i really enjoyed going to the circus school and to rehearse or the messages. let us help at once on. the whole world is going to be a circus worlds because we are to prove that it's possible to work live. so get their wits so much different nationalities together. all gamma circus has long been an odd form that has brought ukrainian or russian performance to gather because of the war. and that's not only possible in countries as far away as the netherlands. but for some sharing the states together, it's difficult with all that's been go with at a whit or russian colleagues be somebody i'm in the, i can't do this now. i would feel i would betray my people because they are fighting for my country. people are dying at a moment that would not be possible for me. oh, a few days before the show, several russian artist canceled despite their trauma anastasia and the other

performers hope that one day sir has come again, bring russian and ukrainian performers together. step, fasten al jazeera door direct in the netherlands. ah, aunt in marion, paul and the operation remains on going. russian forces have been surrounding the side trapping. hundreds of civilians and ukrainian flight is inside. is believe many of the evacuees will be brought to this city of separation harder. abdul hamid is there for you and is giving very little detail anyway injured. in other world news, the government in wander is being sued for $400000000.00 by the family of the man whose life inspired the hollywood film and made a event having held worldwide for international labor day police in paris. 5 gas

for testers. i'm happy with the real ah ah, including measles, the world health organization says cases jumped by near the 80 percent in january and february, compared to the same period last year. call vaccine access, conflict and diversion of resources to fight cobra 19. around the world, the pen to me cause cose cv, describe purchases and inoculations against measles. a viral respiratory illness also dropped. with about 22300000 infants missing out the u. k. dr. parrot pen. connie was a senior clinical lecturer at the university of exeter as medical school. welcome to you all. thanks so much for speaking to us on inside story dr. appraisals. it's

very disappointing because as we all know, measles is a vaccine preventables illness. and if we want to eat so unfortunately, it's fairly a global phenomena in that twitter cove at 9000 over the past 2 years has been disruptions of human zation services across the globe. almost going to replicate what probably transpired with a ball not breaking the d r. c. in 20. 19 an earlier ball outbreaks in west africa re, eventually the number of people as an example, died of measles was doubled. and number of people that died from the power left, because when you have to decide options of you all get services and when child immunization programs, countries especially susceptible dod briggs of measles. and this is going to be something that we're going to need to deal with moving forward for the next few years. unfortunately. ok, important points to raise what the immunization program, you know, the one that make has impacted dilution program on the global get. we witness in

202220 1000000 children were left under, connected via destruction. and in 2021. we saw 120000000 children missed by musics. nation of which pakistan share was 40000000. so focused on under the shared the previous burden of the it's a part of it and the india nigeria and yemen. we speak a 65 percent of the burden of disease in the m region. and though we had 70 different out bricks in pakistan last year, that cost $51.00 bits in children and 100000 cases it up that which was double up to 2020. so we can see that the scale of the impact of this disruption called by the code 19 pandemic. ok, and also dr. nadine, just to add on to what you're saying, the u. n is saying, this is according to you and data that there have been 21 measles outbreaks in the last 12 months. most of them. and you've, you've alluded to this as well, most of them in countries, in africa as well as the eastern mediterranean and certainly where you are in

pakistan. why in these areas specifically? well, for men, 3 reasons. first of all, these going to do but lower routine immunization coverage like pakistan is still has what 65 percent for one and 45 percent coverage for you to so it will be on the targeted 95 percent coded. and the 2nd one, the health system will understand there was underneath the issues in their system and the cord on them when instructed, came with the storm. it impacted the whole system. and so it is, source is the minimum resources that whatever the system there, what you do or the prevention and control of the equipment damage. so that resulted in collision of the cases. and the 3rd one is the population density. and these going to take out in countries, nation continues, we look at it and especially in pakistan,

gives the population density is very high, and it used to work loading of the population. and so that means this outbreak spits more motors or dangerously and ok, dr. pers, i see you nodding along, i mean tell us, do you think that the statistics and this number that the u. n is putting out 21 measles outbreaks over the past 12 months. it could actually be an under estimate as well. i think so. yes, very much so. so what hits the you and you are know radar is the tip of the os i spoke. so we do how sporadic outbreaks all over the world. and it is as our colleague in pakistan has said, it is multifactorial. but the big, big concern is, if this is a tape of the iceberg and the poorer nations are getting more and more outbreaks, it costs the health care system. a lot of money. once the child is ill, it costs a lot of money and some children will die. on the other hand,

if you were to spend some money immunizing it costs pennies compared to thousands of pounds. if a child becomes ill, i wonder what you mean by tip of the iceberg. so what i mean is that what we know is a, just a snapshot of what is going on in the world right? where you might, as i suppose, let me just rephrase that question. what are you basing that on? why do you say it's just the tip of the iceberg right now? okay, so i go by, what has been good for previous practice, which is whenever a surveillance authority is bead b r w h o or any other, are we only get a small measure of the actual picture? that's what i'm referring to, is in actuality, not all cases are always reported and then reported upwards. therefore, what we know is a snapshot of a much bigger picture ah, elsewhere. ok, so bear the w h o is also saying that the disruptions to immunization services will

be felt, quote, for decades to come. how so and how do you read into that statement? yeah, absolutely. but just before i answer that, we thought that he is, and why we believe does his a complete and they estimate is that is not their immunization itself. that has suffered over the course of the past 2 years. but even surveillance systems for vaccine preventables diseases, cept really as suffered. and consequently, i, especially in resource constraint countries, what you would expect is that there would be an unbiased attainment of the number victim preventable diseases as well as hot brakes i thought transcribing. so i fully agree that this is very much and, and estimate are just men. probably many more than $21.00 odd breaks. it's transpired. and especially in the continent such as ethnic go, even before the cobra, endemic are less than 70 percent of children under the age of 5 perceived at least one dose of measles. maxine. so sampling, i do agree with that with the got studied the question that to my son was that the

w, i tell a saying this is going to be felt for decades to come. what, what impact are we going to see because of this. so to some extent, a paradox, if you already starting to see impacts and countries such as the united kingdom. so there's another disease known as pneumococcal disease which is caused by becky dent, honestly, mckoko's. and it's a major cause of hospitalization and death due to pneumonia, especially in low and middle income countries. interestingly, what happened in the united kingdom is that although that eunice sort of ran downward and of course have covered 19, especially in children under age of 15, in the past few months. if seen an increase in pneumococcal disease which goes beyond the rate that occurred before over 19. and what appears to be happening is that it seems to be a balance of susceptibility in children, especially to these extreme preventable diseases, including children that are vaccinated. so that is just one example. so when we talk of andaman ization is much as bought and immunization against measles as

a whole lot of other life threatening diseases. with children of ex, nate that again, which causes pneumonia, which causes dido disease, a leading causes of death, one, what's vaccines? and we can expect those to start increasing. because what's happening now is up to the opening of society's dis, pathogens. i'm more likely to be transmitting including to children, and if they're not adequately protected because of being not immunize or monday midnight. we can expect us to continue. so in this country, start planning on doing mess of ketchup campaigns, including what's referred to as supplemental immunization activity is where you go out in the population to every house. literally are trying to vaccinate every child under the age of 5 against measles as, as an example. unless those supplemental immunization activities gain protection immediately, we are going to experience a surge in vaccine preventables diseases which goes beyond a number of death which transpired before to unsettled her cove. had been demick. right. just one more for you had there before i move on to dr. nadine a pish our i mean in certain countries in africa for example,

there are issues of conflict. so to what extent to those issues, compound the accessibility issues for vaccines and the programs that are meant to take place in the country. absolutely, and it obviously comes up in a context of betty out. the source contains a resource constrained step things and pressure. i'll get systems to stop what so do sort of. busy so, unrest or including movement of people across the border, refugees, unfortunately in africa, especially then not that we all taken care of when it comes to the needs in terms of health care, including immunization of children and the type of conditions that those children and families eventually end up living in africa is conducive to the spread or dyslexia preventable disease, as well as other diseases for which we don't care vaccine. dr. today, let me ask you about vaccine hesitancy and skepticism because it has been an issue . we know with polio vaccines, for example, in pakistan, where you are so to what extent a skepticism actually work again,

so much of the progress that has been made when it comes to immunizations of children, of certain diseases. you really big are the one size issue of his music nation and foolish nation. you know, we suffer greatly because of the big scene hesitancy in parts of pakistan and, and 2012 and 13. we had to put a band on a mission mission that rendered 300000 children unmixed because of a dog was and x and misconceptions that were spreading in their society. finally, we could come or there is it and see by replying this the perception management strategy in the country and, and directing more broadly. and. busy has household level with the parents and it will be in and make us. but still, there are issues that remain in the heart of the people. that means they're not yet fully convinced they're fixing was and it's not only confined to pakistan, understand the somalia. we saw exceed hesitancy in you is in 2018 and 19 and there

was a search in music cases. well, 100 get it out of the view, which at, which was not the case in the year before the usa usa had eliminated mixing, amusing in 2001. so this antivirus are compound, this are trips, misconceptions. and so clear to dogmas against the explanation. it increased the already existing notes and skepticism in doubts and mines of the people, especially there stacked up the society which is a more inclined towards conspiracy duties that list educated electricity that is, that they're already suffering. and that is that a skepticism towards the public affairs entity, the public system. so by and large, it contributed to the increasing that skepticism and, and we've seen hesitancy in the community. but, you know, if we pin down now in pakistan, lease, we do encounter it. but they are really low compared to the previous years that the

year 2019 and before we start. and so when you say that black cine has often see is, is one of the main drivers behind the measles outbreaks or not so much this time around. dr. nancy, it did, it did it, did contribute to not only to me or to me is a big, but other than so they can look it up. well, you'll receive, you see here it is the 2 other scenes as well. so there is a mindset already working against of a scene that we need to counteract that, that mindset by engaging them by reading them and going out of the bus. so out of the box to do you were not, there's those strategies that you've been in practice since the edges and the student type of mentality in this tuesday strategies that wouldn't work anymore. we need to innovate. we need to start a day that we need to engage. i don't need those communities and pinpoint

discussion which are still that it forces to their condition. why that is done. we have that is ok. what are the limited? i'd like to ask you about the innovation and the strategy in a moment. but 1st let me talk to her about this issue and st hesitancy because the world health organization named it as one of the 10 greatest health threats off 2019 so. so just weigh in on this conversation and, and tell us whether it from what you've seen, vaccine hesitancy in skepticism has played an, an issue in the resurgence of the measles outbreak. yes, indeed, in the high income countries, united kingdom, european union, united states, we have seen the consequences of vaccine hesitancy. remember about a 1000000 americans have died from cohen and a lot of that has been due to mismanagement and not applying simple measures like getting immunized in time. so with respect to x in hesitancy, what can we do? well, it is important upon the government. it starts right at the top and they have to

have this program log in for a boys educate. and at the same time, bring into control our we have social media platforms which are spreading lies, spreading misinformation, and they mustn't be allowed to just carrying on under the guise of well, it is free speech. this so called free speech homes. people people die, and i think it is incumbent upon nashville government to say to these social media platforms and some media outlets as well. this is wrong, this is incorrect. we're not allowing you to broadcasting a dr. barris'. how does the resurgence of measles allow for other preventable diseases to find their way into the population? does it, does that happen? yes, so with respect to not taking up measles vaccines, it is a clear proxy indicator that you are also, as my colleagues, has said,

about mucus not taking up all the vaccines and this is very concerning. so we have new a caucus we have meningitis. we have to peer, and we have measles, mumps, rubella and the others. they are all very serious illnesses. people die and when they are ill, it costs a lot of money to make you better. and on the other hand, if we were to immunize it protects you, and often it protects you for life. ok. a severe marty. i mean, how worried are you that other outbreaks of diseases can be expected in the short to medium term? very much so, but just in terms of the question of vaccine hesitancy, right, i've seen africa and many of dog breaks after experiencing is more english, your vaccine excess optic was humans or there was a decrease in vaccine uptake, jude and covered ben demick at that percentage. change was relatively modest compared to what occurred as an example in southeast asia. it's more an issue of

fixing excess. but at the same time with the type of hype and misinformation that grounded on gov at 19, certainly moving forward. one of the applications of that potentially is dep, parents are going to not become hesitant to something which they previously did almost blindly, and that is getting the children vaccinated. so does vaccine hesitant? city hesitancy certainly is going to permit into the child with immunization program and have a ripple effect as a consequence of the misinformation at aunt cove at 19 with the cut to the impact of measles. uncontrolled means loss here on other vaccine preventables diseases. as an example with measles, the majority of children that die die as a consequence of a super imposed bacteria infection, including new markets. and now when you've got children that the susceptible to measles, as rowdy, susceptible to these other vixen preventable diseases for which day being under immunized. again, it's unfortunate to lends itself to a much higher case, but tell it to rate the grade. the percentage of the children that they're getting infected measles will now go on to die if they're not adequately protected against

the other vaccine. preventables diseases also because of andaman ization, so does massive amount of interaction between measles and many other bacteria and viruses. especially bacteria, which is often a complication that eventually causes the vast majority of the children. it dude, i end up with disobeying both bacteria infections. ok, adam and over to a to pass our and dr. nadine, john, you were mentioning a few minutes ago that new strategies need to be adopted in order to increase the inoculation rates. just talk to us a little bit about more and how health systems need to reorient their systems to get back on. and this very important point that it should be a mighty race from johannesburg about vaccine equality. so i will speak on both aspects of this presentation, both the demand and the supplies, i don't know in the demand site. first of all, we can go for an integrated approach and just take a post to where destination light looks you, nation and so may not get benefits,

which in this nation in integrated with other interventions can provide. and it can also provide a boost to the public confidence, as i mentioned earlier, that the public at large has got lower confidence and public and system. so we need to build it public confidence on this nation and health services. and that can be done by integrating mutual recognition board. you've exclamation with other public interventions, nutrition, a wash, and other immunization services, minute and a new bunch of stuff. so if, if they can be back into that and then provider it right there, goes to the people in it will increase the appetite of the people and also with the buying of the people that were being asked. and that's what also impact their demand side of the nation. that's how we can increase that the demand of the people and the rest of the people and i'm mixing ish and then secondly, innovation in this the demand side intervention

a colleagues talked about just so she made up, there are no doubt about it. this is the mentor they've been called that a lot of information, fact news and fed up spears that on social media there forums and. and they contribute towards increasing their critical myself, if uses and, and resistant forces of explanation. so did we need to check to do the station at the global level as it station and at the, at the country all is well then another, another link and another area or just one minute. so we can pinpoint the edges of it. it was an weird is this week, was it? why is this refusal and how we can engage and gone better get people's address? yes for the long term. so that we, when the minds and hearts of the people that for one day, but 4 long years and for all years to come. okay, we just had about a minute and

a half left or so. so allow me to interrupt and bring in doctor power to tell us what's at stake for these children because of the, the postponed inoculation campaigns, whether it's measles or the other communicable diseases that there are short term and unfortunately, and tragically long term consequences. so the short term is you will be ill. there long term is after you have been ill and recovered, hopefully you are still left wonderful. and if you are still left wondering able, and you're not fully covered with other vaccines, you will get these infections like the new market, like the meningitis. and furthermore, when you are ill, you under perform in your school. so the long term consequences are one of the acute illness wonderful to other illnesses and then poor attainment in school and education. and then when you, how quarter attainment in school and education, unfortunately, you also go on could be economically less on the program. again,

any time by visiting our website al jazeera dot com, you can also go to our facebook page for further discussion. that's facebook dot com, forward slash ha, inside story on the conversation on twitter or handle as ha, it's i sorry for myself and the whole thing right here. and uh huh. thanks very much for watching. and bye bye for now. cathy, this morning. we meet with global news makers. i'm talk about the story stuck matter on al jazeera in the vietnam war. the u. s. army used to heidi talks to cover side with catastrophic consequences. agent orange was the most destructive instance chemical warfare a decade later from his father's dictatorship. good frontrunner.