The COVID-19 pandemic causes the largest uninterrupted decline in vaccination in thirty years

WHO and UNICEF sound the alarm over data showing global vaccination coverage continued to decline in 2021 and 25 million infants missed out on vital vaccines

Official data released today by the WHO and UNICEF show the largest uninterrupted drop in childhood vaccination in some 30 years.

The percentage of children who received three doses of the diphtheria, tetanus, and pertussis (DPT3) vaccine—considered a marker of vaccination coverage at the national and international levels—decreased by 5% between 2019 and 2021, reaching the 81%.

This means that in 2021 alone, 25 million children did not receive one or more doses of the DPT vaccine as part of routine immunization services, which is 2 million more than in 2020 and 6 million more than in 2019, and clearly shows the increasing number of children exposed to devastating but preventable diseases. Several factors explain this decline, including the increase in the number of children living in fragile and conflict situations, where access to vaccination is often difficult, the increase in misinformation and problems related to COVID-19, such as disruptions to services and supply chains, diversion of resources to response efforts, and containment measures that limited access to and availability of vaccination services.

“This is a red alert for children's health. We are witnessing the largest continuous drop in childhood immunization in a generation, resulting in loss of human life,” said Catherine Russell, Executive Director of UNICEF. “While the pandemic was expected to take its toll last year due to COVID-19 disruptions and lockdowns, we now see that decline continuing. The pandemic is not an excuse. We need to make up for lost time for the millions of people who have not been vaccinated, or else we will inevitably see increased outbreaks, sick children and increased pressure on already overburdened health systems."

Of these 25 million children, 18 million did not receive a single dose of DPT vaccine 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[1] 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.

Globally, more than a quarter of the HPV vaccine coverage achieved in 2019 has been lost. This situation has serious consequences for the health of women and girls, since global coverage of the first dose of the vaccine against the human papillomavirus (HPV) is only 15%, despite the fact that the first vaccines were authorized more than 15 years ago.

2021 was expected to be a year of recovery in which vaccination programs would be re-established and the cohort of children left unvaccinated in 2020 would catch up. However, DPT3 coverage fell to its lowest level since 2008, which, together with declining coverage of other core vaccines, offset global targets, in particular the vaccination indicator for the Development Goals Sustainable.

This historic setback in vaccination rates occurs in a context of rapidly rising rates of severe acute malnutrition. A malnourished child already has weakened immunity, and the fact that he or she has not received any vaccinations can mean that diseases that are common in childhood can quickly become fatal. The confluence of a famine with the widening vaccination gap threatens to create the conditions for a child survival crisis.

Vaccine coverage declined in all regions, with the East Asia and Pacific regions experiencing the steepest reversal in DPT3 vaccine coverage, falling by nine percentage points in just two years.

"Planning for and combating COVID-19 must also go hand in hand with vaccination against deadly diseases such as measles, pneumonia and diarrhoea," said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “It is not a question of choosing between one option or the other, both are possible”.

Some countries markedly curbed declines. Uganda maintained high coverage levels in routine vaccination programmes, while implementing a targeted COVID-19 vaccination program to protect priority populations, particularly health workers. Pakistan, too, returned to pre-pandemic coverage levels thanks to high-level government commitment and significant catch-up vaccination efforts. It is admirable to achieve this in the midst of a pandemic, when health care systems and health workers were under great pressure.

Monumental efforts will be required to reach universal levels of coverage and prevent outbreaks. Preventable outbreaks of measles and polio due to inadequate coverage levels have already been recorded in the last 12 months, underscoring the vital importance of vaccination to preserve the health of children, adolescents, adults and societies in general.

Coverage of the first measles dose fell to 81 percent in 2021, also the lowest level since 2008. This has meant that 24.7 million children went without their first measles dose in 2021, 5, 3 million more than in 2019. Another 14.7 million did not receive the second dose they needed. 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 girls against cervical cancer later in life.

The dramatic two-year decline follows nearly a decade of stagnant progress, underscoring the need not only to address disruptions due to the pandemic, but also systemic immunization challenges to ensure that all children and teens get vaccinated.

WHO and UNICEF collaborate with Gavi, the Vaccine Alliance, and other partners to deliver on the Immunization Agenda 2030 (AI2030), a global strategy for all countries and relevant global partners to achieve established goals in disease prevention through vaccination and in the administration of vaccines to all people, everywhere and at all ages.

“It is heartbreaking to see more children go without protection from preventable diseases for the second year in a row. The priority of the Alliance must be to help countries maintain, restore and strengthen routine vaccination along with the implementation of ambitious vaccination plans against COVID-19, not only through vaccines, but also structural support adapted to health systems. that will administer them,” said Dr. Seth Berkley, Executive Director of Gavi, the Alliance for Vaccines.

AI2030 partners call on governments and relevant stakeholders to:

• Step up immunization catch-up efforts to address the rollback in routine immunization, and expand outlying services in underserved areas to reach children who have missed out on immunization and launch campaigns to prevent buds;

• Implement evidence-based, people-centered, and tailored strategies to build confidence in vaccines and immunization, counter misinformation, and increase vaccine uptake, particularly among vulnerable communities;

• Ensure that current pandemic preparedness and response and efforts to strengthen the global health architecture promote investment in primary health care services, with explicit support for strengthening and maintaining essential immunization;

• Guarantee the political commitment of national governments and increase the allocation of internal resources to strengthen and maintain vaccination within primary health care;

• Prioritize health information and strengthening disease surveillance systems to provide the data and monitoring necessary for programs to have maximum effect; Y

• Leverage and increase investments in research to develop new and improve existing vaccines and vaccination services that can meet community needs and meet AI2030 goals.

[1] Of countries where more than 10,000 children received no dose in 2021.

Source: World Health Organization