Millions of children around the world, most of them in the poorest countries, have missed some or all of their childhood immunizations over the past two years due to a combination of conflicts, climate emergencies, disinformation campaigns, pandemic lockdowns and Covid vaccination efforts that diverted resources. , according to a new analysis by UNICEF, the UN agency that vaccinates half of the world’s children, and the World Health Organization.
The report says this is the biggest rollback in routine immunization in 30 years. Combined with rapidly rising levels of malnutrition, this has created conditions that could threaten the lives of millions of young children.
“This is a child health emergency — we have to think about the immediate stakes, the number of children who will die because of this,” said Lily Kaprani, head of UNICEF advocacy. “It’s not in a few years; it’s very soon.”
The percentage of children worldwide who received three doses of the diphtheria, tetanus and pertussis vaccine, known as DTP3, which UNICEF uses as a benchmark for immunization coverage, fell five points between 2019 and 2021 to 81 percent. Measles vaccination rates also dropped to 81 percent, and polio coverage also dropped significantly. A vaccination coverage rate of 94 percent is needed for herd immunity to break the chain of disease transmission.
This means that 25 million children have not received basic interventions to protect against deadly diseases.
The number of what UNICEF calls zero-dose children — those who have not received a single dose of the most basic vaccines — has skyrocketed during the pandemic, to 18 million from 13 million in 2019. This group includes half of all children who die before the age of 5.
The agency hoped that after a sharp decline in 2020 caused by lockdowns, school closures and other COVID-19 responses, child vaccination coverage would recover in 2021, the doctor said. Niklas Danielsson, UNICEF Senior Immunization Specialist in Nairobi.
But instead, the problem got worse. The report says DTP3 and measles coverage is at its lowest level since 2008.
Dr. Danielsson said vaccination coverage in 2021 was in line with 2008 levels. “But since then, birth cohorts have increased, which means that the number of children who have not completed or even begun vaccination is the largest in recent memory. 30 years,” he said.
He and many other child immunization experts expected a recovery last year as health systems learned to adapt to the demands of the pandemic. Instead, he said, misinformation campaigns about Covid vaccinations and governments’ broader mistrust of public health measures spilled over into curbing routine immunizations.
At the same time, health systems in the poorest countries have struggled to deliver limited Covid vaccinations, diverting critical access to freezers and paramedics to vaccinate.
The world has made steady progress in childhood vaccination coverage throughout the 1990s and the first decade of this century. Then rates began to stabilize because the remaining children were the hardest to reach, such as in active war zones or in nomadic communities. But before the pandemic, backed by organizations like the Bill & Melinda Gates Foundation and Gavi, the global vaccine alliance, there was a redoubled commitment to try to reach the remaining pockets of children with zero dose. Covid has diverted much of that attention and investment.
Over the past two years, India, Nigeria, Indonesia, Ethiopia and the Philippines recorded the largest number of children who did not receive vaccinations.
Brazil also made the list of the top 10 most affected countries, a dramatic shift for a country once known for its high vaccination coverage rates. About 26 percent of Brazilian babies did not receive vaccines in 2021, compared to 13 percent in 2018.
“The work of 30 years was lost overnight,” the doctor said. Carla Dominguez, epidemiologist and former coordinator of the national immunization program in Brazil.
Vaccination has become a politicized topic in Brazil during the Covid pandemic, she said. The federal government, led by President Jair Bolsonaro, downplayed the coronavirus even as Brazil had one of the highest death rates in the world and said it would not vaccinate its 11-year-old child against the virus.
“This is the first time the federal government has not recommended a vaccine and this has created an atmosphere of doubt that has never been seen in Brazil, where vaccination has been fully accepted,” Dominguez said.
At the same time, anti-vaccination groups that were not in high demand in Brazil moved into the country during the pandemic and began spreading misinformation in Portuguese on social media, she said.
And it all happened, doctor. Dominguez said that at a time when Brazilians were a generation away from serious diseases for which they were urged to vaccinate their children, it made them question the need.
“Parents don’t know about the impact of measles or polio, so they start picking on vaccines,” she said. The data showing that the pneumonia vaccine is taken higher than the polio vaccine clearly shows this. “Parents refuse polio. They say, “It’s been 30 years without polio, so do I need to do this?”
And yet they show clear signs of risk, she said: several cases of measles were discovered earlier this year in Sao Paulo, six years after Brazil declared the disease eradicated. “Measles is currently circulating – it gives us a concrete example of what can happen with diphtheria, meningitis and many other diseases,” she said.
In the Philippines, 43 percent of babies were not vaccinated last year. There, part of the problem lies in the stringent public health measures, including quarantines. “If you are not allowed to take your children separately at certain hours of the day, if they cannot go to school, if living expenses are rising, going to the clinic to vaccinate your child falls into your priority,” Dr. Danielsson said.
But the situation in the Philippines is also complicated by continued distrust of vaccination following the widespread introduction of a dengue vaccine called Dengvaxia in 2016, which was later found to have caused more severe cases in those who received it.
“The Dengvaxia story has exacerbated doubts about the vaccine, especially among schoolchildren,” the doctor said. Anthony Lichon, a public health advocate who advised the President on the Covid response. “That was the problem. We’re still dealing with it.”
RS. Unicef’s Caprani said it would take a huge amount of resources and commitment to get vaccine levels back on track.
“It’s not enough to just go back to business as usual and restore regular routine immunizations,” she said. “We will need really concerted investment and catch-up campaigns because there are a growing number of millions of children who are not fully vaccinated, living in countries with high levels of malnutrition and other stresses.”
Zimbabwe, for example, is currently experiencing a measles outbreak that kills one in ten children hospitalized with the disease. (The usual death rate is one in 100 in low-income countries and below one in 1,000 in high-income countries.)
Dr. Fabien Diomande, a polio eradication expert with the Global Health Task Force who has worked for years on polio campaigns in West and Central Africa, said it will take new ingenuity, innovation and resources to reverse the decline in childhood immunizations.
“It’s like we’re in a new world—these emergencies aren’t going anywhere,” he said. “We will still have Covid. We will still have climate crises. We must learn to deal with multiple public health emergencies.”
Dr. Brazil’s Dominguez said Covid vaccination efforts could provide some lessons on how to catch up. Brazil has achieved high levels of vaccination coverage through the establishment of pop-up vaccination posts and the provision of vaccinations at night and on weekends.
RS. Caprani said that despite the encouraging renewed interest in global health collaboration due to Covid, investment in new surveillance measures and other innovations could detract from the simple intervention needed to address the childhood immunization crisis: deploying thousands of community health workers .
“We are not going to solve this problem with advertising campaigns or social media posts,” she said. “You need to work with reliable, well-trained, properly paid community health workers who work day in and day out to build trust — the kind of trust that means you listen to them about vaccines. And they just aren’t enough.”
Jason Gutierrez provided a report from Manila.