The World Health Organization (WHO) and Unicef warned that the Covid-19 crisis and misinformation generated a red alert due to the steepest continuous drop in childhood vaccination against other diseases in almost three decades.
According to the joint report, the proportion of children receiving all three doses of the diphtheria, tetanus and polio (DTP) vaccine fell from 86% in 2019 to just 81% in 2021. This vaccine is used as key indicator of immunization coverage worldwide.
The decline in 2020 and 2021 comes after a decade of improvements according to the study. "This is a red alert for children’s health. We are seeing the largest sustained decline in childhood immunization for a generation ," said Catherine Russell, executive director of Unicef, in a statement. And she warned that “The consequences will be measured in the number of lives,” she warned.
The reasons for this decline are multiple: conflicts, increased misinformation and supply or continuity of care problems related to the Covid-19 pandemic.
A recovery after lockdowns was expected to begin in 2021, but instead vaccination rates continued to fall in all regions of the world. This low coverage led to preventable outbreaks of measles and polio in the past 12 months, according to the report.
The news comes at a time when malnutrition rates are also on the rise. A malnourished child already has a weaker immune system and is therefore more likely to develop severe cases of these preventable diseases.
The report in numbers
• 25 million children missed one or more doses of DTP through routine immunization services in 2021 alone. This is 2 million more than were missed in 2020 and 6 million more than in 2019 , highlighting the growing number of children at risk of devastating but preventable diseases. The decline was due to many factors, including increased numbers of children living in fragile and conflict environments where access to immunization is often a challenge, increased misinformation, and COVID-19-related issues such as disruptions to service and supply chain, diversion of resources to response and containment efforts, measures that limited access and availability of immunization services.
• 18 million of the 25 million children did not receive a single dose of DTP during the year, the vast majority of whom live in low- and middle-income countries, with India, Nigeria, Indonesia, Ethiopia and the Philippines recording the highest numbers . Among the countries with the largest relative increases in the number of children who did not receive a single vaccine between 2019 and 2021 were Myanmar and Mozambique.
• Globally, more than a quarter of the HPV vaccine coverage achieved in 2019 has been lost. This has serious consequences for the health of women and girls, as global first dose coverage of the human papillomavirus (HPV) vaccine is only 15%, despite the fact that the first vaccines were authorized more than 15 years ago.
• In particular, some countries avoided declines. Uganda maintained high levels of coverage in routine immunization programs, while implementing a targeted COVID-19 vaccination program to protect priority populations, including healthcare workers. Similarly, Pakistan returned to pre-pandemic coverage levels thanks to high-level government commitment and significant catch-up immunization efforts. Achieving this in the middle of a pandemic, when health systems and health workers were under significant pressure, should be applauded.
• Inadequate coverage levels have already resulted in preventable outbreaks of measles and polio in the past 12 months , underscoring the vital role of immunization in keeping children, adolescents, adults and societies healthy.
• First-dose measles coverage dropped to 81% in 2021, also the lowest level since 2008. This meant 24.7 million children did not receive their first measles dose in 2021, 5.3 million more than in 2019. Another 14.7 million did not receive the second dose they needed.
•Similarly, compared to 2019, 6.7 million more children did not receive the third dose of the polio vaccine and 3.5 million did not receive the first dose of the HPV vaccine , which protects girls against cervical cancer in the future.
