In the fight to reduce child morbidity and mortality worldwide, we face two major challenges: malnutrition and infectious diseases. What makes things even more difficult is that the two are interconnected. Many deprivations, including lack of access to healthcare, lack of immunization, poverty and gender-related barriers, can combine to leave children vulnerable.
It stands to reason that if malnutrition prevents the activation of a strong immune response to infection, it may also reduce the effectiveness of immunization.
The World Health Organization estimates that globally 149 million children under five are ‘stunted’, meaning they are too short for their age. Forty-five million people are too thin for their height, this situation is called waste. Both stunting and wasting are symptoms of malnutrition. Approximately 45 percent of deaths under five are linked to malnutrition, most in low- and middle-income countries.
Meanwhile, food insecurity means that a growing number of families cannot consistently access sufficient amounts of the right food. Families trying to provide their children with the nutrients they need to grow stronger and healthier face another related problem: infectious diseases. This is because immune responses to infections are compromised in malnourished individuals.
This is particularly concerning because many of the malnourished children are the same children who need vaccinations against diseases for which they have a high risk of death. 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 may also reduce the effectiveness of immunization. It’s a vicious cycle and we’ve known it for over 50 years.
As we strive to ensure food safety, it is imperative that we:
- Increasing efforts to integrate interventions that address the link between malnutrition and infectious diseases; And
- Examine the effects of interventions to improve them.
Breaking the cycle: How better nutrition and vaccination can help
If we consider this self-perpetuating cycle, we need to vaccinate more children and at the same time improve their diets through nutritional advice and supplements.
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 the child is even conceived and lasts until the age of five.
Parents who are vaccinated against HPV and other viruses and also follow a diet supplemented with micronutrients are healthier; This increases the likelihood of having a healthier baby. For example, maternal vaccination against influenza has been shown to reduce low birth weight by 15%.
Breastfeeding after birth provides milk rich in nutrients and antibodies. This helps nourish children, protect them from infection as their own immune systems mature, and even improve their response to vaccines.
In exchange, vaccination 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 both combat malnutrition and improve the child’s response to vaccines. Studies have shown that vitamin A and iron do this in polio and measles vaccines. In other words, it’s a virtuous cycle.
INI may be particularly 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 were 32% more likely to have received zero doses of the vaccine than those who had received at least one vaccine.
Integrating nutrition and immunization services can help increase the impact and success of both interventions. For example, children may be more likely to receive vaccinations if they also receive nutritional services. This is particularly important for societies in humanitarian crisis, where the risk of malnutrition as well as disruption of health services is high.
Building resilience through partnership despite global shocks
Gavi is currently investing in partnerships that use integrated programs to improve vaccination status and health outcomes. For example, Gavi is working with Unilever Lifebuoy and The Power of Nutrition to improve hygiene, nutrition and immunization in Indonesia, proving that strong partnerships and multi-sector investments will play a role in creating 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) recently committed US$15 million to UNICEF Ethiopia’s “No Child Waste” programme, and Gavi agrees. Investment supported by the UK Foreign, Commonwealth and Development Office (FCDO) Matching Fund.
The program will support Vitamin A supplementation, screening and immunization. This will also support UNICEF’s work to distribute therapeutic food to treat severe acute malnutrition in drought-prone areas of Ethiopia.
In Nigeria, the Eleanor Crook Foundation partnered with Gavi on an implementation research project called Nutrivax to better understand the impact of providing nutrition services and vaccines together.
But more can be done.
That’s why, at this year’s global food security summit hosted by the Foreign Commonwealth Development Office (FCDO) together with the Bill & Melinda Gates Foundation and CIFF, Gavi argues that INI efforts need to be stepped up through health systems strengthening initiatives. .
Such an effort would help us understand the cost-effectiveness and efficiency of the programs. This will enable us to multiply success strategies in the fight against malnutrition and infectious diseases. Cooperation must support this effort, as only together we can 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 worsening malnutrition. A better understanding of the dual impact of INI programs on both nutrition and immunization status could help us reach more children, especially children who have received zero doses, and improve their overall health and well-being. This can reduce vulnerability for both these children and their communities.