The percentage of children who received three doses of the diphtheria, tetanus and pertussis (DTP3) vaccine — a marker of immunization coverage within and across countries — fell 5 percentage points to 81 percent between 2019 and 2021.
As a result, in 2021 alone, 25 million children missed one or more doses of DTP through routine vaccination services. This is 2 million more than those who missed in 2020 and 6 million more than in 2019, indicating the growing number of children at risk of devastating but preventable diseases. The decline was due to many factors, including an increased number of children living in conflict and fragile environments where access to vaccination is often challenging, increased misinformation and COVID-19-related issues such as service and supply chain disruptions, diverting resources for response efforts and containment measures that limited access and availability of vaccination services.
“This is a red warning for children’s health. We are witnessing the largest sustained drop in childhood vaccination rates in a generation. The impact will be measured in lifetimes,” said Catherine Russell, UNICEF executive director. “While a pandemic hangover was expected last year due to COVID-19 disruptions and lockdowns, we are now seeing a continued decline. COVID-19 is no excuse. We must catch up on immunization for the missing millions or we will inevitably witness more outbreaks, more sick children and greater strain on already strained health systems.”
18 million of the 25 million children did not receive any 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 having the highest numbers. between countries1 with the largest relative increase in the number of children who have not received 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 implications for the health of women and girls, as global coverage of the first dose of human papillomavirus (HPV) vaccine is only 15%, despite the first vaccines being approved more than 15 years ago.
It was hoped that 2021 would be a year of recovery in which tense immunization programs would be rebuilt and the cohort of missed children caught up in 2020. Instead, DTP3 coverage was pushed back to its lowest level since 2008, which, along with a decline in coverage for other primary vaccines, pushed the world off track to meet global targets, including the Sustainable Immunization Indicator. Development Goals.
This historic decline in the number of immunizations is taking place against a background of rapidly rising rates of severe acute malnutrition. A malnourished child already has weakened immunity, and missed vaccinations can quickly turn common childhood diseases into fatalities for them. The convergence of a hunger crisis with a growing immunization gap threatens to create the conditions for a child survival crisis.
Vaccination rates declined in every region, with the East Asia-Pacific region recording the strongest reversal in DTP3 coverage, dropping nine percentage points in just two years.
“Planning and tackling COVID-19 must also go hand in hand with vaccination against deadly diseases such as measles, pneumonia and diarrhea,” said WHO Director General Dr Tedros Adhanom Ghebreyesus. “It’s not a matter of either/or, it’s both possible”.
In particular, some countries held back declines. Uganda maintained high levels of coverage in routine immunization programs while rolling out a targeted COVID-19 vaccination program to protect priority populations, including health professionals. Similarly, Pakistan returned to pre-pandemic coverage levels thanks to high-level government commitment and significant catch-up vaccination efforts. Achieving this in the midst of a pandemic, when health systems and health workers have been under great pressure, is to be applauded.
Monumental efforts will be needed to achieve universal coverage levels and prevent outbreaks. Inadequate coverage levels have already led to preventable outbreaks of measles and polio in the past 12 months, underscoring the critical role of immunization in keeping children, adolescents, adults and societies healthy.
First-dose measles coverage fell to 81 percent in 2021, also the lowest level since 2008. This meant 24.7 million children missed their first dose of measles in 2021, 5.3 million more than in 2019. Another 14, 7 million did not receive the necessary second dose. Similarly, 6.7 million more children than in 2019 missed the third dose of polio vaccine and 3.5 million children missed the first dose of the HPV vaccine, which protects girls from cervical cancer later in life.
The sharp two-year drop follows nearly a decade of stalled progress, underscoring the need to address not only pandemic-related disruptions, but systemic immunization challenges to ensure every child and adolescent is reached.
WHO and UNICEF are working with Gavi, the Vaccine Alliance and other partners to realize the Global Immunization Agenda 2030 (IA2030), a strategy for all countries and relevant global partners to achieve set goals for disease prevention through immunization and delivering vaccines to anyone, anywhere, at any age.
“It is heartbreaking to see that for the second year in a row more children are missing out on protection against preventable diseases. The Alliance’s priority should be to help countries maintain, restore and strengthen routine immunization, in addition to implementing ambitious COVID-19 vaccination plans, not only through vaccines, but also through tailor-made structural support for the health systems that will administer them,” said Dr. Seth Berkley, CEO of Gavi, the Vaccine Alliance.
The IA2030 partners call on governments and relevant actors to:
- Intensifying catch-up vaccination efforts to address relapses to routine immunization, and expanding emergency services in deprived areas to reach missed children and implement campaigns to prevent outbreaks;
- Implement evidence-based, people-centred and tailored strategies to build confidence in vaccines and immunization, combat misinformation and increase vaccine uptake, especially among vulnerable communities;
- Ensuring current pandemic preparedness and response and strengthening the global health architecture lead to investment in primary health care (PHC), with explicit support to strengthen and maintain essential immunization;
- Ensure political commitment from national governments and increase domestic resource allocation to enhance and support immunization within PHC;
- Prioritize strengthening health information and disease surveillance systems to deliver the data and monitoring needed to allow programs to have maximum impact; and
- Leverage and increase investment in research to develop and improve new and existing vaccines and immunization services that can meet community needs and achieve the IA2030 goals.
1 From countries with at least 10,000 zero-dose children in 2021
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