Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination
Requirement for Proof of Negative COVID-19 Test or Recovery from COVID-19 for All Air Passengers Arriving in the United States
Immunization services begin slow recovery from COVID-19 disruptions, though millions of children remain at risk from deadly diseases – WHO, UNICEF, Gavi
While immunization services have started to recover from disruptions caused by COVID-19, millions of children remain vulnerable to deadly diseases, the World Health Organization (WHO), UNICEF and Gavi, the Vaccine Alliance warned today during World Immunization Week, highlighting the urgent need for a renewed global commitment to improve vaccination access and uptake.
“Vaccines will help us end the COVID-19 pandemic but only if we ensure fair access for all countries, and build strong systems to deliver them,” said Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General. “And if we’re to avoid multiple outbreaks of life-threatening diseases like measles, yellow fever and diphtheria, we must ensure routine vaccination services are protected in every country in the world.”
A WHO survey has found that, despite progress when compared to the situation in 2020, more than one third of respondent countries (37%) still report experiencing disruptions to their routine immunization services.
Mass immunization campaigns are also disrupted. According to new data, 60 of these lifesaving campaigns are currently postponed in 50 countries, putting around 228 million people - mostly children - at risk for diseases such as measles, yellow fever and polio. Over half of the 50 affected countries are in Africa, highlighting protracted inequities in people’s access to critical immunization services.
Campaigns to immunize against measles, which is one of the most contagious diseases and can result in large outbreaks wherever people are unvaccinated, are the most impacted. Measles campaigns account for 23 of the postponed campaigns, affecting an estimated 140 million people. Many have now been delayed for over a year.
“Even before the pandemic, there were worrying signs that we were beginning to lose ground in the fight against preventable child illness, with 20 million children already missing out on critical vaccinations,” said Henrietta Fore, UNICEF Executive Director. “The pandemic has made a bad situation worse, causing millions more children to go unimmunized. Now that vaccines are at the forefront of everyone’s minds, we must sustain this energy to help every child catch up on their measles, polio and other vaccines. We have no time to waste. Lost ground means lost lives.”
As a result of gaps in vaccination coverage, serious measles outbreaks have recently been reported in countries including the Democratic Republic of the Congo, Pakistan and Yemen, while likely to occur elsewhere as growing numbers of children miss out on lifesaving vaccines, the agencies warn. These outbreaks are happening in places already grappling with conflict situations as well as service disruptions due to ongoing response measures to COVID-19.
The supply of vaccines and other equipment is also essential for child vaccinations. Due to disruptions at the onset of the COVID -19 pandemic, UNICEF delivered 2.01 billion vaccine doses in 2020, compared to 2.29 billion in 2019.
“Millions of children across the world are likely to miss out on basic vaccines as the current pandemic threatens to unravel two decades of progress in routine immunization”, said Dr Berkley, CEO of Gavi, the Vaccine Alliance. “To support the recovery from COVID-19 and to fight future pandemics, we will need to ensure routine immunization is prioritized as we also focus on reaching children who do not receive any routine vaccines, or zero-dose children. To do this, we need to work together – across development agencies, governments and civil society – to ensure that no child is left behind”.
New global immunization strategy aims to save over 50 million lives
To help tackle these challenges and support the recovery from the COVID-19 pandemic, WHO UNICEF, Gavi and other partners today launched the Immunization Agenda 2030 (IA2030), an ambitious new global strategy to maximize the lifesaving impact of vaccines through stronger immunization systems.
The Agenda focuses on vaccination throughout life, from infancy through to adolescence and older age. If fully implemented, it will avert an estimated 50 million deaths, according to WHO - 75% of them in low- and lower-middle income countries.
Targets to be achieved by 2030 include:
- Achieve 90% coverage for essential vaccines given in childhood and adolescence
- Halve the number of children completely missing out on vaccines
- Complete 500 national or subnational introductions of new or under-utilized vaccines - such as those for COVID-19, rotavirus, or human papillomavirus (HPV)
Urgent action needed from all immunization stakeholders
To achieve IA2030’s ambitious goals, WHO, UNICEF, Gavi and partners are calling for bold action:
- World leaders and the global health and development community should make explicit commitments to IA2030 and invest in stronger immunization systems, with tailored approaches for fragile and conflict-affected countries. Immunization is a vital element of an effective health care system, central to pandemic preparedness and response, and key to preventing the burden of multiple epidemics as societies reopen
- All countries should develop and implement ambitious national immunization plans that align with the IA2030 framework, and increase investments to make immunization services accessible to all
- Donors and governments should increase investments in vaccine research and innovation, development, and delivery, focused on the needs of underserved populations
- The pharmaceutical industry and scientists, working with governments and funders, should continue to accelerate vaccine R&D, ensure a continuous supply of affordable vaccines to meet global needs, and apply lessons from COVID-19 to other diseases
Notes to editors
Photos and b-roll are available for download here.
World Immunization Week 2021 takes place in the last week of April (April 24th-30th) to celebrate the lifesaving benefits of vaccines. This year’s theme, ‘Vaccines bring us closer,’ aims to show how vaccination connects us to the people, goals and moments that matter, helping improve the health of everyone, everywhere throughout life.
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.
UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. For more information about UNICEF and its work for children, visit www.unicef.org. For more information about COVID-19, visit www.unicef.org/coronavirus. Follow UNICEF on Twitter and Facebook. More information on UNICEF’s Immunization programme, available here. Visit the Vaccines for All landing page that brings together the latest trustworthy information on COVID-19 vaccines and routine immunization.
Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate half the world’s children against some of the world’s deadliest diseases. Since its inception in 2000, Gavi has helped to immunize a whole generation – over 822 million children – and prevented more than 14 million deaths, helping to halve child mortality in 73 lower-income countries. Gavi also plays a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningitis and yellow fever vaccines. Gavi is a co-convener of COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, together with the Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO). Learn more at www.gavi.org and connect with us on Facebook and Twitter.
The ACT-Accelerator marks its first anniversary today with a special report on the global alliance’s progress against the COVID-19 pandemic. The “ACT Now, ACT Together: 2021 Impact Report” details the major scientific advances that have been made to confront the new disease, along with the history-making collaboration of global health organizations, governments, foundations, civil society, scientists and the private sector.
The report, which was launched at an event hosted by Dr Tedros Adhanom, Director-General of WHO, with live remarks by Cyril Ramaphosa, President of South Africa, and Dag Inge Ulstein, Minister of International Development for Norway, also shows the challenges ahead, including major funding gaps that threaten to derail progress against the pandemic.
“One year after the launch of the ACT Accelerator, world leaders face a choice: invest in saving lives by treating the cause of the pandemic everywhere, now, or continue to spend trillions on the consequences with no end in sight,” WHO Director-General Dr Tedros Adhanom said. “With a remaining funding gap of US$ 19 billion for 2021 and limited supply of products, we can only end the pandemic by funding, sharing, and scaling-up access to the tools we need to fight the disease. The time to ACT is now.”
The ACT-Accelerator alliance was launched on 24 April 2020 by WHO, the European Commission, France, and the Bill & Melinda Gates Foundation to develop and deliver tests, treatments and vaccines the world needs to fight COVID-19.
A year ago, the world was in a very different place. Our collective understanding of COVID-19 was limited, and while we had polymerase chain reaction (PCR) testing that could be done in laboratories, there were no rapid tests, no vaccines, and little was known about effective treatments. Today, rapid diagnostic tests, repurposed treatments, and vaccines exist. This scientific progress has been rapid, and unprecedented in scale and levels of collaboration.
But COVID-19 continues to spread and new variants emerge because the progress on equitably distributing those tools has not been fast enough.
COVID-19 has killed more than 3 million people worldwide, another wave is threatening many countries, and inequitable distribution of tests, treatments and vaccines is allowing the virus to accelerate and change – risking the efficacy of our current tools to fight the disease. Left to rage anywhere, the virus is a threat everywhere. A strengthened, globally coordinated effort to ensure all countries can access the tools they need is essential to help bring this virus under control and is why support for the ACT-Accelerator partnership is so important.
“COVID-19 knows no borders,” ACT-A Special Envoy Carl Bildt said. “A new variant from anywhere could unravel progress everywhere, even in a country that has achieved 100% vaccination. The pandemic is still on the rise. Only a reinforced global effort to deliver tests, treatments, and vaccines to all people everywhere, based on need rather than ability to pay, will bring an end to this pandemic. Ahead of the Global Health Summit we call on the G20, G7, and all richer countries to step up and pay their fair share to fund the global response.”
The rapid development of COVID-19 tools has been achieved thanks to the hard work and ingenuity of governments, global health organizations, scientists, the pharmaceutical industry, and manufacturers from round the world. The ACT-Accelerator partnership has supported and helped drive many of these efforts. Today’s impact report highlights the progress the partnership has made, including:
- Diagnostics Pillar – co-convened by FIND and The Global Fund: Supported the development and Emergency Use Listing of reliable antigen rapid diagnostic tests (Ag RDTs) that can be conducted outside of laboratory facilities, guaranteed access to 120 million affordable rapid diagnostic tests, and procured 65 million tests (32.3 million molecular [PCR] tests and 32.8 million Ag RDTs) for LMICs.
- Therapeutics Pillar – co-convened by Unitaid and Wellcome: Tracked over 300 actionable trials, supported the identification of dexamethasone as the first life-saving therapy against COVID-19 and in less than 20 days after its identification, made 2.9m doses of dexamethasone available to LMICs. Formed the Covid-19 Oxygen Emergency Taskforce to meet the needs of more than half a million COVID-19 patients in LMICs who need oxygen treatment per day.
- COVAX – co-convened by CEPI, Gavi, and WHO – in partnership with UNICEF: Secured over 2 billion doses, with the first international delivery made to Ghana 3 months after the first vaccine was administered in a high-income country, and more than 40 million doses shipped to 119 economies via the COVAX Facility.
- Health Systems Connector – co-led by the World Bank, WHO, and The Global Fund – in partnership with UNICEF and the Global Financing Facility: US$ 50 million of PPE has been procured for LMICs and country readiness assessed for the deployment of COVID-19 vaccines in more than 140 countries.
The development of these tools was the first, critical step in getting the pandemic under control. The need for improved tools, and to get tools to those who need them most, has never been more urgent. Securing financing remains a major challenge, but not the only challenge.
Vaccinating at this scale and in this timeframe constitutes the largest and most complex vaccine rollout in history. There are significant challenges in manufacturing and delivering on such a scale and timeline, with severe supply constraints characterizing the market at present. Of the more than 950 million vaccinations that have been given – just 0.3% have been administered in low-income countries. Testing rates in high-income countries are about 70 times higher than those in low-income countries, leaving many countries blind with little information and current infection rates or the spread of new variants. People will continue to get COVID-19 and so we need to rapidly intensify research to expand the portfolio of effective treatments, and deliver the PPE and Oxygen needed to treat those in hospital – as demand for oxygen surges in many parts of the world.
An unprecedented mobilization of public, private, and multilateral funders has galvanized USD 14.1 billion in commitments so far, but as of today, the ACT-Accelerator partnership needs another US $19 billion to develop and deliver the tests, treatments, and vaccines needed to bring COVID-19 under control, and is calling on governments around the world to work with the ACT-Accelerator partners to fund, share and scale up the tools the world needs to bring an end to the acute phase of the virus.
The International Chamber of Commerce estimates that the global economy stands to lose as much as US$ 9.2 trillion if governments fail to ensure developing economy access to COVID-19 vaccines. Fully financing the ACT-Accelerator for 2021 would cost less than 1% of what governments are spending on stimulus packages to treat the consequences of COVID-19.Notes to editors
The Access to COVID-19 Tools ACT-Accelerator is the proven, up-and-running global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. It was set up in response to a call from G20 leaders in March 2020 and launched by WHO, European Commission, France, and the Bill & Melinda Gates Foundation on 24 April 2020.
The ACT-Accelerator works to speed up collaborative efforts among existing organizations to end the pandemic. It is a framework for collaboration that has been designed to bring key players around the table with the goal of ending the pandemic as quickly as possible through the accelerated development, equitable allocation, and scaled up delivery of tests, treatments and vaccines, thereby protecting health systems and restoring societies and economies in the near term. It draws on the experience of leading global health organizations which are tackling the world’s toughest health challenges, and who, by working together, are able to unlock new and more ambitious results against COVID-19. Its members share a commitment to ensure all people have access to all the tools needed to defeat COVID-19 and to work with unprecedented levels of partnership to achieve it.
The ACT-Accelerator comprises four pillars: diagnostics, therapeutics, vaccines and health system strengthening.
- The diagnostics pillar, co-convened by the Global Fund and FIND, is focused on ensuring equitable access to new and existing tests, supporting country uptake and deployment and strengthening the diagnostic portfolio with R&D investments in low-cost, easy-to-use and quality tests. In 2021, it is focused on procuring and distributing at least 900 million molecular and AG-RDTs to LMICs.
- The therapeutics pillar is led by Unitaid and Wellcome. Therapeutics can play a role in all stages of COVID-19 disease: to prevent infection; suppress symptoms and spread of infection to others; treat or prevent symptoms; as a life-saving treatment for severe symptoms; and as a treatment that can speed up recovery. The aim in the next 12 months is to develop, manufacture and distribute millions of treatment doses, helping COVID-19 sufferers to recover from the disease.
- The vaccines pillar, co-convened by CEPI, Gavi and WHO, is speeding up the search for an effective vaccine for all countries. At the same time, it is supporting the building of manufacturing capabilities, and buying supply, ahead of time so that at least 2 billion doses can be fairly distributed to the most high risk and highly exposed populations globally by the end of 2021.
- The health systems connector pillar, led by the World Bank, the Global Fund and WHO, is working to ensure that these tools can reach the people who need them.
- Cross-cutting all of these is the workstream on Access & Allocation, led by the WHO.
Since April 2020, the ACT-Accelerator has supported the fastest, most coordinated, and successful global effort in history to develop tools to fight a disease. With significant advances in research and development by academia, private sector and government initiatives, the ACT-Accelerator has advanced our understanding of what works to fight the disease. It has transformed our ability to tackle COVID-19 on a global scale: vaccines are being rolled-out worldwide, low-cost high-performing antigen rapid diagnostic tests can now detect transmission anywhere, affordable therapy for severe disease can save lives in any setting, and health systems are being strengthened.
The second round of a World Health Organization “pulse survey“ reveals that over one year into the COVID-19 pandemic, substantial disruptions persist, with about 90% of countries still reporting one or more disruptions to essential health services, marking no substantial global change since the first survey conducted in the summer of 2020.
Within countries, however, the magnitude and extent of disruptions has generally decreased. In 2020, countries reported that, on average, about half of essential health services were disrupted. In the first 3 months of 2021, however, they reported progress, with just over one third of services now being disrupted.
Countries have been working to mitigate disruptions. Many have now stepped up communications efforts to inform the public about changes to service delivery and provide advice about ways to safely seek health care. They are also triaging to identify and better meet the most urgent patient needs.
More than half the countries consulted say they have recruited additional staff to boost the health workforce; redirected patients to other care facilities; and switched to alternative methods to delivering care, such as providing more home-based services, multi-month prescriptions for treatments, and increasing the use of telemedicine.
In addition, WHO and its partners have been helping countries to adapt their processes so they can better respond to the challenges being placed on their health systems; strengthen primary health care, and advance universal health coverage.
“It is encouraging to see that countries are beginning to build back their essential health services, but much remains to be done,” says Dr Tedros Adhanom Ghebreyesus, Director General, WHO. “The survey highlights the need to intensify efforts and take additional steps to close gaps and strengthen services. It will be especially important to monitor the situation in countries that were struggling to provide health services before the pandemic.“
Persisting causes of disruptions
Countries are still having to make important decisions when responding to COVID-19 that may negatively affect access to care for other health issues. Redeployment of staff to provide COVID-19 relief and temporary closures of health facilities and services continue.
Although they may have taken on new staff, 66% of countries continue to report health workforce-related reasons as the most common causes of service disruptions. Supply chains are also still disrupted in nearly one third of countries, affecting the availability of essential medicines, diagnostics, and the PPE needed to safely and effectively provide care.
Communications efforts need to be further scaled up: more than half of countries report service disruptions due to patients not seeking care and because of community mistrust and fears of becoming infected.
Meanwhile, 43% of countries cite financial challenges as major causes for disruptions in service utilization.
As a result, millions of people are still missing out on vital health care. In terms of services, the biggest impact reported by nearly half of countries is on provision of day-to-day primary care to prevent and manage some of the most common health problems. Long-term care for chronic conditions, rehabilitation, and palliative end-of-life care, is also still badly disrupted - severely affecting older people and people living with disabilities.
Potentially life-saving emergency, critical and surgical care interventions are still disrupted in about 20% of countries, reflecting the most immediate indirect consequences of the pandemic. Two thirds of countries also report disruptions in elective surgeries, with accumulating consequences as the pandemic is prolonged.
Among the most extensively affected health services (i.e. those for which more than 40% of countries are reporting disruptions) are those for mental, neurological and substance use disorders; neglected tropical diseases; tuberculosis; HIV and hepatitis B and C; cancer screening, and services for other noncommunicable diseases including hypertension and diabetes; family planning and contraception; urgent dental care; and malnutrition.
Issued ahead of World Immunization Week (which starts 24 April) and World Malaria Day (25 April) the survey reveals that serious gaps also remain in addressing disruptions to services in both these areas.More than one third of countries are still reporting disruptions to immunization services, despite progress in countries reducing disruptions to immunization services in health facilities and “outreach” immunization services by about 20% and 30% respectively compared to 2020. This highlights the need for new and sustained approaches to improving immunization coverage and uptake.
“The COVID-19 pandemic continues to pose serious challenges to global health beyond the impact of the disease itself,” said Henrietta Fore, UNICEF Executive Director. “For children, disruptions to immunization services have serious consequences. As we scale up delivery of COVID-19 vaccines, we have to ensure that this does not come at the cost of essential childhood vaccinations. We cannot allow today’s fight against COVID-19 to undermine our fight against measles, polio or other vaccine preventable illnesses. Prolonged immunization disruptions will have long-term consequences for children’s health. The time to catch up is now.”
Meanwhile, nearly 40% of countries are also reporting disruptions to one or more malaria services. While progress compared to 2020 – with about 10% fewer countries reporting disruptions to malaria diagnosis and treatment and 25-33% fewer countries reporting disruptions to malaria prevention campaigns (including distribution of long-lasting insecticide impregnated bed nets, indoor spraying and seasonal malaria chemoprevention), the reported level of disruption is still significant and needs to be urgently addressed.
WHO will continue to support countries so they can respond to increased strains on health systems and rapidly evolving priorities and needs throughout the course of the pandemic, and to ensure that COVID-19 control strategies are in balance strategies to tackle other health priorities and secure continued access to comprehensive care for everyone, including the most vulnerable.
Key support mechanisms include the ACT-Accelerator, which works to speed up equitable access to COVID-19 vaccines, tests and treatments, and the Strategic Preparedness and Response Plan, which guides actions taken at national, regional, and global levels to tackle COVID-19.
The Organization also remains focused on the delivery of the work it has committed to before the COVID-19 pandemic started. Internally, through the “Boost initiative” and the UHC Partnership, which covers 115 countries, WHO has strengthened its capacity to provide additional support to countries so they can maintain essential health services during the pandemic, and advance progress towards universal health coverage.
Note to editors
This survey looks at 63 core health services across delivery platforms and health areas. It was sent to 216 countries and territories across the six WHO regions. 135 responses were received (63% response rate) from senior ministry of health officials predominantly between January and March 2021. The responses referred to the situation in the country during the 3 months prior to survey submission (in this case predominantly covering periods between October 2020-February 2021).
The purpose of the survey was to gain insights and perspectives on the impact of the COVID-19 pandemic on essential health services and how countries are adapting strategies to maintain essential services. This survey round follows up WHOs previous pulse surveys on continuity of essential health services distributed throughout quarters 2 and 3 of 2020, including: Pulse survey on continuity of essential health services during the COVID-19 pandemic; Rapid assessment on the impact of the COVID-19 pandemic on noncommunicable disease resources and services; Rapid assessment on the impact of COVID-19 on mental, neurological and substance use services; and Round 1 and Round 2 pulse surveys on immunization.
While pulse surveys have limitations such as possible reporting bias and representativeness, the strength of this effort is that it is comprehensive, and delivers information rapidly.
Statement of the Strategic Advisory Group of Experts (SAGE) on Immunization: Continued review of emerging evidence on AstraZeneca COVID-19 Vaccines
WHO is committed to updating its policy guidance whenever relevant new information has been obtained through the use of the vaccine in populations around the world and new results from clinical research.
Accordingly, new data continues to regularly emerge from ongoing clinical trials and monitoring on the AstraZeneca COVID-19 Vaccine and other vaccines. On the basis of this additional evidence, the Strategic Advisory Group of Experts (SAGE) on Immunization has updated its interim guidance on the use of the AstraZeneca vaccines against COVID-19 that are produced by different manufacturers (Astra Zeneca-Vaxzevria, Serum Institute India SII Covishield, and SK Bioscience).
WHO continues to support the conclusion that the benefits of these vaccines outweigh the risks. Pursuant to the latest data, further clarification of precautions and types of risk (ie. Thrombosis with Thrombocytopenia Syndrome) has been added. More data have been obtained on the effectiveness of the vaccines in different population groups, such as older adults, making the evidence base more robust. Clarifications and specifications have been added as to the vaccination of specific population groups (pregnant and lactating women, person with previous SARS-CoV2 infection and others).
The changes to these Interim Recommendations apply to multiple sections of the document. The updated version is available here.
The SAGE Working Group on COVID-19 Vaccines will continue to evaluate available data and modify the guidance as required.