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Pandemic sets back childhood vaccinations

The COVID-19 pandemic caused the largest decline in childhood vaccinations in three decades, threatening millions of children, says UNICEF and WHO.

An Afghan girl preparing to get a COVID-19 booster shot
An Afghan girl preparing to get a COVID-19 booster shot (AN/Jessica Mazzamuto)

The COVID-19 pandemic has fueled the largest backslide in childhood vaccinations in three decades, threatening the health and lives of millions of children across the globe, according to a new report by UNICEF and the World Health Organization.

The report cites a number of factors for the sharp decline, including vaccine misinformation, conflicts and wars, pandemic lockdowns, supply chain disruptions and the diversion of resources to COVID immunization programs.

“This is a red alert for child 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's executive director.

The decline is happening against a backdrop of rapidly rising rates of severe acute malnutrition, a problem that will only grow worse as inflation pushes up commodity prices and the war in Ukraine and the ongoing pandemic continue to wreak havoc on the global supply chain.

“A malnourished child already has weakened immunity, and missed vaccinations can mean 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,” the report says.

The report's data show average global vaccine coverage for children against 11 key diseases fell to 68% in 2021, down from 71% in 2019, which marks the first time in more than 30 years the measurement declined.

The percentage of children who received three doses of the vaccine against diphtheria, tetanus and pertussis fell 5% between 2019 and 2021, down to 81%. The vaccine, DTP3, is a marker for immunization coverage within and across countries.

Some 25 million children missed out on one or more doses of DTP3 through routine immunization services in 2021 alone. This, UNICEF says, is 2 million more than those who missed out in 2020, and 6 million more than in 2019, and highlights the growing number of children at risk from devastating but preventable diseases.

Eighteen million of the 25 million children did not receive a single dose of the vaccine during the year. Most of these children live in low- and middle-income countries, with Ethiopia, India, Indonesia, Nigeria and the Philippines recording the highest numbers. Mozambique and Myanmar are among the countries with the largest relative increases in the number of children who did not receive a single vaccine between 2019 and 2021.

A few developing nations held off 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 workers. Similarly, Pakistan returned to pre-pandemic levels of coverage.

“Planning and tackling COVID-19 should also go hand-in-hand with vaccinating for killer diseases like measles, pneumonia and diarrhea,” said WHO Director-General Tedros Adhanom Ghebreyesus. “It’s not a question of either/or, it’s possible to do both."

The report says “monumental efforts” will be needed to reach universal levels of coverage and to prevent outbreaks of preventable diseases. “Inadequate coverage levels have already resulted in avoidable outbreaks of measles and polio in the past 12 months," it says, "underscoring the vital role of immunization in keeping children, adolescents, adults, and societies healthy.”