Authored by: Zulfah Albertyn-Blanchard and Robyn Mazriel
The COVID-19 pandemic has led to the increase of vaccine preventable disease (VPD) outbreaks across the globe, especially in low-risk countries. A major driver of the current surge in VPD incidence is the COVID-19 restrictions, mainly minimizing public mobility resulting in most of the general population remaining indoors.
This change in population mobility resulted in a reduction of natural boosting of an individual's immune system making it easier for a VPD to develop when exposed. Thus, individuals, especially employees that are unvaccinated, are at a greater risk of developing a VPD and exposing those that are vulnerable. If employees become ill from a VPD, not only are their families at risk but also the business. Immunization is of great benefit to the aftermath of the COVID-19 restrictions that were imposed on populations globally.
COVID-19 Preventative Measures
To mitigate COVID-19 risk, globally, countries imposed several preventative measures. Countries that experienced high COVID-19 incidence at the onset of the pandemic were the first to impose these restrictive measures, which included a rapid change to national and sub-national policy aimed at population mobility. Globally, many countries implemented several preventative measures to minimize the community transmission of COVID-19. These measures included national and sub-national lockdowns, social distancing, handwashing, and the use of face coverings.
The implementation of lockdowns resulted in restrictive population mobility due to school closures, work from home orders, and limitations in social and economic activities like in-person grocery shopping or dining. These restrictions aimed to minimize COVID-19 transmission. However, even though population mobility was restricted, several countries continued to report a surge in COVID-19 activity, especially with the hospitalization of severe cases, thus negatively impacting the ability of healthcare systems to provide accessible and effective services to the general population.
For example, in Japan each prefecture had its own COVID-19 restrictions depending on the risk of disease transmission. Since the start of the COVID-19 pandemic in 2020, Japan continues to report an increase in disease transmission, with healthcare facilities continuing to report an overwhelmed service delivery to manage COVID-19-related case admission.
Disrupted Essential Health Services
Globally, all countries faced many challenges when responding to the COVID-19 pandemic especially managing essential health services needed to attenuate the disruption of these services – such as disease prevention through vaccination. These disruptions to essential health services have a greater adverse health effect on the population, especially those classified as vulnerable such as children, the elderly, and the immunocompromised.
Nearly 40 percent of immunization services were disrupted to prioritize COVID-19 management, and to prevent transmission of the virus. As a result, vaccination rates have significantly decreased, which has increased the risk of VPD outbreaks.
As of April 12, the most reported VPD was measles, where 1,696 individuals were impacted reported by 11 countries compared to pre-pandemic levels (1,088 cases), and five cases confirmed during peak COVID-19 transmission in 2020. This trend in disease incidence can be attributed to the many COVID-19 restrictions that kept people in their homes maintaining a safe distance to avoid disease transmission.
One of the few positive impacts of the COVID-19 pandemic was work from home orders. This COVID-19 restriction highlighted the ability of businesses to continue to perform while keeping their employees safe from COVID-19 infection. However, as with all the COVID-19 restrictions, individuals remained indoors thus reducing the opportunities for natural boosting of an individual's immune system to fight against various infectious diseases due to limited exposure opportunities. This resulted in a population that is more susceptible to diseases that previously their immune system could defend them against, like measles and scarlet fever.
COVID-19 Restrictions and the Immune System
Vaccination is one of the safest and most cost-effective ways to prevent disease transmission and plays a significant role in the overall public health of a country. Drops in vaccination rates coupled with low exposure to viruses because of lockdown measures led to a decrease in immunity against VPDs.
A decline in a robust immune system at an individual level leads to an increase in community-wide transmission of infectious diseases, and consequently results in an increased risk of VPD outbreaks. As COVID-19 restrictions are being dropped, national borders have reopened, leading to increased mobility and subsequent reports of VPD outbreaks in many countries, including those that normally have optimal immunization coverage.
Since 2019, measles outbreaks globally have increased. Measles is one of the most contagious viruses known to humans, causing a high fever and distinctive red rash, and it can be fatal for children under five. The WHO recommends a 95 percent vaccination rate to reach herd immunity for measles to prevent community-wide transmission. Progress to achieving this coverage globally was stalled at nearly 85 percent prior to the pandemic, but COVID-19 disruptions caused that figure to decline to 81 percent, resulting in a spike in measles outbreaks across the globe.
According to the WHO, 20 African countries collectively reported nearly 18,000 measles cases between Jan. 1-March 31, 2022, representing a 400 percent increase in disease activity compared to 2021 over a similar period. Additionally, measles was re-established in ten countries that had previously achieved elimination status between 2018 and 2020. Although largely confined to lower-income countries, measles outbreaks have also begun to emerge in larger numbers across Europe (937 cases in 2022 versus 159 cases in 2021), as well as in the United States (121 cases in 2022 versus 49 cases in 2021).
In addition to measles, there were outbreaks of scarlet fever in locations where prior to the COVID-19 pandemic, these outbreaks were manageable. In 2022, scarlet fever outbreaks were reported in several countries across the European region, namely the UK, France, Ireland, and Sweden. The UK is the most impacted country reporting 129 times more scarlet fever cases in 2023 as of April 12 compared to a similar period in 2022.
This surge in disease activity can be attributed to social distancing and public health restrictions imposed to prevent COVID-19 transmission for the last two years. This has resulted in the immune system not having enough experience to protect against scarlet fever. All the cases were young children that needed a caregiver to take care of them when they were sick, which required these caregivers to take time off from work.
Business Impact of VPDs
The economic benefits of vaccination include avoiding lost work and school days, medical care costs, diversion of resources to outbreak response, and outbreak-related disruptions to local and global economies. VPD outbreaks have a negative impact on businesses and the workplace. The subsequent risk of disease transmission in the workplace can lead to negative economic consequences like the temporary closure of businesses and decreased workforce productivity due to the increased risk of a worker acquiring infection while traveling for business-related matters to known VPD hotspots.
Unvaccinated employees faced with exposure to bacterial and viral infections increases their risk of developing a VPD. If an employee gets infected with a VPD while traveling for business, it could result in additional costs, such as the need for medication, hospitalization, and the extension of the trip to account for recovery. Similarly, if an employee that is a caregiver becomes ill, their time will be spent at home recovering and taking care of dependents if they are ill as well.
Infected business travelers also run the risk of contributing to the transmission of VPDs to other geographic areas or across borders. VPDs can have negative public health and economic consequences if they are introduced or re-introduced by ill travelers traveling to areas with vulnerable populations such as children, the elderly, and those who are immunocompromised.
Immunizations are not only crucial for protecting employee health but necessary for maintaining overall business productivity. Employers can take responsibility of their employee’s well-being by adapting their human resource policies to cover vaccinations and providing accurate information on vaccines to employees.
In terms of employees that are scheduled to travel, employers can facilitate them getting both their required and essential (like the measles-mumps-rubella vaccine) vaccinations by identifying those who will be traveling well in advance and getting them to the appropriate healthcare facility that will provide this service in an effective manner.
Most countries have lifted all COVID-19 restrictions allowing populations to normalize by increasing mobility, thus boosting their immune systems naturally to fight bacterial and viral infections, especially those able to develop a VPD. Over the next few months, VPD outbreaks will stabilize as immunization services return to normal, especially in at-risk countries. Employees traveling for business should ensure that they are up to date with not only recommended vaccines for travel but also essential vaccines to limit their risk.
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