after deterred to retires in july, the next administration will shift its focus and protect indigenous peoples considered by some here to be the last line of defense against climate breakdown. jamal ali dog, n al jazeera book hidden and province southern philippines. as always more news on our website at al jazeera dot com, the very latest on all of our top stories on there, al jazeera dot com. ah no. again, i'm fully battle with the headlines on al jazeera, about a 100 civilians have been freed from a b. c. steel works in mary a bowl after leading nearly 2 months under ground. many of them are expected to go to the city of zapper regional, the u. n and red cross are leading the operation with ukranian and russian forces, or dr. hamid has more, we're still waiting for the rockies of the as of style steel plant or that are

being brought it here at some point maybe today by the u. m. and the international red cross, however, we are in this parking lot where the others are gonna arrive. but a group of iraqis have arrived this morning on their own. actually we spoke to many of them. they come from are you pulled, they come from have so they basically organize themselves who tried to get out of those areas as quick as possible or you can still see here on their car. they have written clearly marked that there's children on board. they have here a little white cloth to also make the point that these are civilians. meanwhile, russia has been intensifying attack, seen that seizing more territory in east in ukraine. that's the new front line. the town of double paleo was targeted on sunday. 7 people were injured when a residential building was struck. the united nations secretary general antonio terrace is on a tour of senegal, leisure. and nigeria is wanting that russia's invasion of ukraine threatened to

devastate some of the least developed african nations. more than 2000000 people have been displaced in the sa hale region. news. siemens has opened its borders to tourists for the 1st time in nearly 2 years travelers from but 60 countries can now visit without the need to isolate or quarantine. but they must be vaccinated against corona virus. was bibs around the world are celebrating the ferocity of eda fisher marking the end of the holy month of ramadan. thousands of palestinians have attended prayers at the alex or mos compounds. tension has been high in recent weeks. falling incursions by far right. ultra nationalists, jewish groups inside the compounds and similar scenes in baghdad, where worshippers pat mosques in iraqi capital, security forces on high alert to prevent attacks during the holiday period. those are the headlines coming up next on al jazeera. it's inside story stay with us. talked to al jazeera, we, what is the time table in your mind?

when do you think that you are, can be off of russian gas? we listen when i've seen and played football with the refugee, i look at them and they're happy smile. and we meet with global news makers and talk about the stories that matter. on the global panoramic has thrown trials, immunization programs into k. all legal cases are up to 80 percent that your other preventable diseases are also reading fast. so what should be done to put childhood vaccination back on track? this isn't like, ah, ah, hello and welcome to the program. i'm getting you navigate them for the past 2 years. the world has focus its attention on battling over 19,

but that's disruptive 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. so malia yemen of gone to star nigeria and g, p o, p, are recorded the highest incidence of measles, the w h o. blame pandemic disruptions, unequal vaccine access, conflict and diversion of resources to fight cove 19 around the world. pundum because cose, c. v disruptions to routine immunization programs, putting millions of children's lives at risk and opening the door to fresh outbreaks of measles and polio. millions of children missed out on routine vaccines and 2020, including 4 diseases like polio and yellow fever. according to the world health organization and unicef, nearly $17000000.00 children did not receive

a single vaccine. while an estimated 22700000 did not get the 3 jobs for the period, tetanus, and purchases and inoculations against measles. a viral respiratory illness also dropped with about 22300000 infants missing out the number. and our guest joining us from pis hours dr. nadine john, who's a public health physician who also lead pakistan's polio vaccine program in johannesburg. should be my tv and the faculty of health sciences and professor vaccine ology at the university of the wit, waterfront, and in bath. in the u. k. dr. parrot pen, connie 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 how sporadic 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 19 over the past 2 years has been disruptions of human as ation services across the globe, including at high income countries. some countries have been able to catch up other countries. unfortunately, us us to lagging behind and this is a perfect storm in so far,

it is almost going to replicate what probably transpired with a ball not breaking the d r. c. in 2019 an earlier ball 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 power left. because when you have disruptions of you all get services and when child immunization programs, i neglected a while focusing on something else. just especially in countries that i know at close to getting to 90 to 95 percent coverage. even before to 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 her 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 the immunization program under global get the business in 202200. 20000000 children were left under,

connected via destruction. and in 2021, we saw 120000000 children missed a music's mission, of which pakistan shed was 40000000. so focused on under the shared the heaviest burden of the usa. it's a part of it. and on the india nigeria and yemen, we speak a 65 percent of the burden of disease in the region. and though we had 70 different out ricks in pakistan last year, that cost $51.00 bits in children, and 100000 cases, the update 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. first of all, this going to go lower immunization coverage like pakistan. this still has got 65 percent or if you run and 45 percent coverage for you too, so it will be on a 95 percent coded. and the 2nd one, the head system was under the strand and there was already issues in the system and the code on them when in stock it, it came with the storm. it impacted the whole system. and so this is source is the minimum resources that are available that their system there were skewed towards the prevention and control of the court. and so that it is collision of the cases. and the 3rd one is the population density. and these going to be late 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 that you store according of the population. and so that means

this outbreak spirits more uh, more continuously 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 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 off 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 authorities beat the 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 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 a suffered. and consequently i especially in resource constrained countries. what you would expect is that there would be an unbiased attainment of the number of bits him preventable diseases throughout his heart based a thought transpiring. so i fully agree that this is very much an and estimate artist man, probably many more than 21 outbreaks it's bounced by it. and especially in the continent such as ethnic away 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 you, 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 toxic you already starting to see impacts in countries such as 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 illness, as sort of ran down to, to and of course of gov at 19, especially in children under age of 15, in the past few months. if seen an increase in pneumococcal disease which goes beyond the right that occurred before cove at 19 and what appears to be happening is that it seems to be a balance of susceptibility in children, especially to dyslexia 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 against which causes pneumonia, which causes dido disease, a leading cause 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 they're being not immunized 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 your supplementary immunization activities, 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 gained direction immediately, we are going to experience a surge in vaccine preventables diseases which goes beyond the number of death which transpired before. the unsettled recovery. endemic right. just one more for you said there before i move on to dr. nadeem at the shower, 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 beauty. the source contains a resource constrained step things in frederick. let's get systems to start with. what so do sort of. busy so, unrest or including movement of people across the border, refugees, unfortunately in africa, especially than 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 diseases, 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 musics, nation and fluency. nation. yeah, 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 new nation that rendered 300000 children and 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 end events are combined. this are trips misconceptions, and so clear to dogmas against the explanation. 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 inclined towards the conspiracy duties that list educated electricity 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 refuses but they are very 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 are 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, the stuff will vc, vc, his, it is easy to 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, if you will notice that 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 just and

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, in hesitancy, what can we do? well, it is important upon the government, it starts right at the top and they have to have these programs over in fall,

advise, 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 on 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 extend hesitancy, right, i say in africa and many of the outbreaks after experiencing is more and is your vaccine excess optic was even though there was a decrease in vaccine uptake, you'd end up covered pandemic that 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, especially bacteria, which is often a complication that eventually causes the vast majority of the children. it would die 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 speak on both aspects of this mission mission, both the demand and the supply. i don't know in the demand site was to hold, we can go for an integrated approach and just take approach towards this nation like the nation and so low may not get their 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, there, the public at large has got lower confidence on public and system. so we need to build it public confidence unless you nation and health services. and that can be done by integrating mutual recognition for you. it's the mission, but other public interventions, nutrition wash and other immunizations. i was a minute and a new bunch of stuff. so if, if they can be baking that on, and then provider it right there goes to the people and 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 big nation. that's how we can increase the demand of the people and the rest of the people on the nation. 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 fed up spears that on social media of their forums and, and they contribute towards increasing their critical, myself, if users and, and resistant forces of explanation a. so did we need to check to do the destination at the global level as it station and at the, at the country, all it is, but then that, that, and that, that link and another very briefly, if you just one minute. so we can pinpoint it yes, i think was an weird is this week was a why is this is susan and how we get in gear and gone to get people that address yes for the long term. so that we, when the by ins and outs of the people that for one day, 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 communicable diseases that there are short term. and unfortunately, and tragically long term. ready 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 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 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, one room to other illnesses and then poor attainment in school and education. and then when you have quarter attainment in school and education, unfortunately you also go on could be economically less or

deliver less financially. when you could have obtained a lock wall, if only you had not been ill for a long period when you were a school child. okay, we'll have to leave it there on that now. thank you so much for joining me on this show. doctor nadine john shabby mcgee and dr. parrot and kenya. 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, forward slash ha inside story on the conversation on twitter handle is a james, i story for myself and the whole thing right here. and uh huh. thanks very much for watching. and what i, for now, this is a region that is rapidly developing, but it's one also that is afflicted by conflict. political up seed was some of those we talk to elsewhere as saying that they fled after hearing that other

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