The largest sustained decline in childhood vaccines in approximately 30 years has been recorded in official published data [July 15] by WHO and UNICEF.
The percentage of children who received three doses of the diphtheria, tetanus, and pertussis (DTP3) vaccine, a marker of immunization coverage within and between countries, fell 5 percentage points between 2019 and 2021 up to 81%.
As a result, 25 million children missed one or more doses of DTP through routine immunization services in 2021. They are 2 million more than those lost in 2020 and 6 million more than in 2019, which highlights the growing number of children at risk for devastating but preventable diseases. The decrease was due to many factors, such as an increase in the number of children living in conflicts and fragile environments where access to immunization is often difficult, increased misinformation, and COVID-19-related problems, such as supply and service chain disruptions, diversion of resources to response efforts, and containment. measures that limited access to and availability of immunization services.
“This is a red alert for children’s health. We are witnessing the largest sustained drop in childhood immunization in a generation. The consequences will be measured in lives,” said Catherine Russell, UNICEF Executive Director. “While a pandemic hangover was expected last year as a result of the interruptions and blockages of COVID-19, what we are seeing now is a continued decline. COVID-19 is not an excuse. We need to put a day of vaccination for the missing millions or, inevitably, we will see more outbreaks, more sick children and more pressure on already tense health systems. “
18 million of the 25 million children did not receive a single dose of DTP during the year, the vast majority of whom live in low- and middle-income countries, with India, Nigeria, Indonesia, Ethiopia and the Philippines registering higher figures. Among the countries1 with the largest relative increases in the number of children who did not receive any vaccine between 2019 and 2021 are Myanmar and Mozambique.
Globally, more than a quarter of the HPV vaccine coverage achieved in 2019 has been lost. This has serious consequences for the health of women and girls, as global coverage of the first dose of the human papillomavirus (HPV) vaccine is only 15%, although the first vaccines were authorized more than 15 years ago.
2021 was expected to be a year of recovery during which tense immunization programs would be rebuilt and the cohort of children lost in 2020 would be up to date. In contrast, DTP3 coverage returned to its lowest level since 2008, which, along with declining coverage of other basic vaccines, pushed the world to achieve global goals, including the indicator of Immunization for Sustainable Development Goals.
This historic decline in immunization rates is occurring in a context of rapidly growing rates of severe acute malnutrition. A malnourished child already has weakened immunity and missed vaccines can mean that common childhood diseases quickly become lethal to them. The convergence of a hunger crisis with a growing immunization gap threatens to create the conditions for a crisis of child survival.
Vaccine coverage fell in all regions, with the East Asia and Pacific region recording the most pronounced investment in DTP3 coverage, falling nine percentage points in just two years.
“The planning and approach of COVID-19 should also go hand in hand with the vaccination of deadly diseases such as measles, pneumonia and diarrhea,” said Dr. Tedros Adhanom Ghebreyesus, director general of the WHO. “It’s not a matter of one, it’s possible to do both.”
Some countries withstood the falls remarkably. Uganda maintained high levels of coverage in routine immunization programs, while deploying a vaccination program aimed at COVID-19 to protect priority populations, including health workers. Similarly, Pakistan returned to pre-pandemic coverage levels thanks to high-level government commitment and significant vaccination efforts to catch up. To achieve this in the midst of a pandemic, when health systems and health workers were under significant stress, applause is to be applauded.
Monumental efforts will be required to achieve universal levels of coverage and prevent outbreaks. Inadequate coverage levels have already led to preventable outbreaks of measles and polio in the last 12 months, underscoring the vital role of immunization in maintaining the health of children, adolescents, adults and society.
The coverage of the first dose of measles fell to 81% in 2021, also the lowest level since 2008. This meant that 24.7 million children lost their first dose of measles in 2021, 5.3 million more than in 2019. 14.7 million more did not receive the second required dose. . Similarly, compared to 2019, 6.7 million more children missed the third dose of the polio vaccine and 3.5 million missed the first dose of the HPV vaccine, which protects against girls against cervical cancer later.
The sharp two-year decline follows nearly a decade of stagnant progress, underscoring the need not only to address pandemic-related disruptions, but also the challenges of systemic immunization to ensure that all children and adolescents are reached. .
WHO and UNICEF are working with Gavi, the Vaccine Alliance and other partners to deliver the 2030 Immunization Agenda (IA2030), a strategy for all countries and relevant global partners to achieve the goals set out in the disease prevention through immunization and vaccine delivery to everyone, everywhere. , at each age.
“It is disconcerting to see more children lose protection from preventable diseases for the second year in a row. The Alliance’s priority should be to help countries maintain, restore and strengthen routine immunization along with the implementation of ambitious vaccination plans against COVID-19, not only through vaccines, but also personalized structural support for the health systems that will administer them, ”said Dr. Seth Berkley. , CEO of Gavi, the Vaccine Alliance.
IA2030 partners call on governments and relevant actors to:
- Intensify efforts to catch up on vaccination to address the decline in routine immunization and expand outreach services to neglected areas to reach missing children and implement outbreaks to prevent outbreaks;
- Implement evidence-based, people-centered, and tailored strategies to build confidence in vaccines and immunization, counteract misinformation, and increase vaccine adoption, especially among vulnerable communities;
- Ensure that current pandemic preparedness and response and efforts to strengthen the global health architecture lead to investments in primary health care (PHC) services, with explicit support to strengthen and maintain immunization. essential;
- Ensure the political commitment of national governments and increase the allocation of national resources to strengthen and maintain immunization in APS;
- Prioritize health information and strengthen disease surveillance systems to provide the data and monitoring needed for programs to have maximum impact; i
- Leverage and increase investment in research to develop and improve new and existing vaccines and immunization services that can meet the needs of the community and achieve the goals of IA2030.
Notes:
1 From countries with at least 10,000 children with zero dose in 2021
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