Data published last Friday (15) by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) reveal that childhood vaccination around the world is suffering the biggest continuous drop in the last three decades. The two UN agencies are sounding an alarm calling attention to a child survival crisis.
The percentage of children who received three doses of the diphtheria, tetanus and pertussis vaccine (DTP3), an important marker in this area, dropped by five percentage points between 2019 and 2021. This means that last year alone 25 million children lost one or more doses of this vaccination schedule.
2021 was expected to be a year of recovery in childhood vaccination numbers, in which overstretched immunization programs would be rebuilt and the amount of children lost in 2020 would be rewarded. Instead, DTP3 coverage has returned to its lowest level since 2008.
The biggest continuous drop in childhood vaccinations in nearly 30 years was recorded in official data published on Friday (15) by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF).
The percentage of children who received three doses of the diphtheria, tetanus and pertussis vaccine (DTP3) – a marker of vaccine coverage within and across countries – dropped by five percentage points between 2019 and 2021, providing protection for just 81% of the public. target.
As a result, 25 million children missed one or more doses of DTP through routine vaccination services in 2021 alone. That’s two million more than in 2020 and six million more than in 2019, highlighting the growing number of children at risk of contracting preventable diseases.
The decline was due to many factors, including an increasing number of children living in environments of conflict and vulnerability – where access to immunization is often challenging –, increased misinformation and challenges related to COVID-19 such as disruptions to services and supply chain, diversion of resources for pandemic response, and prevention measures that limited access to and availability of the immunization service.
“This is a red alert for child health. We are witnessing the largest continuous drop in childhood immunization in a generation. The consequences will be measured in lives,” said UNICEF Executive Director Catherine Russell. “Although a pandemic hangover was expected last year as a result of the disruptions and lockdowns of COVID-19, what we’re seeing now is an ongoing decline. COVID-19 is no excuse. We need to get immunization back for the millions of children who have lost their vaccines or we will inevitably witness more outbreaks, more sick children and greater strain on already overstretched health systems.”
Of these 25 million children, at least 18 million did not receive even 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, nations that recorded the highest numbers of unvaccinated children. Among the countries with the largest relative increases in the number of children not receiving a single vaccine between 2019 and 2021 are Myanmar and Mozambique.
Globally, more than a quarter of the HPV vaccine coverage that was achieved in 2019 was lost. This has serious health consequences for women and girls, as global coverage of the first dose of the human papillomavirus (HPV) vaccine is only 15%, despite the first vaccines being licensed more than 15 years ago.
Historical setback – 2021 was expected to be a year of recovery during which overstretched immunization programs would be rebuilt and the amount of children lost in 2020 would be rewarded. Instead, DTP3 coverage has returned to its lowest level since 2008, which, along with the decline in coverage of other routine vaccines, has taken the world off track towards global targets, including the immunization indicator for Sustainable Development Goals.
This historic setback in immunization rates is taking place against a backdrop of rising rates of severe acute malnutrition. A malnourished child already has weakened immunity and missed vaccines can mean that common childhood illnesses quickly become lethal to them. The convergence of a hunger crisis with a growing immunization gap threatens to create the conditions for a child survival crisis.
Vaccination coverage declined in all regions, with the East Asia and Pacific region recording the largest reversal in DTP3 coverage, falling nine percentage points in just two years.
“Planning for and fighting COVID-19 must also go hand in hand with vaccination against deadly diseases like measles, pneumonia and diarrhea,” said WHO Director-General Tedros Adhanom Ghebreyesus. “It is not a matter of one or the other, it is possible to do both”.
good examples – Some countries have remarkably held back the declines. Uganda maintained high levels of coverage in routine immunization programs while implementing a targeted COVID-19 vaccination program to protect priority populations, including healthcare workers. Similarly, Pakistan has returned to pre-pandemic coverage levels thanks to high-level government commitment and significant immunization efforts. Achieving this in the midst of a pandemic, when healthcare systems and healthcare workers were under significant pressure, is to be applauded.
Monumental efforts will be needed to achieve universal levels of coverage and prevent outbreaks. Inadequate coverage levels have already resulted in preventable measles and polio outbreaks in the last 12 months, underscoring the vital role of immunization in maintaining the health of children, adolescents, adults and societies.
Data – Coverage of the first dose of measles vaccine dropped to 81% in 2021, also the lowest level since 2008. This means that 24.7 million children missed their first dose of this vaccine in 2021, or 5.3 million more than than in 2019. Another 14.7 million did not receive the required second dose. Likewise, 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 girls against cervical cancer. uterus later in life.
The two-year sharp decline follows nearly a decade of stalled progress, underscoring the need to not only address pandemic-related disruptions but also systemic immunization challenges to ensure that every child and adolescent is reached.
Action – WHO and UNICEF are working with Gavi, the Alliance for Vaccines, and other partners to deliver the Global Immunization Agenda 2030 (AI2030), a strategy for all relevant countries and global partners to achieve established targets on disease prevention by through immunization and vaccine delivery to everyone, everywhere, for all ages.
“It is heartbreaking to see more children losing protection against preventable diseases for the second year in a row. The Alliance’s priority must be to help countries maintain, restore and strengthen routine immunization, along with the execution of ambitious COVID-19 vaccination plans, not only through vaccines but also through structural support tailored to systems. that will manage them,” said Seth Berkley, CEO of Gavi, the Vaccine Alliance.
AI2030 partners call on governments and relevant actors to:
- Intensify vaccination recovery efforts to address backlash in routine immunization, expand outreach services in underserved areas to reach unvaccinated children, and implement campaigns to prevent outbreaks;
- Implement evidence-based, people-centred and tailored strategies to build trust in vaccines and immunization, combat misinformation and increase vaccine uptake, particularly among vulnerable communities;
- Ensure that current pandemic preparedness and response and efforts to strengthen the global health architecture lead to investment in primary health care (PHC) services, with explicit support to strengthen and sustain essential immunization;
- Secure political commitment from national governments and increase domestic resource allocation to strengthen and sustain immunization in PHC;
- Prioritize strengthening health information systems and disease surveillance to provide the data and monitoring needed for programs to have maximum impact; and
- Leverage and increase research investment to develop and improve new and existing vaccines and immunization services that can meet community needs and meet AI2030 targets.
Access the UNICEF English dataset: Overview Page, Full Datasets, Data Visualization, Country Profiles
Access the WHO dataset also available in English only: Global dashboard, Complete datasets, Information page
Read the Guiding Principles for recovery, building resilience and strengthening immunization in 2022 and beyond here.
About the data – Based on country-reported data, the WHO and UNICEF Estimates of National Immunization Coverage provide the world’s largest and most comprehensive dataset on immunization trends for vaccinations against 13 diseases administered by regular health systems – such as clinics, community centers, outreach services or visits by health professionals. For 2021, data from 177 countries were provided.
About the 2030 Immunization Agenda – The Immunization Agenda 2030 (AI2030) is an ambitious global strategy to maximize the life-saving impact of vaccines – one of the most successful and cost-effective public health interventions of all time. AI2030 aims to halve the number of children still not receiving core vaccines, achieve 500 new or underused vaccine introductions in low- and middle-income countries, and achieve 90% coverage for key life-saving vaccines.
Achieving these goals would prevent more than 50 million deaths and help build health systems that can withstand the impact of pandemics and provide a rapid response to vaccination. The strategy was endorsed by all countries through the 73rd World Health Assembly and is a commitment by AI2030 partners comprised of UN agencies, global health initiatives (such as Gavi, the Vaccine Alliance, the Global Polio Eradication Initiative , the Measles and Rubella Initiative), non-governmental organizations, civil society organizations, faith-based organizations, and academia. For more information about AI2030 partners, please visit the partners engagement page.