The State of the World’s Children 2023: Universal Vaccination, Childhood Immunization, and the Impact of the COVID-19 Pandemic.

The State of the World’s Children 2023 report examines the steps needed to ensure universal protection of children against vaccine-preventable diseases. Unfortunately, the COVID-19 pandemic has caused a serious setback in vaccine coverage, generating a red alert in children’s health worldwide.

The COVID-19 pandemic has had dire consequences on childhood immunization and poses a threat to children’s health. According to the State of the World’s Children report, in just three years more than a decade of progress in this field has been lost.

Today, we are seeing a resurgence of preventable diseases in areas where we had achieved effective control. If we do not address this situation, the most vulnerable children will face an uncertain future due to the inability to access health care centers and participate in vaccination campaigns.

It is evident that many children around the world continue to be unprotected against serious and fatal diseases due to the difficulties of implementing vaccination programs in the post-COVID-19 context. During the period 2019-2021, more than 67 million children did not receive one or more doses of preventive vaccines, exposing them to various preventable diseases.

Worldwide, it is estimated that approximately one in five children has not received the necessary vaccination, which implies that they have not been fully immunized. These coverage levels had not been observed since 2008.

The group called “zero dose” refers to those children who have not received their first dose of vaccination against diphtheria, pertussis and tetanus (DTP1). On the other hand, undervaccinated children are those who have received one dose, but have not completed the vaccination schedule with the third protective dose.

The resurgence of preventable diseases and the uncertain future of vulnerable children.

The reappearance of outbreaks of preventable diseases, such as cholera, measles and polio, is cause for alarm. These diseases are re-emerging in countries where they had previously been controlled and cases are also increasing in countries that have not yet eradicated them.

Cholera spreads mainly due to lack of access to safe drinking water and adequate sanitation systems. This disease can have a fatal outcome in a short period of time if it is not treated promptly. During the year 2022, there was an increase in the incidence of cases and deaths from cholera worldwide, after years of declining rates.

The lack of access to vaccines and the vulnerability of many children around the world.

Measles is highly contagious and has a high mortality rate globally. Measles cases can have serious complications, including pneumonia, severe diarrhea, blindness, and encephalitis. Unfortunately, in 2021, approximately 40 million children did not receive the measles vaccine, leading to multiple mass outbreaks with devastating consequences around the world the following year.

Afghanistan, Ethiopia, Nigeria, Somalia, and Yemen were some of the countries hardest hit by these measles outbreaks.

Polio is a highly infectious disease that mainly affects unvaccinated children. In severe cases, it can cause permanent paralysis. Although significant progress has been made in eradicating this disease, in the past two years we have seen an increase in outbreaks, jeopardizing the gains made so far.

Children in Chad, Nigeria, the Democratic Republic of the Congo and Yemen have been especially affected by polio. In addition, during the year 2022, cases of this disease were reported in Malawi and Mozambique, two countries that had been free of the virus for decades. This situation is closely related to socioeconomic inequalities, poverty and lack of access to health services in these communities.

More than three quarters of unvaccinated children globally are found in just 20 countries. These children live in extremely remote rural areas, on the fringes of cities, in conflict-affected regions, or in migrant and refugee communities. It is vitally important to urgently provide them with the vaccines they need.

Chronic deficiencies in health systems worldwide, exacerbated by the COVID-19 pandemic, have been a determining factor in the decline in vaccination coverage. It is crucial to take immediate steps to ensure universal vaccination of all children, regardless of their place of birth or geographic location. This will give current childhood and future adults the opportunity to achieve their full development.

To overcome the current challenges, key measures and collaborative strategies must be implemented. The implementation of effective immunization programs and campaigns to update the vaccination schedule for children who were not vaccinated during the pandemic are recommended. It is critical to identify unvaccinated or under-dosed children and establish a collaborative dialogue with communities to develop strategies to meet their needs.

It is important to address the difficulties faced by both urban and rural areas, strengthening community participation and recovering human resources lost during the pandemic. In emergency or conflict situations, there is a need to focus on the recovery of health workers and infrastructure in those fragile contexts to ensure that children have access to vaccines.

The role of financing, health personnel and accountability in effective vaccination.

Investment in primary health care is essential for the success of effective vaccination campaigns. Strong health systems and adequate resources are essential. Financing must support equitable access to health services, even in times of tight budgets, as immunization has been shown to have high returns.

There is a need to increase the number and skills of health workers, especially women, and improve their working conditions and pay. Accountability must also be promoted and leadership capacity strengthened to oversee healthcare spending, especially in countries with fragile health systems and limited funds.

Donor funding should be tailored to strengthen comprehensive health systems rather than focus solely on disease-specific initiatives and campaigns. Investment in novel technologies is needed to increase the accessibility and affordability of vaccines, especially in low- and middle-income countries. Innovation such as messenger RNA has proven its worth during the COVID-19 pandemic and it is important to continue funding research in this field.

Over time, we have managed to protect millions of children through vaccination. However, vaccination coverage needs to be improved. More than three decades ago, the United Nations ratified the Convention on the Rights of the Child, which guarantees the protection of children’s health and access to quality health care.

Routine immunization is essential to ensure protection of children’s health, and a significant shift in political will is needed to deliver on this commitment. Investing in children’s health through vaccination is not only a matter of health, but also a long-term economic investment, since it allows for the full development of children and their contribution to society.

Although achieving global and effective vaccination coverage can be complex, we must not lose hope. With significant measures and prioritizing routine immunization, it is possible to reach children living in remote areas or in vulnerable situations, such as wars.

Keywords: universal vaccination, child health, vaccine coverage, pandemic setback, preventable diseases, COVID-19 pandemic, childhood immunization, immunization programs, outbreaks, cholera, measles, polio, public health.

2023-07-06 16:22:51
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