The World Health Organization y UNICEF have published data showing that the pandemic of COVID-19 has caused the largest sustained decline in childhood vaccination in 30 years.
The percentage of children who received all three doses of the diphtheria, tetanus and pertussis (DTP3) vaccine – which is used as a marker of immunization coverage – fell five percentage points between 2019 and 2021, to 81%. .
As a result, 25 million children did not receive one or more doses of DTP through routine immunization services in 2021 alone. This is two million more than were lost in 2020 and six million more than in 2019, highlighting the growing number of children at risk of devastating but preventable diseases.
The decline is due to many factors, including an increase in the number of children living in fragile and conflict settings; misinformation and issues related to COVID-19, such as service and supply chain disruptions and the diversion of resources to pandemic response and containment measures.
“This is a red alert on children’s health. We are witnessing the largest sustained decline in childhood immunization in a generation. The consequences will be measured in lives,” said Catherine Russell, Executive Director of UNICEF. “While a hangover from the pandemic was expected last year as a result of disruptions and lockdowns brought about by COVID-19, what we are seeing now is a continued descent. COVID-19 is not an excuse. We need to catch up on immunization for the millions who are missing, or we will inevitably see more outbreaks, more sick children and more pressure on already strained health systems.”
Of the 25 million children who missed out on vaccines, some 18 million did not receive a single dose of DTP during the year. The vast majority of them live in low- and middle-income countries, with India, Nigeria, Indonesia, Ethiopia and the Philippines reporting the highest numbers. Among the countries* with the largest relative increases in the number of children who did not receive a single vaccine between 2019 and 2021 are Myanmar and Mozambique.
In addition, more than a quarter of the coverage of human papillomavirus vaccines that was achieved in 2019 has been lost, which was already low with only 15% of those vaccinated with the first dose.
Sustained decline
© UNICEF/Cesar Poveda
A girl receives a hepatitis B vaccine during an immunization campaign in Venezuela
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2021 was expected to be a year of recovery. Instead, DTP3 coverage fell to its lowest level since 2008. The decline in other core vaccines moves the world away from the 2030 targets set in the Sustainable Development Goals.
Coverage of the first dose of measles fell to 81% in 2021, also the lowest level since 2008. This means that 24.7 million children did not receive their first dose, 5.3 million more than in 2019, and 14.7 million did not receive their second dose. Similarly, compared to 2019, 6.7 million more children did not receive the third dose of the polio vaccine and 3.5 million the first dose of the human papillomavirus vaccine, which protects girls against cervical cancer.
The sharp decline in the past two years comes after nearly a decade of stagnant progress, which these agencies say underscores the need not only to address pandemic-related disruptions, but also systemic challenges.
“Planning for and fighting COVID-19 must go hand in hand with vaccination against deadly diseases like measles, pneumonia and diarrhoea,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “It’s not a matter of one or the other, it’s possible to do both.”
Child malnutrition
© UNICEF/Ismail Taxta
This severely malnourished one-year-old is receiving care at a hospital in Dolow, Ethiopia.
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This historic setback in immunization rates comes against a background of rapidly rising rates of severe acute malnutrition. A malnourished child already has weakened immunity and a lack of vaccinations can mean that common childhood illnesses quickly become lethal for them. The convergence of a hunger crisis with a growing immunization deficit threatens to create the conditions for a child survival crisis.
Vaccine coverage decreased in all regions, with East Asia and the Pacific recorded the largest setbacksor in DTP3 coverage, with a drop of nine percentage points in just two years.
Some countries notably curbed declines. Uganda maintained high levels of coverage in routine immunization programs, while launching a selective vaccination program against COVID-19 to protect priority populations, including health personnel. Pakistan recovered pre-pandemic levels of coverage thanks to high-level government commitment and significant catch-up efforts. The agencies applaud that this was achieved in the midst of a pandemic, when health systems and health workers were under great pressure.
In the rest of the world, they stress, “monumental efforts will be needed” to reach levels of universal coverage and prevent outbreaks. Inadequate levels of coverage have already led to outbreaks of measles and polio in the last twelve months.
Global Agenda for Immunization 2030
WHO and UNICEF are working with Gavi, the Vaccine Alliance, and other partners to deliver on the Global Agenda for Immunization 2030 (IA2030), a strategy for all countries to achieve disease prevention goals through of immunization.
“It is heartbreaking to see more children lose protection against preventable diseases for the second consecutive year. The Alliance’s priority must be to help countries maintain, restore and strengthen routine immunization alongside the implementation of ambitious COVID-19 vaccination plans, not only through vaccines but also structural support tailored to the health systems that will administer them,” said Seth Berkley, CEO of Gavi.
IA2030 partners call on governments and relevant stakeholders to take action to bring back vaccination and tackle setbacks:
- Expand services in underserved areas to reach children who have missed doses and launch campaigns to prevent outbreaks
- Build confidence in vaccines and immunization, counter misinformation, and increase vaccine acceptance, especially among vulnerable communities
- Invest in primary care services
- Secure political commitment from national governments and increase resource allocation to strengthen and sustain immunization within primary care
- Strengthen disease surveillance and information systems to provide the data and monitoring needed for programs to have maximum impact
- Leverage and increase investment in research to develop and improve vaccines
* From countries with at least 10,000 children with zero dose in 2021
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