For residents of the world’s wealthier nations, the highly promising coronavirus vaccines that are about to be approved, along with those that are still in development, guarantee that the pandemic will end. Not soon enough, and certainly not before a winter of continued death and darkness is behind us. But, eventually, it will end. Then, after countless recriminations—Why did we have no proper testing or tracing? How did we allow the President and his team to catastrophically mismanage the worst public-health crisis in a century?—we will move on.
For many of the world’s poorest children, however, the suffering may have only begun. This spring, the World Health Organization warned that the coronavirus could spread rapidly in clinics throughout lower-income nations where children assemble to receive common vaccinations. Some of those countries, sensibly enough, in the absence of active outbreaks, suspended their childhood-vaccine programs. Since then, however, in parts of Africa and Asia, cases of cholera, diphtheria, and pertussis have risen, and a resurgence of measles and polio has caused greater concern. According to W.H.O. models, measles vaccines prevented 23.2 million deaths between 2000 and 2018; most measles deaths occur in children who are under the age of five. Without a polio vaccination, at least eighteen million people who are walking around today would have been paralyzed.
In the West, the measles vaccine was introduced in 1963. Most low-income countries could not afford it until the mid-eighties. This is a pattern—rich countries benefit from medical advances long before others—that has a well-documented and deadly history. In 1980, measles killed more than two million children, most of whom lived in the world’s poorest countries. That figure fell steadily for decades, as the vaccine was adopted more widely, and by 2016 there were fewer than a hundred and thirty-five thousand measles infections in the world, with ninety thousand deaths. In the past year, though, researchers from UNICEF and the W.H.O. have reported that more than ninety-four million children missed their planned measles vaccination. At the same time, sixty polio-eradication campaigns in twenty-eight countries were suspended. That has already caused new outbreaks of a disease that, just a few years ago, had been nearly wiped out. In the two nations where polio has remained endemic, Afghanistan and Pakistan, some forms of the virus have increased fivefold since 2019. In the coming year, as children—and viruses—begin to move around again, the spread of polio, measles, and other potentially deadly but preventable diseases will almost certainly be considerably wider.
“For months, the world has been appropriately fixated on the COVID-19 vaccine race,’’ Bruce Gellin, the president of global immunization at the Sabin Vaccine Institute, told me. But, he added, the impact of the pandemic on routine immunizations could become enormous, as lockdowns cease and people are able to mingle freely again. “We are in the eye of the storm, with grim predictions that we will soon see large outbreaks of measles. And, worse, the malnutrition that results from COVID-induced stresses on social and economic systems will turn measles from a severe infection into a killer.” Measles can be seen as a kind of index for poverty and weakened public-health systems. The relationship between malnutrition and measles has been noted for decades; children who die from measles are often malnourished (and, in economically deprived regions, those who survive measles often become malnourished).
The possibility of an explosion of measles in the coming year is particularly ominous because it is one of the world’s most contagious diseases. Outbreaks of vaccine-preventable diseases still occur when too few individuals in a population are vaccinated, and, with measles, about ninety-five per cent of children need to be vaccinated in order to stop the spread. Measles was declared eliminated in the United States in 2000, but the number of infections has risen since 2016—fuelled, in part, by widespread but unfounded fears of vaccines in this country and in Western Europe—and they surged in 2019. There were a hundred and twenty cases per one million people in 2019, up from eighteen cases per one million in 2016. In 2019, there were twelve hundred and eighty-two cases reported in this country, the highest number in decades. The same year, the W.H.O. reported 869,770 cases of measles around the globe, the most since 1996. Sustained outbreaks occurred in every region monitored by the organization. There were some two hundred and seven thousand deaths—though exact statistics are hard to measure, and public-health experts agree that the number of reported cases is far short of the true number of infections. Although measles has killed no one in the United States since 2015, it is clear that as the infections grow so does the risk of serious injury and death.
As always, the countries that face the greatest peril are the least financially equipped to deal with the added burden. As of September, according to both the W.H.O and UNICEF, nineteen countries were responding to twenty-nine distinct polio outbreaks, nearly all of them in Africa. According to a report from researchers at the London School of Hygiene & Tropical Medicine, published in The Lancet, the risks of delaying vaccination in the poorest countries will be worse than the risks of the COVID-19 pandemic itself. In other words, disrupting the vaccine programs in Africa, in an effort to curb the pandemic, will have the unintended effect of killing more people than would have died from COVID-19 after visiting clinics.
Now that coronavirus vaccines are on the horizon, there has been much discussion about whether the world’s poorest people will have access to them, and at what cost. Many philanthropies, including the Bill & Melinda Gates Foundation and GAVI, the Vaccine Alliance, have launched serious efforts to insure that the vaccine is not available only in rich countries. The world’s poorest people will certainly suffer the most from the massive economic contraction caused by the pandemic. The question is how bad the damage from the virus will be, and that is up to the wealthier nations. Without their support, most people on earth will continue the battle against COVID-19 long after it is forgotten in New York or Paris.
“COVID-19 has had a devastating effect on health services and, in particular, immunization services, worldwide,” Tedros Adhanom Ghebreyesus, the director-general of the W.H.O., said recently, in a public statement. “But, unlike with COVID, we have the tools and knowledge to stop diseases such as polio and measles. What we need are the resources and commitments to put these tools and knowledge into action,” he added. “If we do that, children’s lives will be saved.’’ Public-health officials have estimated that it will cost less than a billion dollars to prepare for and treat expected increases in polio and measles in Africa and Asia over the next year or two. Americans have already shouldered the enormous financial, and moral, burden of refusing to prepare for pandemics or to take them seriously. COVID-19 has cost us trillions of dollars. Will we deny the world’s poorest people a sliver of that amount and watch as they continue to die of another preventable disease?