by In the fight to reduce child morbidity and mortality around the world, we face two main problems: malnutrition and infectious diseases. What makes things even more challenging is that the two are interconnected. Multiple deprivations, including lack of access to health services, not being vaccinated, poverty and gender-related barriers, can intertwine and leave children vulnerable.
It stands to reason that if malnutrition prevents the activation of a strong immune response to infection, it could also reduce the effectiveness of immunization.
The World Health Organization estimates that worldwide 149 million children under five years of age are stunted, that is, they are too short for their age. Forty-five million are too thin for their height, a condition called wasting. Both stunting and wasting are manifestations of malnutrition. About 45% of all deaths under five years of age (most of which occur in low- and middle-income countries) are related to malnutrition.
Meanwhile, food insecurity means that more and more families do not have consistent access to a sufficient amount of adequate food. As families struggle to give children the nutrients they need to grow stronger and healthier, they face another related problem: infectious diseases. This is because immune responses to infections are compromised in malnourished people.
This is especially worrying because an alarming number of malnourished children are often the same ones who need vaccines for diseases from which they are at high risk of dying. These include diarrhea, measles, meningitis, tuberculosis, influenza, and bacterial pneumonia.
It stands to reason that if malnutrition prevents the activation of a strong immune response to infection, it could also reduce the effectiveness of immunization. It is a vicious circle and we have known it for more than 50 years.
As we strive to ensure food security, it is imperative that:
- Intensify efforts to combine interventions that address the nexus between malnutrition and infectious diseases; and
- Study the effects of interventions to improve them.
Breaking the cycle: how better nutrition and vaccination can help
If we address this self-perpetuating cycle, we must vaccinate more children while improving their diet through nutritional counseling and supplementation.
Immunization-nutrition integration (INI) is a strategic approach that combines nutrition and immunization interventions to improve child health and well-being. The best window of opportunity for INI opens before a child is even conceived and lasts until age five.
Parents who have been vaccinated against HPV and other viruses, and who also have a diet supplemented with micronutrients, are healthier, which in turn increases the chances of having healthier babies. For example, maternal influenza vaccination has been shown to reduce low birth weight by 15%.
After birth, breastfeeding provides milk rich in nutrients and antibodies. This helps nourish children, protect them from infections while their own immune systems mature, and even improve their responses to vaccines.
Reciprocally, immunization keeps infectious diseases at bay and means they are better protected against malnutrition. At the same time, providing nutritional supplements at the time of vaccination can combat malnutrition and improve the child’s response to vaccines. Studies have shown that vitamin A and iron do the same with polio and measles vaccines. In other words, it’s a virtuous circle.
The INI could be especially useful in reaching zero-dose children, who are more likely to be malnourished and live in families facing multiple deprivations. One study, which included data from 80 countries, found that stunted children are 32% more likely to receive zero doses than to have received at least one vaccine.
Integrating nutrition and immunization services can help improve the impact and success of both interventions. For example, children may be more likely to receive vaccines if they also receive nutrition services at the same time. This is of particular importance for populations in a humanitarian crisis, where there is a high risk of malnutrition along with disruption to health services.
Building resilience through partnerships amid global crises
Gavi has already invested in partnerships that use integrated programs to improve vaccination status and health outcomes. For example, in Indonesia, Gavi is working with Unilever Lifebuoy and The Power of Nutrition to improve hygiene, nutrition and immunization, demonstrating that powerful partnerships and multi-sector investments have a role to play in generating demand for health-seeking behaviors.
Another example is Ethiopia, where the Seqota declaration aims to end all forms of malnutrition in the country by 2030. The Children’s Investment Fund Foundation (CIFF) has recently allocated $15 million to the “End with child wasting” by UNICEF in Ethiopia and Gavi is providing matching funds. the investment supported by the UK Foreign, Commonwealth and Development Office (FCDO) Matching Fund.
The program will support vitamin A supplementation, screening and immunization. It will also support UNICEF’s work in distributing therapeutic foods to treat severe acute malnutrition in drought-prone regions of Ethiopia.
In Nigeria, the Eleanor Crook Foundation has partnered with Gavi for an implementation research project, Nutrivax, to better understand the impact of joint delivery of nutrition and vaccine services.
But more can be done.
That is why this year, at the global food security summit organized by the Commonwealth Development Office (FCDO), together with the Bill & Melinda Gates Foundation and CIFF, Gavi is proposing that INI efforts be intensified through of initiatives to strengthen health systems. .
Such an effort would help us understand the profitability and efficiency of the programs. This would allow us to replicate successful strategies to address malnutrition and infectious diseases. Collaboration must underpin this effort, as only together can we protect the most vulnerable children and their families, whose resilience is constantly tested.
Multiple global crises, including the COVID-19 pandemic, conflict in Ukraine and the Middle East, and climate-related disasters, are exacerbating the food supply crisis and worsening malnutrition. A better understanding of the dual impact of INI programs on both nutrition and vaccination status can help us reach more children, especially those receiving zero doses, and improve their overall health and well-being. This, in turn, can reduce the vulnerability of both these children and their communities.
