Pandemic caused ‘major backsliding’ on childhood vaccinations in 2020

Around 23 million children did not receive routine vaccinations in 2020, which was 3.7 million more than the previous year, according to official figures by the World Health Organization and UNICEF.

Both agencies describe this as a ‘major backsliding’ on childhood vaccinations, a situation which has of course been exacerbated by the COVID-19 pandemic.

The latest set of comprehensive worldwide childhood immunization figures, the first official figures to reflect global service disruptions due to COVID-19, reveal that most countries experienced drops last year in childhood vaccination rates.

Of most concern to WHO and UNICEF is that most of these – up to 17 million children – likely did not receive a single vaccine during the year, widening already immense inequities in vaccine access. Most live in communities affected by conflict, in under-served remote places, or in informal or slum settings where they face multiple deprivations including limited access to basic health and key social services.

Dr Tedros Adhanom Ghebreyesus, Director General of WHO, said: “Even as countries clamour to get their hands on COVID-19 vaccines, we have gone backwards on other vaccinations, leaving children at risk from devastating but preventable diseases like measles, polio or meningitis. Multiple disease outbreaks would be catastrophic for communities and health systems already battling COVID-19, making it more urgent than ever to invest in childhood vaccination and ensure every child is reached.”

In all regions, rising numbers of children miss vital first vaccine doses in 2020; millions more miss later vaccines

Disruptions in immunization services were widespread in 2020, with the WHO Southeast Asian and Eastern Mediterranean Regions most affected.  As access to health services and immunization outreach were curtailed, the number of children not receiving even their very first vaccinations increased in all regions. As compared with 2019, 3.5 million more children missed their first dose of diphtheria, tetanus and pertussis vaccine (DTP-1) while 3 million more children missed their first measles dose.

Henrietta Fore, Executive Director of UNICEF, said: “This evidence should be a clear warning – the COVID-19 pandemic and related disruptions cost us valuable ground we cannot afford to lose – and the consequences will be paid in the lives and wellbeing of the most vulnerable.

“Even before the pandemic, there were worrying signs that we were beginning to lose ground in the fight to immunize children against preventable child illness, including with the widespread measles outbreaks two years ago. The pandemic has made a bad situation worse. With the equitable distribution of COVID-19 vaccines at the forefront of everyone’s minds, we must remember that vaccine distribution has always been inequitable, but it does not have to be.”

WHO says that funding shortfalls, vaccine misinformation, instability and other factors, are also contributing to a ‘troubling picture’ in its Region of the Americas, where vaccination coverage continues to fall. Only 82 per cent of children are fully vaccinated with diphtheria, pertussis, and tetanus (DTP), down from 91 per cent in 2016.

Countries risk resurgence of measles, other vaccine-preventable diseases

Even prior to the COVID-19 pandemic, global childhood vaccination rates against diphtheria, tetanus, pertussis, measles and polio had stalled for several years at around 86 per cent. This rate is well below the 95 per cent recommended by WHO to protect against measles –often the first disease to resurge when children are not reached with vaccines – and insufficient to stop other vaccine-preventable diseases.

With many resources and personnel diverted to support the COVID-19 response, there have been significant disruptions to immunization service provision in many parts of the world. In some countries, clinics have been closed or hours reduced, while people may have been reluctant to seek healthcare because of fear of transmission or have experienced challenges reaching services due to lockdown measures and transportation disruptions.

Dr Seth Berkley, CEO of the Vaccine Alliance, said: “These are alarming numbers, suggesting the pandemic is unravelling years of progress in routine immunization and exposing millions of children to deadly, preventable diseases. This is a wake-up call – we cannot allow a legacy of COVID-19 to be the resurgence of measles, polio and other killers. We all need to work together to help countries both defeat COVID-19, by ensuring global, equitable access to vaccines, and get routine immunization programmes back on track. The future health and wellbeing of millions of children and their communities across the globe depends on it.”

Concerns are not just for outbreak-prone diseases. Already at low rates, vaccinations against human papillomavirus (HPV) – which protect girls against cervical cancer later in life – have been highly affected by school closures. As a result, across countries that have introduced HPV vaccine to date, approximately 1.6 million more girls missed out in 2020. Globally only 13 per cent of girls were vaccinated against HPV, falling from 15 per cent in 2019.

The agencies are working with countries and partners to deliver the ambitious targets of the global Immunization Agenda 2030, which aims to achieve 90 per cent coverage for essential childhood vaccines; halve the number of entirely unvaccinated, or ‘zero dose’ children, and increase the uptake of newer lifesaving vaccines such as rotavirus or pneumococcus in low and middle-income countries.