Childhood Immunization Begins Recovery After COVID-19 Backslide

New WHO and UNICEF data show promising signs of immunization services rebounding in some countries. In the Americas, countries have managed to halt the fall in coverage

Geneva/New York/Washington, 18 July, 2023 – Global immunization services reached 4 million more children in 2022 compared to the previous year, as countries stepped up efforts to address the historic backsliding in immunization caused by the COVID-19 pandemic.

According to data published today by the World Health Organization (WHO) and UNICEF, in 2022, 20.5 million children missed out on one or more vaccines delivered through routine immunization services, compared to 24.4 million children in 2021. In spite of this improvement, the number remains higher than the 18.4 million children who missed out in 2019 before pandemic-related disruptions, underscoring the need for ongoing catch-up, recovery and system-strengthening efforts.

The vaccine against diphtheria, tetanus and pertussis (DTP) is used in the global market for immunization coverage. Of the 20.5 million children who missed out on one or more doses of their DTP vaccines in 2022, 14.3 million did not receive a single dose, so-called zero-dose children. The figure represents an improvement from the 18.1 million zero-dose children in 2021 but remains higher than the 12.9 million children in 2019.

“These data are encouraging, and a tribute to those who have worked so hard to restore life-saving immunization services after two years of sustained decline in immunization coverage,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But global and regional averages don’t tell the whole story and mask severe and persistent inequities. When countries and regions lag, children pay the price.”

The early stages of recovery in global immunization have not occurred equally, with the improvement concentrated in a few countries. Progress in well-resourced countries with large infant populations, such as India and Indonesia, masks slower recovery or even continued declines in most low-income countries, especially for measles vaccination.

Of the 73 countries that recorded substantial declines (5 percentage points or more in 2020 and/or 2021 compared to 2019) in coverage during the pandemic, 15 recovered to pre-pandemic levels, 24 are on route to recovery and, most concerningly, 34 have stagnated or continued declining. These concerning trends echo patterns seen in other health metrics. Countries must ensure they are accelerating catch-up, recovery, and strengthening efforts, to reach every child with the vaccines they need and – because routine immunization is a fundamental pillar of primary healthcare – take the opportunity to make progress in other, related health sectors.

Vaccination against measles – one of the most infectious pathogens – has not recovered as well as other vaccines, putting an additional 35.2 million children at risk of measles infection. First-dose measles coverage increased to 83 per cent in 2022 from 81 per cent in 2021 but remained lower than the 86 per cent achieved in 2019. As a result, last year, 21.9 million children missed the routine measles vaccination in their first year of life – 2.7 million more than in 2019 – while an additional 13.3 million did not receive their second dose, placing children in under-vaccinated communities at risk of outbreaks.

“Beneath the positive trend lies a grave warning,” said UNICEF Executive Director Catherine Russell. “Until more countries mend the gaps in routine immunization coverage, children everywhere will remain at risk of contracting and dying from diseases we can prevent. Viruses like measles do not recognize borders. Efforts must urgently be strengthened to catch up with children who missed their vaccination while restoring and further improving immunization services from pre-pandemic levels.”

Countries with steady, sustained coverage in the years before the pandemic have been better able to stabilise immunization services since, the data indicates. For example, South Asia, which reported gradual, ongoing increases in coverage in the decade prior to the pandemic, has demonstrated a more rapid and robust recovery than regions that suffered longstanding declines, such as Latin America and the Caribbean.

Vaccination coverage in the Americas recovers

In 2022, countries and territories in the Americas managed to halt the decline in vaccination coverage that the region had been experiencing. Coverage of the first dose of the DPT vaccine reached 90 per cent compared to 86 per cent in 2021. The vaccination rate with the third dose of this vaccine also rose to 83 per cent compared to 81 per cent the previous year.

All other vaccines, which protect against diseases such as polio, human papillomavirus and rotavirus, have improved their coverage, with the exception of the first dose of the measles vaccine, which dropped from 85 per cent in 2021 to 84 per cent in 2022.

While countries also managed to reduce the number of children who did not receive a single dose of vaccine to pre-pandemic levels (1.3 million), this number remains high, leaving 1 in 10 children in the region unprotected against a range of dangerous diseases. Meanwhile, 2.3 million children did not complete their vaccination schedule, although this number is the lowest it has been since 2019.

“Countries’ efforts have paid off, but there are still far too many children in the Americas who do not receive the vaccines they need to be protected,” Dr Jarbas Barbosa, Director of the Pan American Health Organization (PAHO) said. “Moreover, while coverage has improved, rates are not optimal. Countries must continue to invest in their immunization programs to reach each and every child in every corner of their territory,” he stressed.

PAHO continues to work with countries in the region and partners to strengthen immunization programs and supports the implementation of campaigns to regain coverage, as well as to strengthen the infrastructure of national immunization programs and improve epidemiological and laboratory surveillance to detect outbreaks and respond immediately.

Many stakeholders are working to expedite recovery in all regions and across all vaccine platforms. Earlier in 2023, WHO and UNICEF, along with Gavi, The Bill & Melinda Gates Foundation and other Immunization Agenda 2030 (IA2030) partners launched ‘The Big Catch-Up’, a global communications and advocacy push, calling on governments to catch up with the children who missed vaccinations during the pandemic, restore immunization services to pre-pandemic levels, and strengthen these going forward.

About the data

Based on country-reported data, the WHO and UNICEF estimates of national immunization coverage (WUENIC) provide the world’s largest and most comprehensive data-set on immunization trends for vaccinations against 13 diseases given through regular health systems – normally at clinics, community centres, outreach services, or health worker visits. For 2022, data were provided from 183 countries.

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