Aqilah Rahman
An estimated 67 million children missed one or more vaccinations between 2019 and 2021. Forty-eight million did not receive any vaccine during the period, according to a new United Nations International Children’s Emergency Fund (UNICEF) report titled The State of the World’s Children 2023.
The report stated that high confidence in vaccination is significantly associated with vaccine uptake. However, data suggests declining confidence in vaccination in 52 out of 55 countries studied after the start of the pandemic.
The perception of the importance of vaccines for children dropped by more than a third in South Korea, Papua New Guinea, Ghana, Senegal and Japan after the start of the pandemic. The three countries that saw an increase in vaccine confidence are China, India and Mexico. Despite the slipping confidence in vaccines, overall support remains relatively high. In almost half the 55 countries studied, over 80 per cent of respondents perceived vaccines as necessary for children.
While trends in vaccine confidence are highly volatile and location-specific, the report highlighted that any signs of loss of confidence must be taken seriously.
The COVID-19 pandemic has set back childhood immunisation worldwide to levels not seen since 2008. It has also brought vaccine hesitancy to attention – the state of being undecided or uncertain about vaccination. “At the height of the pandemic, scientists rapidly developed vaccines that saved countless lives. But despite this historic achievement, fear and disinformation about all types of vaccines circulated as widely as the virus itself,” said UNICEF Executive Director Catherine Russell.
“This data is a worrying warning signal. We cannot allow confidence in routine immunisations to become another victim of the pandemic. Otherwise, the next wave of deaths could be of more children with measles, diphtheria or other preventable diseases.”
Before a vaccine was introduced in 1963, measles killed an estimated 2.6 million people globally every year, primarily children. By 2021, the figure dropped to 128,000.
However, two years of decline during the pandemic saw a five-percentage point fall in the number of children receiving their first measles shot. In 2022, measles cases doubled compared to the previous year. Because measles is so contagious, around 95 per cent of a community must be immunised to reach herd immunity. As a result, any decline in coverage raises the risk of significant outbreaks.
Polio cases have also shown a concerning trend. The number of children paralysed by polio was up 16 per cent year-on-year in 2022, whereas 2019-2021 saw an eight-fold increase compared to the previous three-year period.
Often, vaccination is not available, accessible or affordable. As a result, around one in five children worldwide are not fully protected against diseases that vaccines can prevent. Even before the pandemic, many children missed out on vaccination, particularly those in marginalised communities who live in poverty. In the poorest households, just over one in five children are unvaccinated compared to one in 20 in the wealthiest. The gap is even more significant in some regions, such as West and Central Africa, where almost one in two children in the poorest households are unvaccinated, compared with around one in 16 in the wealthiest.
The report highlighted that it is essential to strengthen primary healthcare and support its frontline workers to vaccinate every child. Women make up most of the frontline workers for vaccination but face issues such as low pay, informal employment, and lack of formal training and career opportunities.
To address this matter, UNICEF called for governments to identify and reach all children, especially those who missed vaccinations during the COVID-19 pandemic; strengthen demand for vaccines, including by building confidence; prioritise funding to immunisation services and primary healthcare; and build resilient health systems through investment in female health workers, innovation and local manufacturing.
“Immunisations have saved millions of lives and protected communities from deadly disease outbreaks,” said Catherine Russell.
“We know all too well that diseases do not respect borders. Routine immunisations and strong health systems are our best shot at preventing future pandemics, unnecessary deaths and suffering. With resources still available from the COVID-19 vaccination drive, now is the time to redirect those funds to strengthen immunisation services and invest in sustainable systems for every child.”
Vaccines save 4.4 million lives annually and are considered one of humanity’s most outstanding public health achievements. This figure could rise to 5.8 million by 2030 if the goals are met for the Immunisation Agenda 2030, a global strategy which envisions a world where everyone, everywhere, at every age, fully benefits from vaccines for good health and well-being.
