After ‘historic backslide’ during pandemic, global childhood immunization rates

CNN
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Although the Covid-19 pandemic saw unprecedented speed in the development and distribution of coronavirus vaccines, experts say it was also marked by a significant and concerning drop in the rate of routine vaccinations. New data from the World Health Organization and the United Nations International Children’s Emergency Fund shows the world has yet to recover.

The pandemic signified a “historic backslide,” according to Dr. Katherine O’Brien, director of the Department of Immunization, Vaccines and Biological at WHO. Now, she says, the race is on to reach children who missed shots during the pandemic and to restore and strengthen immunization services beyond pre-pandemic levels.

WHO and UNICEF’s 2023 immunization coverage report, released Sunday, is the world’s largest dataset on immunization trends for vaccinations against 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 1-year-olds — as the global marker for immunization coverage.

The data revealed that previous progress in reaching pre-pandemic immunization levels has stalled. Worldwide DTP3 coverage was 84% in 2023, the same as in 2022 but below 86% recorded in 2019. The report’s authors say this is a derailment on the trajectory toward the Immunization Agenda 2030 goal of 90% coverage for essential childhood and adolescent vaccines.

This stagnation reflects ongoing challenges with disruptions in health-care services, logistical challenges, vaccine hesitancy and inequities in access to services, the organizations said in a news release.

The new report also showed that the number of children who had not received a single dose of DTP3 increased by 600,000 from 2022 to 2023, leaving 2.7 million more children un- and under-immunized than before the pandemic.

“Today’s release highlights that we are off track and need to accelerate efforts to meet this challenge,” said Dr. Ephrem T. Lemango, associate director for health and global chief of immunization at UNICEF.

Amid the overall challenge, however, “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 overall coverage, and countries such as Bangladesh, Indonesia, Brazil and Nigeria made notable strides in recovering post-pandemic, according to O’Brien and Lemango.

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

In Africa, vaccine coverage in the first year of life increased despite a rising number of births, which required more vaccinations to maintain the same coverage level, according to O’Brien.

The 2023 report also found HPV vaccine coverage in girls increased 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, according to the news release.

WHO estimates that global immunization efforts have saved 154 million lives — 6 lives every minute — over the past 50 years. About 60% of that can be attributed to the measles vaccine, the organization says, projecting it to be the “top contributor to preventing deaths in the future.”

But the 2023 data revealed that measles coverage in countries with large or disruptive outbreaks after the pandemic is too low to control further outbreaks. Nearly 35 million children were left with no or only partial protection, a decline the report called “concerning,” even for countries that have not had outbreaks in the past five years.

Low vaccination coverage was a major factor in outbreaks in 103 countries – accounting for roughly three-quarters of the world’s infant population – in the past five years, said the report.

Cases of the highly contagious virus have also reemerged in the United States. In 2023, the 92% of US children that have been vaccinated against measles, mumps and rubella by age 2 fell below the federal target of 95%, according to a report from the US Centers for Disease Control and Prevention that…