The unprecedented drop in non-Covid vaccination rates during the pandemic was worse in lower-middle-income countries than in the world’s most impoverished ones, according to data from the World Health Organization.

That counterintuitive finding seems to have a simple explanation: Unlike low-income countries, lower-middle-income countries don’t receive help from Gavi, the international vaccine alliance supported by governments and nongovernmental organizations such as the Bill & Melinda Gates Foundation.

In lower-middle-income countries, basic vaccine coverage declined by an average of 12 percent, according to the WHO data, while Gavi-supported countries — those with per capita annual income below $1,660 — saw an average decline of 5 percent.

A Centers for Disease Control and Prevention analysis found that middle-income countries also saw steeper declines in basic vaccine coverage than Gavi-supported countries.

Uneven impact: Gavi’s records show the decline in vaccination rates was shorter-lived in some countries and didn’t include all vaccinations.

Of the 57 low-income countries that Gavi supports, 19 increased vaccine coverage in 2021.

And coverage for some specific immunizations, including the rotavirus vaccine series, the second dose for measles and the pneumococcal conjugate vaccines, increased in low-income countries.

The vaccine alliance has announced the launch of a program to mitigate vaccine backsliding in middle-income countries. Angola, Bolivia, Honduras and Indonesia will be the first to receive the new assistance.

Big picture: The pandemic set vaccination levels back worldwide for the first time in three decades, threatening herd immunity against measles and polio.

The biggest increases in children who missed basic immunizations, from pre-pandemic levels, were in Southeast Asia (1.6 million), the Americas (1.4 million) and the Western Pacific (800,000).

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Today on our Pulse Check podcast, Lauren Gardner talks with Megan R. Wilson about why lobbyists are bracing for what happens when Sen. Bernie Sanders (I-Vt.) takes the reins of the Health, Education, Labor and Pensions Committee next month.

The World Bank’s new Pandemic Fund will issue its first call for proposals next month, seeking to finance disease surveillance, national laboratory systems and human resources, the bank said last week.

Why it matters: The success of the first round of funding will be pivotal in proving the fund’s value and attracting more contributions toward the $10 billion estimated cost of preventing, preparing and responding to disease outbreaks.

What’s next: The fund is relying on only $1.6 billion in commitments from 25 governments, and organizations like the Gates Foundation, with nearly $600 million already received. The amount of money to be distributed with the initial grants is still to be decided, a fund spokesperson said.

The United States is the fund’s top contributor, with $450 million committed. Part, if not all, of the planned $5 billion over five years in the National Defense Authorization Act earmarked for pandemic preparedness will also go to the fund.

But the defense bill also caps the U.S. contribution to about a third of total funding for the Pandemic Fund.

Government agencies often fail to use technology accessible to people with disabilities — and the Department of Veterans Affairs is a glaring example of the problem, an investigation by Senate Aging Committee Chair Bob Casey (D-Pa.) has found.

The report also found accessibility gaps at the Social Security Administration, the General Services Administration, HHS, the CDC and CMS.

In 1998, Congress mandated that federal agencies implement Section 508 of the 1973 Rehabilitation Act, which requires them to use technology that’s accessible for people with disabilities.

The VA, which serves about 9 million veterans a year, has a lot of work to do to comply.

According to the report::

• All 58 Veterans Benefits Administration regional websites are only partly accessible. 
• The administration’s phonebook intranet site is inaccessible.
• Career websites are largely inaccessible. 
• VA’s Office of Employment Discrimination Complaint Adjudication has many accessibility challenges that create a barrier to filing complaints for people with disabilities.
• Kiosks in offices often fail to adequately accommodate people with disabilities. 

VA responds: The VA has previously told Casey it’s working to fix those issues, starting with its most popular websites.

Simultaneous cannabis and alcohol use ticked up between 2008 and 2019, new research has found.

The findings indicate unintended health consequences might accompany state cannabis legalization.

Researchers from Columbia, the University of Arizona and the New York State Psychiatric Institute found that in states where pot is legal, simultaneous use — meaning a person is under the influence of both substances at once — rose about a percentage point among people between ages 21 and 50. It didn’t rise for people of other ages.

The researchers say the increase in simultaneous use is cause for public health action: “Efforts to minimize harms related to simultaneous cannabis/alcohol use are critical,” they wrote.