In the fight to reduce infant mortality and mortality worldwide, we face two major challenges: malnutrition and infectious diseases. What makes things all the more challenging is that the two are linked. Multiple hardships, including lack of access to healthcare, not being vaccinated, poverty and gender-related barriers, can all intertwine and leave children vulnerable.
Obviously, if malnutrition prevents the activation of a strong immune response to infection, this could also reduce the effectiveness of immunization.
The World Health Organization estimates that 149 million children under the age of five worldwide are “stunted,” meaning they are too small for their age. Forty-five million are too thin for their height, a condition called wasting. Both stunted growth and wasting are manifestations of malnutrition. About 45% of all deaths under the age of five – most of which occur in low- and middle-income countries – are linked to malnutrition.
Meanwhile, food insecurity means that more and more families do not have consistent access to enough of the right types of food. As they struggle to give children the nutrients they need to grow stronger and healthier, families are faced with another related problem: infectious diseases. This is because the immune response to infections is compromised in malnourished individuals.
This is especially concerning because an alarming number of malnourished children are often the same children who need vaccines for diseases that put them 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, this could also reduce the effectiveness of immunization. It is a vicious circle and we have known that for more than fifty years.
As we work to ensure food security, it is imperative that we:
- Step up efforts to combine interventions that address the link between malnutrition and infectious diseases; And
- Study the effects of the interventions to improve them.
Breaking the cycle: how better nutrition and vaccination can help
To tackle this self-perpetuating cycle, we need to vaccinate more children while improving their diet through nutritional advice and supplements.
Immunization-nutrition integration (INI) is a strategic approach that combines nutrition and immunization interventions to improve the health and well-being of children. The best opportunities for INI start before a child is even conceived and last 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 chance of healthier babies. For example, vaccination of mothers against influenza has been shown to reduce low birth weight by 15%.
After birth, breastfeeding produces milk that is rich in nutrients and antibodies. This helps nourish children, protect them from infections as their own immune systems mature, and even improve their responses to vaccines.
Conversely, immunization keeps infectious diseases at bay and they are better protected against malnutrition. At the same time, providing nutritional supplements during vaccination can combat malnutrition and stimulate a child’s response to vaccines. Studies have shown that vitamin A and iron do this for polio and measles vaccines. In other words, it’s a virtuous cycle.
INI could be especially useful in reaching children who are not receiving doses, as they are more likely to be malnourished and live in families facing multiple deprivations. One study, which included data from 80 countries, found that children with stunted growth are 32% more likely to have received a zero dose than to have received at least one vaccine.
Integrating nutrition and vaccination services can help improve the impact and success of both interventions. For example, children are more likely to receive vaccinations if they also receive nutritional services at the same time. This is of particular importance for populations in humanitarian crisis, where there is a high risk of malnutrition in addition to healthcare disruption.
Building resilience through partnership amid global shocks
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 strong partnerships and multi-sectoral investments can play a role in generating demand for health-seeking behavior.
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) recently committed $15 million to UNICEF Ethiopia’s ‘End Child Wasting’ program and Gavi is contributing to the investment supported by the UK Foreign, Commonwealth and Development Office (FCDO) Matching Fund.
The program supports 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 is partnering with Gavi on an implementation research project, Nutrivax, to better understand the impact of jointly delivering nutrition services and vaccines.
But more can be done.
That is why at this year’s Global Food Security Summit organized by the Foreign Commonwealth Development Office (FCDO) – together with the Bill & Melinda Gates Foundation and the CIFF – Gavi is proposing that INI efforts through initiatives to strengthen healthcare systems need to be scaled up. .
Such an effort would help us understand the cost-effectiveness and efficiency of the programs. This would allow us to replicate success strategies in tackling malnutrition and infectious diseases. Collaboration must support this effort, because only together can we protect the most vulnerable children and their families, whose resilience is constantly tested.
Multiple global shocks, including the COVID-19 pandemic, conflicts in Ukraine and the Middle East, and climate-related disasters are exacerbating the food supply crisis and exacerbating malnutrition. Better understanding the dual impact of INI programs on both nutrition and immunization status can help us reach more children, especially zero-dose children, and improve their overall health and well-being. This in turn can reduce vulnerability for both these children and their communities.