After ‘historic decline’ during pandemic, global childhood vaccination rates are stagnating, new data shows | CNN

CNN
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While the COVID-19 pandemic has seen the development and distribution of coronavirus vaccines at unprecedented speed, experts say it has also been marked by a significant and worrying decline in routine vaccination rates. New data from the World Health Organization and the United Nations International Children’s Emergency Fund show that the world has yet to recover from the crisis.

According to Dr Katherine O’Brien, Director of WHO’s Department of Vaccines and Biologicals, the pandemic marked a “historic setback.” Now, she says, the race is on to reach children who were missed during the pandemic and to restore and strengthen immunization services beyond pre-pandemic levels.

The WHO-UNICEF 2023 Immunization Coverage Report, released Sunday, is the world’s largest dataset on vaccination trends for 14 diseases. It analyzed estimates from 185 countries and used a third dose of the diphtheria, tetanus and pertussis (DTP3) vaccine — which is recommended for one-year-olds — as a global marker of immunization coverage.

The data reveal that progress made so far in reaching pre-pandemic vaccination levels has stalled. Global DTP3 coverage was 84% ​​in 2023, the same as in 2022 but lower than the 86% recorded in 2019. The report authors say this represents a derailment on the trajectory towards the Immunization Agenda 2030 target of 90% coverage for essential childhood and adolescent vaccines.

This stagnation reflects ongoing challenges related to disruptions to health services, logistical challenges, vaccine hesitancy and inequalities in access to services, the organizations said in a press release.

The new report also showed that the number of children who did not receive a single dose of DTP3 increased by 600,000 between 2022 and 2023, leaving 2.7 million more children unimmunized or underimmunized than before the pandemic.

“Today’s statement shows that we are falling behind and must accelerate our efforts to meet this challenge,” said Dr. Ephrem T. Lemango, UNICEF Deputy Director for Health and Global Chief of Immunization.

However, amid this global challenge, “there are places where there are positive signs,” Lemango told CNN.

The data showed that the African region made the most progress last year in terms of overall coverage, and that countries such as Bangladesh, Indonesia, Brazil and Nigeria made notable progress in their recovery from the pandemic, according to O’Brien and Lemango.

“Low-income countries… where health systems have been hardest hit by the pandemic… are starting to see some improvement compared to 2022,” O’Brien said at a news briefing.

In Africa, vaccination coverage in the first year of life has increased despite a growing number of births, requiring more vaccinations to maintain the same level of coverage, according to O’Brien.

The 2023 report also found that HPV vaccination coverage among girls increased by 7%, returning to near pre-pandemic levels. Studies have shown that the vaccine can reduce cervical cancer rates in women by 87%.

However, current coverage remains well below the 90% target to eliminate cervical cancer as a public health problem, reaching only 56% of adolescent girls in high-income countries and 23% in low- and middle-income countries, the press release said.

The WHO estimates that global vaccination efforts have saved 154 million lives, or 6 lives every minute, over the past 50 years. The organization says 60% of that figure is due to the measles vaccine, which is expected to be the “single largest contributor to preventing deaths in the future.”

But data from 2023 show that measles vaccination coverage in countries with large or disruptive outbreaks after the pandemic is too low to control new outbreaks. Nearly 35 million children lost or were only partially protected, a decline the report calls “worrying,” even for countries that have not experienced an outbreak in the past five years.

Low vaccination coverage has been a major factor in outbreaks in 103 countries – representing about three-quarters of the world’s child population – over the past five years, the report says.

Cases of the highly contagious virus have also resurfaced in the United States. As of 2023, the 92% of American children vaccinated against measles, mumps and rubella by age 2 is below the federal goal of 95%, according to a report from the U.S. Centers for Disease Control and Prevention that year.

“Measles outbreaks continue to increase while measles vaccination coverage has stagnated,” Lemango said. “The world has recorded more than 300,000 confirmed cases of measles in 2023, which is a nearly three-fold increase from what we saw in 2022.”

There is hope that the introduction of new, underused vaccines through partnerships such as Gavi, the Vaccine Alliance, will broaden protection against infectious diseases such as measles, the organisations say.

“These advances are essential to reduce the burden of diseases that have long plagued communities,” Lemango added.

According to the data, more than half of unvaccinated children in 2023 lived in countries affected by fragility, conflict and vulnerability, even though these countries account for only 28% of new births worldwide. Many of these countries have seen “a worrying decline in performance since 2019,” the report said.

Of the children who received no vaccines in 2023, 59% were in just 10 countries. Countries like Sudan, Yemen and Afghanistan are new to the list, the report said.

“Protecting children in any conflict situation is of critical importance,” said WHO’s O’Brien. “(Conflict) creates an environment in which infectious diseases are at high risk of causing large-scale outbreaks with devastating consequences.”

Some conflict-affected countries, such as Ukraine, saw an initial decline in vaccination coverage but did not see an overall decline in vaccinations. But in other regions, such as Sudan and parts of the Middle East, this was not the case.

According to O’Brien, vaccination coverage saw a “significant reduction” in Gaza in 2023, a reduction that was not seen to the same extent in Israel. The Gaza report’s data only covers the period from January to September and “does not cover what happens in 2024,” Lemango noted.

Analysis of vaccination coverage in other conflict zones paints “a mixed picture,” O’Brien said.

“I will, however, cite the example of Ukraine, which has seen an improvement in coverage. Not all conflict zones result in reduced coverage,” she said, referring to the resilience of programmes, the nature of the conflict and the safety of health workers.

According to Lemango, there is a “clear trend” in Ukraine: Service availability typically declines at the start of a conflict and picks up again once aid and resources arrive. The question, he said, is how to maintain this improved state.

In the United States, vaccination coverage is between 95% and 98%, which is a sign of good health care availability, according to Lemango. But that doesn’t mean Americans are fully protected.

“Until everyone or every country has the capacity and the ability to vaccinate every child, the vulnerability to epidemics and potentially pandemics will always be imminent,” he said.

In April 2023, WHO and UNICEF joined forces with organizations including Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation to launch The Big Catch Up initiative in response to declining vaccination coverage levels following the pandemic.

The goal of the initiative is to strengthen childhood immunization and close gaps between pre- and post-pandemic efforts, according to the partnership. Achieving these goals and those outlined in the 2030 Agenda for Immunization will require collaboration and investment in innovation, according to the IA2030 Partnership Council.

“The future will probably be one in which we have many vaccines that can prevent preventable diseases,” Lemango said.

“Vaccination is one of humanity’s greatest achievements.”