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On second thought Russia’s Health Ministry now says routine immunizations should continue during the coronavirus pandemic

Source: Meduza

Meduza first published this story on April 21, 2020, with the headline “Immunity Disrupted: Contrary to Global Health Recommendations, Some Regions in Russia Are Suspending Routine Vaccinations During the Coronavirus Pandemic.” On April 24, however, Russia’s Health Ministry released new immunization policy recommendations with different advice. This important update is reflected below in yellow-highlighted text.

Several regions across Russia have virtually suspended routine immunizations, following recommendations from the federal government that scheduled vaccinations can wait until after the coronavirus epidemic. At the same time, the World Health Organization says immunizations remain vital. Meduza looks at the dangers of disrupted vaccinations in parts of Russia.

Russia is limiting routine immunizations

On March 25, 2020, Russia’s Federal Service for Consumer Rights Protection and Human Welfare published a letter endorsing the “suspension of routine immunizations in Russia’s constituent entities [...] among the adult population until the epidemiological situation stabilizes.”

Three weeks later, Russia’s Health Ministry published the following message on social media: “The routine vaccination of children and adults is suspended. This new policy will remain in effect until the epidemiological situation stabilizes. Immunizations will continue for newborns at maternity hospitals.” In mid-April, the Health Ministry asked regional officials to set their own vaccination policies during the coronavirus epidemic. Officials have cited no legal grounds for this sweeping change in policy. 

Some regions across Russia have in fact halted immunizations (with certain exceptions). On social media, moreover, people have complained that their requests for vaccinations have been rejected at both private and public facilities, despite the fact that local health officials haven’t formally prohibited the procedure in their regions.

A week after its comments on social media, however, Russia’s Health Ministry released policy recommendations that stated: “Routine immunizations for healthy children who have not been in contact with sick people should not stop!” The agency also specified who should get vaccinated first.

The WHO says immunizations should be a priority during the pandemic

The World Health Organization has repeatedly emphasized the importance of continuing to vaccinate people against other infectious diseases during the global coronavirus pandemic. Suspending these preventative measures, warns the organization, risks new outbreaks of infections now under control, leading to additional stress on healthcare systems, not to mention the deaths of newborns and people in other vulnerable groups. 

In Europe, the WHO’s “Guidance on Routine Immunization Services During the COVID-19 Pandemic” contains detailed recommendations about how healthcare providers should set vaccination policy and minimize risks to the public. The guidance describes no situation where immunizations should be halted completely.

The World Health Organization recommends prioritizing vaccinations against measles, polio, and diphtheria, as well as against yellow fever where it’s common (which doesn’t apply in Russia). It’s also important to keep vaccinating newborns at maternity hospitals and people susceptible to pneumococcal disease and seasonal flu. Patients are also advised to get their immunizations in combined batches, so they don’t need to come to health clinics as often.

In a joint statement, Russia’s Union of Pediatricians and the National Association for the Control of Infections sharply criticized regional officials’ prohibitions of routine immunizations for children, arguing that it is especially important now to vaccinate infants against tuberculosis and hepatitis B (both these vaccines are usually administered at maternity hospitals). The two groups also say immunizations remain vital for “susceptible individuals and patients in groups at risk of pneumococcal infection, type b hemophilic infection, poliomyelitis, measles, diphtheria, pertussis, and mumps.” According to specialists, Russia risks a particularly dangerous outbreak if it suspends vaccinations against whooping cough. New restrictions could also lead to increased incidences of tick-borne encephalitis.

In a separate statement, Russia’s Union of Pediatricians says disrupting routine vaccinations could also reduce the effectiveness of the immunizations that have already been administered because stable immunity against some diseases requires multiple vaccinations at specific intervals. In some cases, Russia’s current restrictions could make it impossible to immunize people against certain diseases, like the rotavirus, against which vaccinations must be carried out before a baby is eight months old and the first of three shots needs to take place within 15 weeks of the child’s birth. 

When drafting its new recommendations, Russia’s Health Ministry apparently took into account these positions, announcing that vaccinations should continue especially for infants and young children. The agency also stresses that patients should receive combined immunizations when possible. “It is especially important to vaccinate susceptible persons and patients in risk groups against pneumococcal infection, haemophilus influenzae type b, and seasonal flu,” says the Health Ministry.

Keep vaccinating, but there are certain rules

Of course, administering immunizations during a pandemic poses certain risks to medical personnel, patients receiving vaccinations, and parents whose children are vaccinated. This is why Russia’s Health Ministry offers the following advice in regions where routine immunizations are still permitted:

These guidelines largely overlap with recommendations from the World Health Organization, which also advocates carrying out vaccinations at home — a practice that is perfectly legal in Russia. In other words, state officials could take steps to shift immunization efforts in this direction. Russia’s Union of Pediatricians shares this view and says hospitalized patients should also be vaccinated. 

People should avoid public transit when visiting outpatient clinics for shots and children who need vaccinations should be accompanied by as few people as possible. Nikolai Smirnov, the chief physician at the “Fantasy” children’s clinic in Moscow, and Marina Demidova, the director of the “DocDeti” children’s evidentiary medicine clinic also in Moscow, told Meduza that immunizations have not been banned in the capital and their patients have had no problems getting permits to come in for routine vaccinations.

When the coronavirus pandemic passes, Russia will need to play catch-up with vaccinations

Immunizations are scheduled according to the ages at which people respond best, justified based on epidemiological threats in a particular area, and spaced out at necessary intervals. When this routine is disrupted, doctors must determine how to proceed: do they pick up where they left off or start over from the beginning? These decisions are made on a case-by-case basis, considering all the above factors for each individual patient, and it’s not always simple. 

Health officials in some countries have designed “catch-up immunization schedules” and the World Health Organization has its own recommendations, arguing that catch-up immunization activities in overwhelmed healthcare systems should prioritize outbreak-prone vaccine-preventable diseases like measles, polio, diphtheria, and yellow fever (where necessary).