Despite rapid development and distribution of Covid-19 vaccines during the pandemic, routine vaccination rates have significantly declined, according to new data from the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF). This setback signals that the world has not yet bounced back from the disruption.
Dr. Katherine O’Brien, WHO’s director of the Department of Immunization, Vaccines, and Biologicals, described the situation as a “historic backslide.” Efforts are now focused on vaccinating children who missed their shots during the pandemic and enhancing immunization services beyond pre-pandemic levels.
A mother and her child wait for vaccinations at a rural childcare center in Brindaban village, Gopalganj, India, on June 19.
According to the WHO and UNICEF’s 2023 immunization coverage report, global immunization trends for 14 diseases were analyzed, using the third dose of the diphtheria, tetanus, and pertussis (DTP3) vaccine as a key indicator. This vaccine, recommended for 1-year-olds, serves as a global benchmark for immunization coverage.
The report reveals that progress towards pre-pandemic immunization levels has stalled. In 2023, global DTP3 coverage remained at 84%, the same as in 2022 but lower than the 86% recorded in 2019. This stagnation hinders the path to achieving the Immunization Agenda 2030 goal of 90% coverage for essential childhood and adolescent vaccines. Disruptions in healthcare services, logistical challenges, vaccine hesitancy, and inequities in access are cited as ongoing barriers.
The report also highlights an increase of 600,000 children who did not receive a single DTP3 dose from 2022 to 2023, totaling 2.7 million more children un- and under-immunized than before the pandemic.
Dr. Ephrem T. Lemango, UNICEF’s associate director for health and global chief of immunization, emphasized the urgency of accelerating efforts to meet this challenge.
Bright Spots and Persistent Challenges
Despite these challenges, there are areas showing improvement. The African region saw the most progress in overall coverage last year, with countries like Bangladesh, Indonesia, Brazil, and Nigeria making significant strides in post-pandemic recovery. According to O’Brien, even low-income countries, where health systems were hit hardest by the pandemic, are beginning to see improvements compared to 2022.
Notably, HPV vaccine coverage in girls increased by 7%, nearing pre-pandemic levels. This vaccine is crucial in reducing cervical cancer rates by 87%. However, current coverage is still below the 90% target, with only 56% of adolescent girls in high-income countries and 23% in low- and middle-income countries receiving the vaccine.
Measles Outbreaks on the Rise
The report underscores the impact of global immunization efforts, which have saved 154 million lives over the past 50 years, with the measles vaccine being a major contributor. However, measles coverage remains too low in several countries, risking further outbreaks. In 2023, over 300,000 confirmed measles cases were reported, nearly three times the number in 2022.
Immunizations in Conflict Zones
More than half of the unvaccinated children in 2023 lived in countries facing conflict and instability, which represent only 28% of the world’s new births. Countries like Sudan, Yemen, and Afghanistan have seen significant declines in immunization coverage.
In contrast, Ukraine, despite conflict, has shown improvements in coverage due to resilient programs and the flow of assistance. However, regions like Gaza have experienced severe reductions in vaccine coverage.
Global Vaccine Efforts
In the U.S., vaccine coverage ranges from 95% to 98%, indicating good healthcare availability. However, global vaccination efforts are crucial to prevent outbreaks, epidemics, and potential pandemics.
In April 2023, WHO and UNICEF, along with partners like Gavi, the Vaccine Alliance, and the Bill & Melinda Gates Foundation, launched The Big Catch Up initiative to address the decline in vaccine coverage. This initiative aims to boost childhood immunizations and close the gaps created by the pandemic, requiring collaboration and investment in innovation to achieve the goals outlined in the Immunization Agenda 2030.
“Immunization stands as one of humanity’s greatest achievements,” said Lemango.
