re along the street in italy, the 3 main trade unions gathered in the central town of a c. c. mead is called the piece a reminder perhaps of how the conflict in ukraine is pushing up prices of commodities. they also stress safety for workers and the need for higher wages, like other countries, italy's economic growth has been affected by the war in ukraine. and the risk of recession remains high. it's still heavily dependent on russian energy supplies, despite attempts to win itself off. and that is an issue which many countries will have to address as the war drags on. sunday ela al jazeera. ah, your child is era with lisa hill roman in doha, remind her of our top stories, the u. n. and red cross of completed the 1st phase of evacuation civilians from the as of style steel plant and maria paul, more than

a 100 civilians headed to ukrainian controlled territory and areas held by russian force as an eastern crime. mush managed to day. finally, we managed to start the evacuation of the people from as up style. after many weeks of negotiations and many different meetings, people calls countries, proposals. finally, there was not a single day that we didn't try to find a solution to ensure the safe rescue of those people to day for the 1st time during this war, this vital safe passage started working 2 days at cease fire on the whole territory . and we managed to rescue more than 100 people, civilians, women and children who were hiding it, as of style. for the speaker of the us. house of representatives has thanked ukraine's president for what she described as his fight for freedom. during a visit to keith, nancy pelosi reassured, brought him is a lensky of their continued support. russia is intensifying a tax aimed at seizing mortar trainees in ukraine. the town of double appeal yeah,

was targeted on saturday. 7 people injured when the residential building was struck . un secretary general antennae good terrorist, as in said ago, for the start of a 3 country told of west africa garish worn, that russia's invasion of ukraine threatens to devastate some of the latest develop a least developed african countries to his presence as his country will have a new constitution within days, kai said that a committee will be formed to write the constitution. what he called a new republic sides initiated a political crisis. 9 months by sucking, govern suspending parliament and taking emergency powers. please in china say the arrested at least 9 people following the collapse of the building in turn shot on friday, including the rescue. workers continued to search for survivors in the ruins of the residential building. 7 people were pulled from the rubble. another $39.00 remained missing in front of those stories on

a website down dot come back with more knees in half an hour, but next it's inside story to stay with us. me. the global academic has really filed the immunization programs into k all me. those cases are up to 80 percent. that's your other preventable diseases are also reading fast. so what should be done to put childhood vaccinations back on track? this isn't like ah

hello and welcome to the program. i'm letting you navigate them for the past 2 years. the world has focus its attention on battling co with 19, but that's disrupted prevention and treatment programs for other diseases. millions of children have missed out on crucial vaccinations for preventable illnesses, 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 covert 19 around the world. the pundum cause cose senior disruptions to routine immunization programs. putting millions of children's lives at risk and opening the door to fresh outbreaks of measles and polio practices and inoculations against measles. a viral respiratory illness also dropped with about 22300000 infants missing out

the number. and our guest joining us from per se hours dr. nadine john, who is a public health physician who also lead pakistan's pull the u. k. dr. parrot penn county was a senior clinical lecture at the university of exeter as medical school. welcome to you all. thanks. so much for speaking to us on inside story dr. power out over in the you came. so mizo cases are up by 80 percent this year and that's compared to last year. how big a setback is this for the treatment program and the fight against measles? it's very disappointing because as we all know, measles is a vaccine preventables illness. and if we were to immunize more than 95 percent of our population with 2 seems it provides lifelong immunity. so for a g 7 nation, likely united kingdom to house or at the outbreaks is a failure. it's a failure of public health interventions and measures. there is no cure for measles

. the only prevention is by vaccines and we should be vaccinating ok, severe math here. what would you say was the biggest driver behind the statistic? so unfortunately, it's fairly a global phenomenon in that twitter cove at 9000 over the past 2 years has been disruptions of human as ation services across the globe. including in high income countries. some countries have been able to catch up other countries, unfortunately, us to us to lagging behind. and this is a perfect storm in so far. it is almost going to replicate what probably transpired with a bon are breaking the d r. c, in 2019, and april outbreaks in west africa re eventually the number of people as an example, died of measles was doubled. the number of people that died from the bar let because when you have to disruption of you get services and when child immunization programs, i neglected a while focusing on something else. just especially in countries that, that know at close to getting to 90 to 95 percent coverage. even before the

pandemic. those countries especially susceptible dod break of measles and does 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. we'll get to them in just a moment. but let me bring in the eye doctor nadine john let to get the view from his shower in pakistan from what you've seen on the ground there. how is the pandemic it impacted the immunization program? you know, the plan that make has impacted immunization program under global get the business in 202200. 20000000 children were left unders connected by a destruction. and in 2021 we saw 120000000 children missed a music's mission, of which pakistan share was 40000000. so focused on under the shared the heaviest burden of the music. it's a part of it. and on the india, nigeria and yemen. speak 8065 percent of the burden of disease in the region. and though we had 70 different out bricks in pakistan last year,

that cost $51.00 bits in children and $20000.00 cases it, 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 and pakistan. why in these areas specifically? well, for many reasons, 1st of all, this going to go lower, or even immunization coverage like pakistan is still has got 65 percent or mtv one and 45 percent coverage for it too. so it will be on a 95 percent coded. and the 2nd one, the head system was under the strand that there was underneath the early issues

into his system and the code on them when in stock, it came with the stomp, it impacted the whole health system. and so this is source is the minimum resources that are available and then system there was you towards the prevention and control of the code. and so there is collision of the cases. and the 3rd one is the population density in these guarantees like this up out. and going to do this is going to look at it. and especially in pakistan, yes, the population density is, is very high and it used to work coding of the population. and so that means this old brick stairs more, more dangerously and the ok, dr. barrett, i see you nodding along. i mean, tell us, do you think that these statistics and this number that the u. n. is putting out 21 measles outbreaks over the past 12 months. it could it actually be an under estimate as well. i think so. yes, very much so. so what hits the you and you,

i know radar is the tip of the also i spoke. so we do how a 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 authorities, b, r, w h o or any other, are we only get a small measure off 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 this is a complete and they estimate is that is not or immunization itself. that gets us suffered over the course of the past 2 years. but even surveillance systems for vaccine preventables diseases kept really as suffered. and consequently, i especially in resource constrained countries. what you would expect is that there

would be an unjust attainment of the number of vaccine preventables diseases as well as outbreaks. i thought transpiring. so i fully agree that this is very much an under estimate to dismantle probably many more than 3 impacts in countries such as the united kingdom. so there's another disease known as pneumococcal disease, which is caused by a becky dent, honestly, mckoko's and it's a major cause of hospitalization and death due to pneumonia, especially a low and middle income countries. interestingly, what happened in the united kingdom is that although that units sort of ran downward and of course of got it. so that is just one example. so when we talk of andaman ization is much is about and immunization against measles as a whole. lot of other life threatening diseases with children approximated again which causes pneumonia, which causes dido disease, a leading cause of death, one which vaccines. and we can expect those to start increasing, not immunize, or monday midnight. we can expect us to continue. so in this country, start planning on doing mess of catch up campaigns,

including what's referred to as supplementary missed those supplemental immunization activities, gained direction immediately. we are going to experience a surge in vaccine preventables diseases which goes beyond a number of deaf, which transpired before the unsettled to cove. it been demick right. just one more for you said there before i move on to dr. nadine at the shower. i mean, in certain countries in africa. absolutely. and that obviously come so in the context of beauty out, the source contains a resource constrained step things in frederick guess systems to start of what so do sort of so. busy unrest, or including movement of people across the borders for dirt or few g. unfortunately, in africa, especially then not that we all they can, kids use of to, to spread our district seem to rent the brit diseases as well as other diseases. or we treat dr. vaccines, the doctor 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 rightly big the name on site issue of his music's mission and for you as a nation. yeah, we suffer greatly because of the applying this, the perception management strategy in the country and, and connecting more broadly and a household level with the parents. and i would go 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 that it's seen amusing in 2001. so this antivirus are combined this very trips misconceptions, and so clear to dogmas against that makes the nation. it increased the already existing notes and skepticism and doubts and minds of the people, especially there stacked up. this was id which is more of as entity, the public and 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, use reduce encounter refuses, but they are very low compared to the previous years that the year 2019 and before we decide. and so when you say that roxanne has often see is, is one of the main drivers behind the measles outbreaks or so much this time around . dr. nadine, it did it did it did contribute to not only to mozilla to music a birthday did is a mindset already working against of a scene that we need to contact that, that mindset by engaging them by reading them. i 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 those galleries which are still that exist existing forces to live in it and 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 ask doctor her about this issue of vaccine hesitancy because the world health organization named it as one of the 10 greatest health threats of 2019 so. so just weigh in on this conversation and 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 covey, 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? while it is important upon the government, it stops right at the top and they have to have this program log in, fall, advise, educate, and at the same time, bring into control. we have social media platforms which are spreading lies, spreading misinformation, and then mustn't be allowed to just turning on under the guise of well,

it is free speech, this so called free speech harms. people, people die. and i think it is incumbent upon national 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 and talk to her is how does the resurgence of measles allow for other preventable diseases to find their way into the population to 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 extend hesitancy, writes, i say in africa and many of the outbreaks after experiencing is more an issue. vaccine excess. apic was even though there was a decrease in vaccine uptake. should enter covered pandemic at that percentage. change or relatively modest compared to what the current ext an example in southeast asia. so it's more an issue of fixing excess. but at the same time with the type of hype and misinformation, as grounded on cove 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 at 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 measles he has on other vaccine preventables diseases. as an example with measles, 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 route is susceptible to these other vaccine preventable diseases for which day being under immunized. again, it's unfortunate to lends itself to a much higher case with 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 lead to pass our inductor. 19. john, you were mentioning a few minutes ago that new strategies need to be adopted in order to increase the

inoculation rates. just talked to us a little bit about more and how health systems need to reorient their systems to get back on track and, and their demand and the supply site. and the demand site was the whole week and go for an integrated april and a just take a post reward. this nation like lucy nation is so low. menard give their benefits, which in this nation integrated with other interventions can provide. and it also provides a boost to the public confidence, as i mentioned earlier, that the public at large has got lower confidence on public and system. so we need to build it public confidence on the nation and health services. and that can be done by integrating mutual recognition. would you like the mission with other public interventions, nutrition, a wash, and other immunization services? minute done, a new bunch of stuff. so if they can be back into that and then provider it right there, goes to the people in it for increase the appetite of the people and also with the

banging of the people that were being asked. and that's what also impact their demand side of the explanation. that's how we can increase the demand of the people and the best of the people on, on mixing ish. and then secondly, the innovation in this, the demand side interventions a colleagues talked about just social media. there are no doubt about it this as the mentor. they've been going through a lot of information, in fact, news and, and resistant forces of explanation. a. so did we need to check to do the station at the global level as it station and at the, at the country as well, then another another link and another very briefly in just one minute. so we can pinpoint areas of it. where does this week, why is this refusal and how we can engage and gone that it was of interest? yes for the long term. so that we,

when the minds and hearts of the people that for one time, but for long years and for all years to come. ok, 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. isabel disease is after you have been ill and recovered, hopefully you are still left one rouble. and if you are still left wonderful, and you're not fully covered with other vaccines, you will get these infections like the new mcculloch. i like the meningitis. and furthermore, when you are ill, you under perform in your school on that. now, thank you so much for joining me on this show. dr. nadine john shabby mcgee and dr . parrots and connie, we appreciate your time. thank you for watching. you can see 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,

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