In the fight to reduce child morbidity and mortality worldwide, we are faced with two major issues: malnutrition and infectious diseases. Even more challenging is that the two are interconnected. Multiple deprivations, including lack of access to health services, lack of vaccination, poverty and gender-related barriers, can all combine to leave children vulnerable.
The reason is that if malnutrition prevents the activation of a strong immune response to infection, it may also reduce the effectiveness of the immune system.
The World Health Organization estimates that 149 million children under the age of five around the world are ‘stunted’, which means they are too short for their age. Forty-five million are too thin for their height, a condition known as wasting. Stuttering and wasting are manifestations of undernourishment. Around 45% of all under-five deaths – the majority of which occur in low- and middle-income countries – are linked to undernutrition.
Meanwhile, food insecurity means that families do not have consistent access to enough of the right kinds of food. As families struggle to give children the nutrients they need to grow stronger and healthier, families face another related problem: infectious disease. This is because immune responses to infections in malnourished individuals are affected.
This is of particular concern as an alarming number of malnourished children are often the same ones who need vaccines for high-risk diseases. These include diarrhoea, measles, meningitis, tuberculosis, influenza and bacterial pneumonia.
This is because if malnutrition prevents the activation of a strong immune response to infection, it may also reduce the effectiveness of the immune system. It’s a vicious cycle and we’ve known about it for over 50 years.
In our efforts to ensure food security, it is essential that we:
- increase efforts to combine interventions that address the nexus of 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 need to vaccinate more children, while improving their diet through nutritional advice and supplements.
Nutrition-immunity 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 the age of five.
Parents who have been vaccinated against HPV and other viruses, and have a diet rich in micronutrients, are healthier – which increases the chances of healthier children as a result. For example, vaccination of mothers against influenza has been shown to reduce low birth weight by 15%.
After birth, breastfeeding provides milk that is rich in nutrients and antibodies. This helps to nourish children, protect them from infection as 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 during vaccination can combat malnutrition and boost the 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 very helpful in reaching zero-dose children, who are 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 have received a zero dose than at least one vaccine.
Integrating nutrition and immunization services can improve the impact and success of both interventions. For example, children are more likely to receive immunizations if they are also receiving nutrition services at the same time. This is particularly important for a population in humanitarian crisis, where there is a high risk of malnutrition and disruption to health services.
Building resilience through partnership amid global shocks
Gavi is 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 immunity, demonstrating that powerful partnerships and multi-sector investments have a role to play in generating demand for health-seeking behaviours.
Another example is Ethiopia, where Seqota’s declaration aims to end all forms of malnutrition in the country by 2030. The Children’s Investment Fund Foundation (CIFF) has recently allocated US$15 million to the “End Child” program Wasting” UNICEF in Ethiopia and Gavi is matching. the investment is 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 food to treat acute malnutrition in Ethiopia’s drought-prone regions.
In Nigeria, the Eleanor Crook Foundation is partnering with Gavi for an implementation research project, Nutrivax, to better understand the impact of delivering nutrition services and vaccines together.
But more can be done.
That’s why this year at the global food security summit hosted by the Foreign Commonwealth Development Office (FCDO) – together with the Bill & Melinda Gates Foundation and the CIFF – Gavi is recommending that INI’s efforts through health system strengthening initiatives to increase. .
Such an effort would help us understand the cost-effectiveness and efficiency of the programs. This would enable us to replicate successful strategies in tackling malnutrition and infectious diseases. Collaboration must underpin this effort, because only together can we protect the most vulnerable children and their families, whose resilience is constantly tested.
The food supply crisis is worsening with multiple global shocks, including the COVID-19 Pandemic, conflict in Ukraine and the Middle East and climate-related disasters and malnutrition is worsening. A better understanding of the dual impact of INI programs on both nutritional and immune 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 community.