An unusual silence fills the waiting area of my fellow paediatrician's office in suburban Maryland. On a typical day, one would expect to see the animated bustle of children. Nowadays, only two out of 10 scheduled visits might take place. Unused vaccine vials accumulate rapidly as families shelter at home.
With lockdowns and fears of the coronavirus pandemic, this scene is playing out in paediatricians' offices around the United States.
Data from the Centres for Disease Control and Prevention's Vaccine Safety Datalink shows an almost 50 per cent drop in children being vaccinated for measles during the first quarter of this year, compared with the same period last year.
This situation is also unfolding elsewhere in the world as countries order lockdowns of varying severity.
At least 25 countries have suspended mass measles immunisation campaigns in the face of the pandemic as of late last month, according to Unicef, the United Nations Children's Fund. As the coronavirus continues its relentless spread, leaving death and economic devastation, other ancient diseases may gain a foothold while vaccination rates drop precipitously.
Measles can cause pneumonia, swelling of the brain and death. Very young children and susceptible adults are more likely to suffer from these complications. Like the coronavirus, it is spread person-to-person through droplets in the air. But the measles virus is about 10 times more transmissible than the coronavirus, and often deadlier. Vaccination coverage of up to 95 per cent is needed to prevent measles transmission in communities.
Before the pandemic, global measles cases were already surging, reaching an estimated 10 million in 2018 with 140,000 measles-related deaths - a 58 per cent increase from the previous two years. Although measles was all but eliminated in the United States in 2000, misinformation and a loss of public trust in vaccines resulted in 1,200 cases of measles last year - the highest number in almost three decades.
In recent years, many measles cases entered the US from foreign travel destinations. Now, with diminished vaccinations of children causing a wider gap in community immunity, there is a clear and present danger that hard-won gains could be reversed.
As schools start reopening their doors, vaccination rates among children could improve. However, school vaccination requirements are not ironclad; medical and non-medical exemptions will leave some children unprotected. Public understanding of this risk and improved confidence in vaccines are crucial.
And yet, the anti-vaccine movement has seized on the Covid-19 pandemic as a rallying point, inexplicably arguing against any vaccine that may be developed. The assertions are baseless and endanger public health.
At the same time, other deadly scourges lurk in the shadows. Poliomyelitis, one of the most feared diseases of the early 1900s, had been heading towards global eradication, with only a few remaining pockets of transmission in the world.
Now these clusters are expanding. The Global Polio Eradication Initiative's interactive map indicates that polio cases have increased this year.
Diphtheria, another deadly disease of the early 20th century, has resurged recently in countries such as Venezuela, Bangladesh and Yemen, where public health systems are severely weakened because of state failure, conflict or the displacement of populations.
The danger is that the continuing pandemic will disrupt immunisations and monitoring of infectious diseases, which could lead to the further spread of these ancient diseases into new populations instead of being consigned to history.
No example from the recent past could be more poignant than the West African Ebola virus disease outbreak in 2014, whose devastating impact extended far beyond just Ebola cases and deaths. Ebola overwhelmed local healthcare systems, while societal stigma and anxiety led to reduced vaccination. An estimated 200,000 cases of measles may have resulted because of these disruptions.
Last year, twice as many children died from a fast-moving outbreak of measles in the Democratic Republic of Congo than from an Ebola outbreak in the country that received far more public attention.
As the pandemic advances and universal immunisation keeps slipping worldwide, preventable diseases in children will keep surging in the background. Many outpatient dispensaries and vaccination clinics have been shuttered as healthcare systems shift to support the response to the coronavirus, public transport has become unavailable, and fear of Covid-19 is rife.
The World Health Organisation says routine immunisation services should be prioritised, yet estimations indicate that more than 100 million children around the world are unlikely to receive their basic vaccines.
The Greek historian Thucydides vividly described the plague of Athens of 430BC. He attributed the strikingly deadly toll not just to disease but also to the failed societal response. History can be instructive, but only if we take its lessons seriously.
Avoiding vaccine-preventable deaths is critical for nations to preserve their gains in child survival. To do so, governments should establish vaccination as an essential service and reinstate services to stop diseases from re-emerging, particularly among vulnerable populations.
Next, while Covid-19 control measures are being instituted, countries must also catch up on missed immunisations.
Third, governments should improve how they communicate with the public, to allay concerns about vaccinations and re-establish community demand for them.
Finally, health agencies should expand collaborations with nutrition, education and other government operations - and especially with regional and national governments. Disease surveillance within and across nations is essential to these public health efforts. Neither the coronavirus nor the measles virus respects geographic boundaries.
In the face of the current pandemic, it can be easy to lower our guard against the potential for future public health disasters. We cannot let that happen. Governments at all levels must work together to protect children from the deadly preventable scourges we have done so much to eradicate.
NYTIMES
• Anita Shet is the director of child health and senior scientist at the International Vaccine Access Centre and a paediatric infectious diseases specialist at the Johns Hopkins Bloomberg School of Public Health.
