Added Dr Campbell: “This, no doubt, would prove burdensome to any health system, further depleting scarce resources and exhausting the already burnt -out health practitioners. Vaccination is one of the most cost-effective mechanisms to prevent debilitating childhood diseases.”
Dr Fulford Ramdial also highlighted pertussis as a disease to watch.
“We give DPT vaccine [used to combat diphtheria; pertussis, also known as whooping cough; and tetanus] in the first year of life at six weeks or three months old, and we may start seeing pertussis in our younger babies, which is a respiratory illness, and this is something that we have to consider. We do see that from time to time but if people are delaying the vaccines, we may see it more often.”
Meanwhile, the Pan American Health Organization in July highlighted a “major backsliding” on childhood vaccinations globally due to the pandemic. The organisation said globally, the vaccination rate for three doses of diphtheria-tetanus and pertussis (DTP-3) vaccine fell from around 86 per cent in 2019 to 83 per cent in 2020.