Data Shows ‘Major Backsliding’ in Routine Childhood Vaccinations

The World Health Organization and UNICEF recently released data regarding the state of vaccinations across the world showing that there has been a major backsliding in childhood vaccinations.

“Vaccination coverage had stalled for a number of years, but this year we saw an actual slip in childhood vaccination rates, which is alarming. In 2020, we saw the highest number of unvaccinated children in over a decade,” said Ann Lindstrand, head of the expanded program on immunization at the WHO. 

The data examines 13 vaccines, including polio, measles, hepatitis, and rotavirus, in 160 countries, and researchers found that 23 million children missed out on vaccinations due to the COVID-19 pandemic.

The data also shows that 17 million children are likely to have not received a single vaccine during 2020, which is 3.7 million more than in 2019, and the highest number of children missed since 2009. 

Prior to the pandemic, the global rates for diphtheria, tetanus, pertussis, measles and polio vaccines had stalled for several years around 86%, but COVID-19 caused a decline in that stalled trend. 

Researchers used the ​​Institute for Health Metrics and Evaluation-led modeling to gather the data, a method which uses administrative data, electronic medical records, and human movement data captured through anonymized tracking of mobile phones. 

They found the reasons for the backsliding in childhood vaccinations include disruptions in immunization services, funding shortfalls, vaccine misinformation, fear of seeking health care because of possible transmission, and others like school closures, or transportation hardship experienced during the COVID-19 pandemic. 

School closures, for example, affected the rates of girls receiving the HPV vaccine, a vaccine which protects against human papillomavirus, a sexually transmitted infection which can cause genital warts and cervical cancer if untreated. 

Approximately 1.6 million more girls missed out in 2020, and globally only 13% of girls were vaccinated against HPV. 

“Without urgent efforts to make up [for] lost ground, WHO estimates the decline in coverage in 2020 alone, across those countries that had so far introduced the vaccine, will contribute to up to 36,000 more cases of cervical cancer in the future,” said Lindstrand.

There are three regions which are especially concerning for declines in immunization coverage: Southeast Asia, Eastern Mediterranean region, and the Region of the Americas.

In the WHO’s Region of the Americas, vaccination coverage fell from 91% in 2016, to only 82% of children fully vaccinated with DTP, a combination of vaccines to prevent diphtheria, pertussis, and tetanus.

India, which was hit hard by the pandemic, now has the greatest number of under and unvaccinated children globally, totaling 3.5 million, and the overall DTP vaccination coverage rate dropped from 91% to 85%. 

Recovery efforts at the end of 2020 helped to blunt the impact of coverage and decline and recover lost ground in immunization services in the Eastern Mediterranean region. 

There were also 11 countries that experienced a substantial increase in children not receiving the first dose of DTP vaccine including Pakistan, the Philippines, Mexico, and Venezuela.

The WHO said many of the children impacted were from communities already affected by conflict, living in under-served or remote places, or in informal or slum settings where they have limited access to health services. 

“Children are at greatest risk where health systems are least able to care for them adequately if they get sick, where these same systems are most likely to be overwhelmed if multiple disease outbreaks occur, and where compounding factors like malnutrition increase their chance of severe disease. For this reason, it will likely be the poorest children who face the greatest risks,” said Lindstrand.

Now, countries face a risk of resurgence of measles and other vaccine-preventable diseases, as the rate of vaccination is well below the 95% recommended by the WHO.

“As a result of gaps in vaccination coverage, serious measles outbreaks have recently been reported in countries including the Democratic Republic of the Congo, Pakistan and Yemen, while likely to occur elsewhere as growing numbers of children miss out on life saving vaccines,” said Lindstrand. 

The resurgence of measles outbreaks from 2019-2020 is a warning sign for how quickly diseases can spread when people are not vaccinated, and the WHO is warning countries not to wait until an outbreak occurs before responding to falling vaccination rates. 

Consequently, the WHO and UNICEF devised an immunization agenda 2030 plan of action to reach 90% coverage of essential childhood vaccines globally. 

The agenda aims to halve the number of entirely unvaccinated, or zero dose children, and increase the uptake of newer vaccines, such as rotavirus or pneumococcus in low and middle-income countries.

Along with partners like Global Alliance for Vaccines and Immunization known as Gavi, the agencies will work to restore services for countries to safely deliver routine immunization programs, help health workers and community leaders communicate with caregivers to explain importance of vaccinations, and identify communities and people who have been missed during the pandemic.

The agencies will also work with countries to implement plans to prevent and respond to outbreaks of vaccine-preventable diseases. and ensure that any COVID-19 vaccine delivery is planned for and financed alongside these immunization programs. 

“If we fail to catch up on routine immunizations, the risk of serious disease outbreaks will continue to grow. We must not trade one crisis for another,” said Lindstrand.