Childhood immunisation rises as vaccines reach 4m more children – WHO

Global immunisation coverage appears to be rising as four million more children received vaccines in 2022 compared to 2021 due to improved efforts to tackle the declining vaccination rate caused by the COVID-19 pandemic, the World Health Organisation (WHO), said on Tuesday.

About 20.5 million children missed out on one or more vaccines delivered through routine immunisation services, compared to 24.4 million children in 2021, according to data released by the WHO and UNICEF.

Despite the progress, the number remains higher than the 18.4 million children who missed out in 2019 before pandemic-related disruptions, underscoring the need for ongoing catch-up, recovery, and system-strengthening efforts, WHO said.

The vaccine against diphtheria, tetanus, and pertussis (DTP) was used as the global marker for immunisation coverage.

Of the 20.5 million children who missed out on one or more doses of their DTP vaccines in 2022, 14.3 million did not receive a single dose, so-called zero-dose children. The figure represents an improvement from the 18.1 million zero-dose children in 2021 but remains higher than the 12.9 million children in 2019.

“These data are encouraging, and a tribute to those who have worked so hard to restore life-saving immunisation services after two years of sustained decline in immunisation coverage,” said Tedros Ghebreyesus, WHO director-general.

“But global and regional averages don’t tell the whole story and mask severe and persistent inequities. When countries and regions lag, children pay the price.”

The early stages of recovery in global immunisation have not occurred equally, with the improvement concentrated in a few countries.

Progress in well-resourced countries with large infant populations, such as India and Indonesia, masks slower recovery or even continued declines in most low-income countries, especially for measles vaccination.

Of the 73 countries that recorded substantial declines in coverage during the pandemic, 15 recovered to pre-pandemic levels, 24 are on route to recovery and, most concerning, 34 have stagnated or continued declining.

As a result, WHO has urged countries must ensure they are accelerating catch-up, recovery, and strengthening efforts, to reach every child with the vaccines they need and – because routine immunisation is a fundamental pillar of primary healthcare – take the opportunity to make progress in other, related health sectors.

Vaccination against measles – one of the most infectious pathogens – has not recovered as well as other vaccines, putting an additional 35.2 million children at risk of measles infection.

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First-dose measles coverage increased to 83 percent in 2022 from 81 percent in 2021 but remained lower than the 86 percent achieved in 2019.

As a result, last year, 21.9 million children missed the routine measles vaccination in their first year of life, 2.7 million more than in 2019 – while an additional 13.3 million did not receive their second dose, placing children in under-vaccinated communities at risk of outbreaks.

“Beneath the positive trend lies a grave warning,” said Catherine Russell, UNICEF executive director.

“Until more countries mend the gaps in routine immunization coverage, children everywhere will remain at risk of contracting and dying from diseases we can prevent. Viruses like measles do not recognize borders.
Efforts must urgently be strengthened to catch up with children who missed their vaccination while restoring and further improving immunisation services from pre-pandemic levels.”

Countries with steady, sustained coverage in the years before the pandemic have been better able to stabilise immunization services since the data indicates.

The African region, which is lagging behind in its recovery, faces an extra challenge.

DTP3 vaccine coverage in the 57 lower-income countries supported by Gavi, the Vaccine Alliance, increased to 81 percent in 2022 – a considerable increase from 78 percent in 2021 – with the number of zero-dose children who receive no basic vaccines also dropping by 2 million in these countries.

However, the increase in DTP3 coverage in Gavi-implementing countries was concentrated in lower-middle-income countries, with low-income countries not yet increasing coverage – indicating the work remaining to help the most vulnerable health systems rebuild.

“It is incredibly reassuring, after the massive disruption wrought by the pandemic, to see routine immunization making such a strong recovery in Gavi-supported countries, especially in terms of reducing the number of zero-dose children,” said Seth Berkley, CEO of Gavi, the Vaccine Alliance.

“However, it is also clear from this important study that we need to find ways of helping every country protect their people, otherwise we run the risk of two tracks emerging, with larger, lower-middle-income countries outpacing the rest.”

For the first time, HPV vaccination coverage surpassed pre-pandemic levels. HPV vaccination programmes that began pre-pandemic reached the same number of girls in 2022 than 2019.

However, coverage in 2019 was well below the 90 percent target, and this has remained true in 2022, with mean coverage in HPV programmes reaching 67 percent in high-income countries and 55 percent in low- and middle-income countries.

The newly launched HPV revitalisation, led by the Gavi Alliance, aims to strengthen existing programme delivery and facilitate more introductions.