Maintaining Polio-Free Status in Indonesia During the COVID-19 Pandemic

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Abstract

Despite the negative impact that the COVID-19 pandemic has had on polio eradication efforts, ensuring the high coverage of polio immunization and high performance of surveillance are essential to maintaining Indonesia’s polio-free status and the reaching the 2023 global polio eradication target.

Key Messages

Indonesia’s polio-free status as well as the 2023 global polio eradication target have been threatened by disruptions to immunization services caused by the coronavirus disease (COVID-19) pandemic and related restrictions.
Fear of contracting COVID-19, human resource diversion, and travel restrictions posed barriers to delivering polio immunization services during the pandemic.
To resume polio vaccination efforts and maintain polio-free status, Indonesia health authorities need to take action to:
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  Maximize vaccine service reach by mapping children who have not been vaccinated and monitor the vaccine supply chain
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  Integrate vaccine delivery with pandemic response efforts
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  Mobilize communities for advocacy and education
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  Adjust programs to address human resource, physical, and financial resource gaps
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  Strengthen monitoring and evaluation and surveillance efforts

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Most cited references 44

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Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

Timothy Roberton, Emily Carter, Victoria Chou … (2020)

Summary Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9% and the prevalence of wasting is increased by 10–50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding Bill & Melinda Gates Foundation, Global Affairs Canada.

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Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit–risk analysis of health benefits versus excess risk of SARS-CoV-2 infection

Kaja M Abbas, Simon R. Procter, Kevin van Zandvoort … (2020)

Summary Background National immunisation programmes globally are at risk of suspension due to the severe health system constraints and physical distancing measures in place to mitigate the ongoing COVID-19 pandemic. We aimed to compare the health benefits of sustaining routine childhood immunisation in Africa with the risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection through visiting routine vaccination service delivery points. Methods We considered a high-impact scenario and a low-impact scenario to approximate the child deaths that could be caused by immunisation coverage reductions during COVID-19 outbreaks. In the high-impact scenario, we used previously reported country-specific child mortality impact estimates of childhood immunisation for diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, Streptococcus pneumoniae, rotavirus, measles, meningitis A, rubella, and yellow fever to approximate the future deaths averted before 5 years of age by routine childhood vaccination during a 6-month COVID-19 risk period without catch-up campaigns. In the low-impact scenario, we approximated the health benefits of sustaining routine childhood immunisation on only the child deaths averted from measles outbreaks during the COVID-19 risk period. We assumed that contact-reducing interventions flattened the outbreak curve during the COVID-19 risk period, that 60% of the population will have been infected by the end of that period, that children can be infected by either vaccinators or during transport, and that upon child infection the whole household will be infected. Country-specific household age structure estimates and age-dependent infection-fatality rates were applied to calculate the number of deaths attributable to the vaccination clinic visits. We present benefit–risk ratios for routine childhood immunisation, with 95% uncertainty intervals (UIs) from a probabilistic sensitivity analysis. Findings In the high-impact scenario, for every one excess COVID-19 death attributable to SARS-CoV-2 infections acquired during routine vaccination clinic visits, 84 (95% UI 14–267) deaths in children could be prevented by sustaining routine childhood immunisation in Africa. The benefit–risk ratio for the vaccinated children is 85 000 (4900–546 000), for their siblings ( 60 years) is 96 (14–307). In the low-impact scenario that approximates the health benefits to only the child deaths averted from measles outbreaks, the benefit–risk ratio to the households of vaccinated children is 3 (0–10); if the risk to only the vaccinated children is considered, the benefit–risk ratio is 3000 (182–21 000). Interpretation The deaths prevented by sustaining routine childhood immunisation in Africa outweigh the excess risk of COVID-19 deaths associated with vaccination clinic visits, especially for the vaccinated children. Routine childhood immunisation should be sustained in Africa as much as possible, while considering other factors such as logistical constraints, staff shortages, and reallocation of resources during the COVID-19 pandemic. Funding Gavi, the Vaccine Alliance; Bill & Melinda Gates Foundation.

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Making waves: Wastewater-based epidemiology for SARS-CoV-2 – Developing robust approaches for surveillance and prediction is harder than it looks

Dr. David Polo, Marcos Quintela-Baluja, Alexander Corbishley … (2020)

Highlights • Presence of SARS-CoV-2 in feces and wastewater constitutes a paradigm shift in surveillance • WBE has potential as a surveillance and predictive tool during the COVID-19 pandemic • Validated protocols for concentration and quantification of SARS-CoV-2 and other markers are needed

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Author and article information

Journal

Journal ID (nlm-ta): Glob Health Sci Pract

Journal ID (iso-abbrev): Glob Health Sci Pract

Journal ID (hwp): ghsp

Journal ID (publisher-id): ghsp

Title: Global Health: Science and Practice

Publisher: Global Health: Science and Practice

ISSN (Electronic): 2169-575X

Publication date Collection: 28 February 2022

Publication date (Electronic): 28 February 2022

Volume: 10

Issue: 1

Electronic Location Identifier: e2100310

Affiliations

[a ]Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Indonesia.

[b ]Center for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Indonesia.

[c ]World Health Organization , Country Office for Indonesia.

[d ]Sub-directorate of Immunization, Directorate of Surveillance and Health Quarantine, Ministry of Health of The Republic of Indonesia.

[e ]National Certification Committee for Polio Eradication (NCCPE) Indonesia.

[f ]Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Indonesia.

[g ]Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada , Yogyakarta, Indonesia.

Author notes

Correspondence to Riris Andono Ahmad ( risandono.ahmad@ 123456gmail.com ).

Article

Publisher ID: GHSP-D-21-00310

DOI: 10.9745/GHSP-D-21-00310

PMC ID: 8885360

PubMed ID: 35294381

SO-VID: 5fe66287-1812-4f05-9797-c263141cad00

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-21-00310

Maintaining Polio-Free Status in Indonesia During the COVID-19 Pandemic

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Novel Coronavirus Disease COVID-19

Most cited references 44

Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit–risk analysis of health benefits versus excess risk of SARS-CoV-2 infection

Making waves: Wastewater-based epidemiology for SARS-CoV-2 – Developing robust approaches for surveillance and prediction is harder than it looks

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