Opinion: Investing in health workers can help close the vaccination gap — and improve global health

The sharp decline in routine childhood immunization rates the World Health Organization recently reported is a stark warning that today’s pandemic mistakes and rise of vaccine misinformation could harm generations to come.

The enormity of the immunization gap in 2021 is difficult to comprehend: 25 million kids under-vaccinated, with 18 million missing immunizations completely — the highest numbers since 2009. To put that into perspective, imagine that every baby born last year in North America and the European Union combined did not receive the basic vaccinations that would protect them against many of the deadliest childhood diseases on the planet.

This gap represents a major backslide following years of steady progress to protect children around the world from preventable diseases such as polio, pertussis, diphtheria, and tetanus. The consequences are profound: more kids dying before their 5th birthdays, more people suffering from long-term disabilities, more parents forced to miss work to care for sick children, and a cascading burden for economies and health systems. As countries seek post-pandemic stability, the growing immunization gap will hinder their efforts to recover and further weaken health systems ahead of the next big health threat.


A basic step policymakers can take to address today’s childhood immunization gap and strengthen the world’s ability to fight future epidemics is to invest in protecting and expanding the number of frontline health workers, especially nurses and community health workers.

Whether in impoverished rural communities or overcrowded and underserved urban neighborhoods, frontline health workers are frequently the primary available source of treatment, education, and preventive medicine. They are the glue holding many communities together, trusted by parents, businesses, and political leaders alike. But their ranks were already dwindling before Covid-19 emerged and swept around the globe, exacting a high toll among frontline responders in both industrialized and emerging economies from deaths and decisions to leave health care.


Directing funds to hire, train, and protect health workers around the world supports childhood vaccination efforts in three key ways.

First, frontline health workers function as a critical link to new parents as they make vaccine decisions. The drop in immunizations wasn’t just a phenomenon in poor countries: around the world, parents either chose to skip the trip to the doctor’s office during Covid infection spikes or were unable to get access to the care they needed because health systems were overwhelmed. Investing to recruit, train and fairly pay frontline health workers may provide one of the best options for quickly addressing the dramatic decline in immunization rates and ensuring a resumption of the decades of progress the world has made protecting children from preventable diseases.

Second, clinicians, nurses, and doctors working in communities serve an invaluable role as health educators. The work of countering misinformation, engaging patients, and building greater trust in institutions begins at the local level. Frontline health workers are the face of care — and caring — to the millions of people they serve.

Third, community health workers are essential for the early detection of disease outbreaks and the response to them. With outbreaks of preventable diseases such as measles and polio on the rise, health workers frequently are the first to identify infections before they spread through their community. Increasingly, health workers also serve as sentinels to novel pathogens, alerting district and national health authorities when new threats emerge — the time when rapid, community vaccination campaigns are needed to stop spread.

It’s time to allocate sufficient funding to back up the calls to support frontline health workers. The Biden-Harris administration has prioritized investments in health workers through the Global Health Worker Initiative, an important part of the 2023 fiscal budget. By endorsing this important allocation in the upcoming budget negotiations, the U.S. Congress will send a powerful signal to other countries that investing in the recruitment, training, retention, and safety of frontline health workers provides a clear path to improving the health of millions of children and adults while strengthening vital national and global security measure against future pandemics.

Amanda McClelland, a registered nurse, is the senior vice president of Prevent Epidemics, a project of Resolve to Save Lives, a not-for-profit organization working to prevent new disease threats.

Source: STAT