Childhood Immunization Begins Recovery After COVID-19 Backslide

New WHO and UNICEF data show promising signs of immunization services rebounding in some countries, but, particularly in low-income countries, coverage still falls short of pre-pandemic levels putting children at grave risk from disease outbreaks.

GENEVA/NEW YORK, 20 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.

“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 vaccine against Diphtheria, Tetanus, and Pertussis (DTP) is used as the global marker 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.

In the Pacific, more than 90 per cent of children have received their first DTP dose, however, many of the Pacific Island countries faced challenges in maintaining high coverage in subsequent doses.

The early stages of recovery in global immunization have not occurred equally, with the improvement concentrated in a few countries. Of the 73 countries that recorded substantial declines* 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.

While countries such as Fiji, Nauru, Niue, Tonga and Tuvalu have been generally consistent with more than 90 per cent vaccine coverage, countries such as the Cook Islands, Federated States of Micronesia, Kiribati, and Vanuatu are yet to recover to pre-pandemic levels.

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.

Measles is of particular concern in the Pacific as half of the countries have not achieved the WHO recommendation of over 90 per cent coverage for the first dose. Coverage for the second dose is even lower. For instance, in Kiribati 85 per cent of children have received their first dose while only 68 per cent received their second dose protecting them fully from measles. Similar trends have been noted in Samoa with 82 per cent receiving the first dose and only 45 per cent receiving their second dose against measles. Low coverage of measles containing vaccines is also observed in Cook Islands (61 per cent and 51 per cent for first and second doses, respectively), Republic of Marshall Islands (81 per cent and 54 per cent, respectively), and Federated States of Micronesia (69 per cent and 38 per cent, respectively).

“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 children who missed their vaccination, while restoring and further improving immunization services from pre-pandemic levels.”

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 IA2030 partners launched ‘The Big Catch-Up’, a global communications and advocacy push, calling on governments to catch up the children who missed vaccinations during the pandemic, restore immunization services to pre-pandemic levels, and strengthen these going forward by:

· Doubling-down on their commitment to increase financing for immunization and to work with stakeholders to unlock available resources, including COVID-19 funds, to urgently restore disrupted and overstretched services and implement catch-up efforts.

· Developing new policies that enable immunizers to reach children who were born just before or during the pandemic and who are moving past the age when they would be vaccinated by routine immunization services.

· Strengthening immunization and primary health care services -including community health systems - and addressing systemic immunization challenges to correct longer-term stagnation in vaccination and reach the most marginalised children.

· Building and sustaining vaccine confidence and acceptance through engagement with communities and health providers

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