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Covid-19: PAHO calls for Americas to reverse vaccination setbacks caused by pandemic

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2344 (Published 28 September 2022) Cite this as: BMJ 2022;378:o2344
  1. Luke Taylor
  1. Bogota

Senior officials at the Pan American Health Organization (PAHO) have called for renewed efforts to vaccinate the Americas, as setbacks caused by the covid pandemic have left the region vulnerable to preventable diseases.

Members of the World Health Organization’s Americas branch told the 30th Pan American Sanitary conference held in Washington, DC, that hard earned health gains made in recent decades, particularly in vaccination, had been reversed in the past two years as focus shifted to the pandemic. Rates of vaccination against preventable diseases have either stalled or declined in all countries of the region, and vaccination coverage against several illnesses has reached historic lows.

The resurgence of serious diseases showed why countries must work hard to reverse vaccination losses, said Sebastian Garcia Saiso, director of PAHO’s Department of Evidence and Intelligence for Action in Health, as the latest edition of PAHO’s Health in the Americas report was unveiled.1 He told the conference, “The pandemic has directly and indirectly affected the health of people and threatened progress against various diseases. We hope the publication will help decision makers and inform public policies to resume progress towards better health for all.”

The Americas were acutely affected by the pandemic, which caused health services and vaccination campaigns to be paused while efforts were redirected towards containing and treating covid-19. Some 93% of PAHO member countries had all types of essential health services interrupted by the end of 2021, the Health in the Americas report found.

PAHO’s director, Carissa Etienne, said on 26 September that gaps in immunisation caused by stalling vaccination campaigns had “rolled back nearly three decades of progress on childhood vaccinations in recent years.” The circulation of global health threats from monkeypox to polio showed why it was important to redouble vaccination efforts, she told the conference.

Polio resurgence

The first case of polio in the US in almost a decade was detected in New York on 21 July, and wastewater samples suggested that it was spreading, leading the city’s governor to announce a state of emergency on 9 September.2 Cases of the virus, which can cause paralysis, have also been detected in London and Jerusalem.

Etienne told a PAHO press conference the previous week that vaccine coverage against polio had fallen to 79% in the Americas, the lowest level since 1994, making the region particularly vulnerable. Diseases were now circulating in the Americas that “we had either already eliminated or were once on the verge of surpassing,“ she said, adding that “other diseases like diphtheria and yellow fever are just one outbreak away from becoming regional emergencies.”

Brazil, the Dominican Republic, Haiti, and Peru were identified by PAHO to be at very high risk of polio because of falling vaccination rates, while Argentina, the Bahamas, Ecuador, Panama, Suriname, and Venezuela were at high risk.

Future health threats

The Health in the Americas report, which examined the impact of covid-19 and how to prepare for future health threats, features the health profiles of individual countries and territories in the region, including 80 standardised health metrics. Underfunded health systems, a shortage of vaccines early on in the pandemic, and the inability to enforce lockdowns meant that Latin America and the Caribbean were often the pandemic’s epicentre.

Some 37% of the world’s confirmed cases of covid-19 and 45% of related deaths were reported in the Americas. The disease was particularly deadly in Latin America and the Caribbean, where 62% of all deaths occurred, despite North America recording 55% of the region’s infections.

The high number of fatalities caused by covid-19, as well as the wider damage to health from lockdowns and the suspension of health services, caused life expectancy in Latin America and the Caribbean to drop sharply. The average life expectancy dropped by 2.9 years, from 75.1 years in 2019 to 72.2 in 2021, showed estimates from the United Nations’ World Population Prospects 2022.3

More health professionals

The Americas Health Corps, an initiative to plug a severe lack of healthcare professionals in the region, was also formally presented to health ministers and state leaders attending the conference. Coordinated by PAHO and funded by the US, the scheme aims to train half a million public health professionals over the next five years.

A long term lack of investment has led to a shortage of health workers, said PAHO officials, but there has also been an exodus of professionals to wealthier nations, said Christopher Tufton, minister of health and wellness for Jamaica.

“Jamaica has traditionally been a supply market for healthcare workers,” said Tufton. “Over the past four years, over 3000 healthcare workers, primarily nurses, migrated to the US and to Canada and the UK. This has resulted in a backlog in surgery cases because we don’t have operating theatre nurses, and challenges in terms of treatment of chronic diseases such as cancer.

“We would like to train more, but we are limited by faculty and clinical rotation space. And this is why this collaboration to expand capacity through partnerships is so necessary—not just for Jamaica but for other small countries in the Caribbean region.”

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