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The last week of April celebrates ‘World Immunisation Week’, ran by the World Health Organization (WHO), which aims to promote the use of vaccines globally to protect people of all ages against disease. Immunisation is a cost effective and critical element of preventive care around the world, estimated to prevent two to three million deaths each year.[1] At present, the vaccination we are most familiar with is for COVID-19. Coronavirus vaccination has been very successful here in the UK; however, uptake in other countries, particularly less economically developed countries, has been less so. Significantly, the coronavirus pandemic has had a negative impact on other vaccination programmes, both within the UK and globally, an issue that may have far-reaching consequences. COVID-19 vaccination across the world Since the first COVID-19 vaccine was delivered in the UK (and indeed in the world) in December of 2020, almost 120 million doses have been administered across the UK[2] and close to 9 billion doses worldwide.[3] This has saved innumerable lives and greatly reduced pressure on the NHS. Governments, organisations and private firms have spent billions in the development of effective vaccines for COVID-19 since the pandemic began.[3] The fast-tracked development of multiple vaccines is unprecedented; this process usually takes 8-15 years from start to finish.[3] Notably, the coronavirus vaccination has been the largest vaccination programme in British history.[4] As of 15 March 2022, a total of 52,717,164 people had received their first dose of the coronavirus vaccine, 49,239,879 their second, and 38,556,133 their booster (or third) dose.[4] Globally, vaccination rates have been highest for the White British ethnic group.[4] However, there has been hesitancy among some groups in receiving the COVID-19 vaccine in the UK. This has been most apparent in pregnant women who were concerned about safety of the vaccine for their unborn child and the mixed messages from the government and NHS – this is particularly worrying because recent figures have shown that one in six of the most critically ill COVID-19 patients are unvaccinated pregnant women.[5] Many other countries have made significant progress in immunising their citizens, while others have vaccinated only small fractions of their populations.[3] The immunisation of a critical mass of the world’s population, which is crucial for getting the pandemic under control, continues to face challenges.[3] The uneven rollout of vaccines was greatly felt in countries such as India, where the spread of the delta variant and relaxed restrictions led to a surge in mid-2021 that hampered vaccine shipments elsewhere.[3] Meanwhile, the WHO has warned that the lack of access to vaccines in Africa, where less than 10% of the population has been fully vaccinated, will prolong the pandemic.[3] The impact COVID-19 has had on UK vaccination programmes The coronavirus pandemic, and indeed it’s subsequent vaccination roll-out, has unfortunately had a negative impact on routine vaccination programmes throughout the UK. On 1 February, the UK Health Security Agency revealed that coverage of the measles, mumps and rubella (MMR) vaccine’s first dose had dropped below 90% in two-year-olds – 22 million children missed their first vaccine dose in 2020 – and by age five, uptake of two doses had dropped to 85.5%.[6] Worryingly, this is well below the WHO’s 95% target needed for elimination of measles. Measles is one of the most contagious viruses to date; it is roughly six times more infectious that coronavirus and kills over 60,000 people a year, mostly young children.[7] It is entirely preventable through vaccination, but as a result of poor vaccine uptake, measles could see a lethal comeback.[8] Hesitancy around receiving the COVID-19 vaccine – largely due to a loss of trust in government, lack of the awareness of the importance of vaccines, and confusion among parents over whether healthcare services were still open during lockdown measures – has led to this huge impact on childhood MMR vaccine uptake.[6] Additionally, many childhood MMR vaccinations were missed because parents were afraid to go to their general practice due to fear of either contracting coronavirus or of adding to the burden on healthcare workers.[7] It is not only MMR vaccination that has suffered since COVID-19: small decreases have been seen in coverage of other childhood vaccines, including diphtheria, tetanus and whooping cough, as well as those for rotavirus and meningitis B.[6] Increase in vaccination coverage during the early 21st century has overall been threatened by the rise of antivaccination groups, who often display aggression and hostility and vocally doubt the effectiveness of vaccines. Antivaccine stories are primarily spread online through social media and are usually not based on scientific evidence, but they generate public distrust in immunisation programmes and as a result can put children who do not receive vaccinations at increased risk.[9] This is of course a huge patient safety issue. Vaccination programmes in other countries Routine immunisation programmes had to suspend or reduce across the rest of the world, too, during the pandemic in order to limit transmission of the virus. However, this has left less economically developed countries with weak health systems more vulnerable to resurgence in preventable childhood diseases such as measles and polio once coronavirus restrictions are lifted.[10] More than 25 countries have placed their measles immunisation programme on hold because all human and financial resources have had to be diverted to manage COVID-19. The pandemic has dramatically impeded US efforts to vaccinate children for other diseases – about 350,000 fewer children were vaccinated against preventable illnesses such as measles and whooping cough in the past year.[11] Similarly, the delivery of Ebola vaccinations across central Africa, and polio vaccination campaigns in Pakistan and Afghanistan, have been suspended.[10] This global disruption to vaccine services carries serious implications for populations of high-risk countries as they could subsequently see a huge rise in childhood disease cases.[10] However, despite the disruption caused by COVID-19, some global vaccination programmes have still been progressing. For instance, children across much of Africa are soon to be vaccinated against malaria – after the success of pilot immunisation programmes in Ghana, Kenya and Malawi, WHO says the vaccine will be rolled out across sub-Saharan Africa and in regions with high malaria transmission.[12] Trials reported in 2015 showed that the malaria vaccine could prevent around 4 in 10 cases of malaria, which is the highest success so far for a malarial vaccine. Conclusion Immunisation is essential for public health. In recent years, vaccination for COVID-19 has been a huge success for science and society alike. Most of the success has been seen in the UK, with distribution and uptake of the vaccine far less in many other countries. However, lockdown measures of the pandemic over the last few years, and the anti-vaccine sentiment around coronavirus vaccination, have resulted in a negative impact on routine childhood immunisations for common diseases such as measles. This can be seen both in the UK and across the rest of the world and, sadly, will likely lead to a resurgence in otherwise preventable diseases. References 1. Immunisation - Public Health. Royal College of Nursing, 2022. 2. Vaccines Minister on the success of COVID-19 vaccine programme. GOV.UK, 2021. 3. Felter C. A Guide to Global COVID-19 Vaccine Efforts. Council on Foreign Relations, 2022. 4. Coronavirus (COVID-19) latest insights. Office For National Statistics, 2022. 5. Summers H. Pregnant women at risk from NHS workers’ mixed messages over safety of jab. The Guardian, 2021. 6. Wilkinson E. Is anti-vaccine sentiment affecting routine childhood immunisations? BMJ, 2022; 376. 7. Sample I. Missed vaccinations could lead to other fatal outbreaks, doctors warn. The Guardian, 2020. 8. Sharma S. Measles could see a deadly comeback after Covid-19 pandemic saw children miss vaccines. The Independent, 2021. 9. Conklin L, Hviid A, Orenstein W, et al. Vaccine safety issues at the turn of the 21st century. BMJ Global Health, 2021; 6. 10. Lovett S. COVID-19 disruption could erase decade’s worth of global vaccine coverage for childhood diseases, Unicef warns. The Independent, 2020. 11. Yang M. Pandemic disrupted routine vaccinations of US kindergarteners. The Guardian, 2022. 12. Gallagher J. Historic go-ahead for malaria vaccine to protect African children. BBC News, 2021.