CNN
—
The COVID-19 pandemic has seen unprecedented speed in the development and distribution of coronavirus vaccines, but experts say there have been significant and worrying declines in routine vaccination rates, and new data from the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (ICEF) shows the world has not yet recovered.
The pandemic has represented a “historic setback,” according to Dr. Catherine O’Brien, head of WHO’s Immunization, Vaccines and Biologicals Department. Now, she says, the race is on to reach children who missed out during the pandemic and restore and ramp up immunization services beyond pre-pandemic levels.
The WHO and UNICEF Immunization Coverage Report 2023, released on Sunday, is the world’s largest dataset on vaccination trends against 14 diseases. The report analyzed estimates from 185 countries and used the third dose of the recommended diphtheria-tetanus-pertussis (DTP3) vaccine at one year of age as a global indicator of vaccination coverage.
The data finds a stall in previous progress towards pre-pandemic vaccination levels: global DTP3 coverage will be 84% in 2023, the same as in 2022, but below the 86% recorded in 2019. The report authors say this is a deviation from trajectory towards the Immunization Agenda 2030 target of 90% coverage for essential childhood and adolescent vaccines.
The holdup reflects ongoing challenges including disruptions to health services, logistical challenges, vaccine hesitancy and unequal access to services, the groups said in a news release.
The new report also shows that the number of children who have not received at least one dose of the DTP3 vaccine will increase by 600,000 between 2022 and 2023, leaving 2.7 million more children unvaccinated or under-vaccinated than before the pandemic.
“Today’s announcement highlights that we are off track and that we need to accelerate efforts to address this challenge,” said Dr Efrem T. Lemango, UNICEF’s Deputy Director for Health and Global Head of Immunization.
But despite the overall challenges, “there are some positive signs in some places,” Lemango told CNN.
O’Brien and Lemango said the data showed that the African region made the greatest progress in overall coverage last year, with countries such as Bangladesh, Indonesia, Brazil and Nigeria making notable progress in their post-pandemic recovery.
“Low-income countries, where health systems have been hit hardest by the pandemic, are starting to see some improvement compared to 2022,” O’Brien told a news conference.
O’Brien said vaccination rates in the first year of life had risen in Africa despite rising birth rates, meaning more vaccines were needed to maintain the same coverage.
The 2023 report also found that HPV vaccination rates among girls had increased by 7%, nearly returning to pre-pandemic levels, and studies have shown that the vaccine can reduce cervical cancer rates in women by 87%.
However, current vaccination coverage is well below the 90 percent goal to eliminate cervical cancer as a public health problem, reaching just 56 percent of adolescent girls in high-income countries and 23 percent in low- and middle-income countries, according to the news release.
The WHO estimates that global vaccination efforts have saved 154 million lives over the past 50 years, equivalent to six lives every minute. About 60% of those deaths can be attributed to the measles vaccine, which the WHO predicts will make the “biggest contribution to preventing future deaths.”
But data from 2023 reveals that countries that have experienced large or disruptive measles outbreaks since the pandemic have measles vaccination coverage rates that are too low to contain further outbreaks. Even in countries that have not experienced an outbreak in the past five years, around 35 million children remain fully or only partially vaccinated, a decline the report calls “worrying.”
Subhash Shrestha/NurPhoto/Getty Images
A Nepali emergency medical worker prepares to administer a measles-rubella vaccine during a nationwide vaccination campaign in Kathmandu, Nepal, in February.
Low vaccination coverage was the main factor behind outbreaks in 103 countries, accounting for around three-quarters of the world’s infant population, over the past five years, according to the report.
Cases of the highly contagious virus are resurfacing in the U.S. According to a 2023 report from the Centers for Disease Control and Prevention, the percentage of U.S. children vaccinated against measles, mumps and rubella by age 2 was 92%, below the federal government’s goal of 95%.
“Measles cases continue to rise as measles vaccination coverage stagnates,” Lemango said. “More than 300,000 measles cases were confirmed globally in 2023, an almost three-fold increase compared to 2022.”
The organizations say the introduction of new and underutilized vaccines through partnerships such as the Vaccine Alliance (Gavi) is expected to expand protection against infectious diseases such as measles.
“This progress is crucial in reducing the burden of diseases that have plagued our communities for so long,” Lemango added.
The data shows that more than half of unvaccinated children in 2023 will live in countries experiencing fragility, conflict and vulnerability, yet these countries account for just 28% of the world’s newborns. Many of these countries have “done a worrying decline in performance since 2019,” the report said.
Just 10 countries accounted for 59% of children who did not receive the vaccine in 2023. Countries such as Sudan, Yemen and Afghanistan are new to this list, according to the report.
“Child protection is crucial in any conflict,” said WHO’s O’Brien.[Conflict] It creates an environment where there is a great risk of infectious diseases causing large-scale and impactful outbreaks.”
Countries that have experienced conflict, such as Ukraine, saw an initial drop in vaccination coverage but did not see an overall decline in vaccinations, but this was not the case in other regions, such as Sudan and parts of the Middle East.
O’Brien said there was a “significant decline” in vaccination rates in the Gaza Strip in 2023, but not to the same extent in Israel. Data in the report from the Gaza Strip was only submitted from January to September, and “does not cover what will happen in 2024,” Lemango noted.
O’Brien said an analysis of vaccination rollouts in other conflict zones paint a “mixed picture”.
“But I will give you the example of Ukraine, where coverage has improved. Not all conflict zones will experience a decline in coverage,” she said, citing resilient programs, the nature of the conflict and health worker safety.
Lemango said there was a “clear pattern” that Ukraine’s capacity to provide services weakened early in the conflict, only to bounce back as aid and resources flowed in. The question, he said, was how to sustain the improvements.
The U.S. vaccination rate is between 95% and 98%, indicating good access to health care services, Lemango said, but that doesn’t mean Americans are fully protected.
“Until every person, every country has the capacity and the coverage to vaccinate every child, the risk of outbreaks, epidemics and potentially pandemics will always be imminent,” he said.
Get the CNN Health weekly newsletter
In April 2023, WHO and UNICEF launched the “Big Catch Up” initiative in partnership with organizations including Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation, in response to declining vaccination coverage in the wake of the pandemic.
According to the partnership, the effort aims to accelerate childhood immunization and close the gap between pre- and post-pandemic efforts. Achieving these goals and targeting the targets outlined in the Immunization Agenda 2030 will require investments in collaboration and innovation, according to the IA2030 Partnership Council.
“In the future, there will be many vaccines that can prevent preventable diseases,” Lemango said.
“Vaccination is one of the greatest achievements of mankind.”
