Millions of children around the world, most of them in the poorest countries, have missed some or all of their childhood vaccinations over the past two years due to a combination of conflicts, climate emergencies, misinformation campaigns, pandemic lockdowns and COVID vaccination efforts. divert resources. , according to a new analysis by UNICEF, the United Nations agency that immunizes half the world’s children, and the World Health Organization.
This is the biggest drop in routine vaccination in 30 years, the report said. With rapidly rising rates of malnutrition, it has created conditions that can put the lives of millions of young children at risk.
“This is an emergency for children’s health – we have to think about the immediate stakes, the number of children dying because of it,” said Lily Caprani, head of advocacy for UNICEF. “It is not in a few years time; It’s too early.”
Percentage of children worldwide who received three doses of vaccine against diphtheria, tetanus and pertussis, known as DTP3 – which UNICEF uses as a benchmark for vaccination coverage – 2019 and 2021 between the five points fell to 81 percent. The measles vaccination rate also dropped to 81 percent, and polio coverage also dropped significantly. To interrupt the chain of transmission of a disease, a vaccination coverage rate of 94 percent is required for herd immunity.
This translates to 25 million children who did not receive basic interventions to protect them from deadly diseases.
The number of children with UNICEF zero-dose – who have not received a single dose of the most basic vaccines – rose sharply during the pandemic to 18 million, up from 13 million in 2019. This group comprises half of all children who die first. age 5.
Dr. Niklas Danielson, UNICEF’s Nairobi-based senior immunization specialist, said the agency was hoping to resume childhood vaccination coverage in 2021 after a sharp drop in 2020, driven by lockdowns, school closures and other COVID response measures. Will be done.
But on the contrary the problem got worse. DTP3 and measles coverage is at its lowest level since 2008, the report found.
Dr. Danielson said the vaccination coverage rate in 2021 matches 2008. “But since then, there has been an increase in the birth cohort, which means that the number of children who have not completed or even started vaccination is the highest in the last 30 years,” he said.
He and many others in the child immunization sector projected a recovery last year as health systems learned to adapt to the demands of the pandemic. Instead, misinformation campaigns about COVID vaccination, and widespread mistrust of governments on public health measures, spread to prevent routine vaccination, he said.
At the same time, health systems in the poorest countries scrambled to execute limited COVID vaccination, giving vital access to freezers and health workers to lay down arms.
During the 1990s and the first decade of this century, the world has made steady progress on childhood vaccination coverage. Rates then began to stabilize, as the remaining children were the most difficult to reach, such as those in active war zones or in nomadic communities. But before the pandemic, there was a doubling commitment to trying to reach the remaining pockets of zero-dose children, with support from organizations such as the Bill and Melinda Gates Foundation and the Global Vaccine Coalition. Covid has dragged that attention and investment too far.
In the past two years, India, Nigeria, Indonesia, Ethiopia and the Philippines have recorded the highest number of children who have missed vaccines.
Brazil was also on the list of the 10 most affected countries, a drastic change for a country once renowned for its high vaccination coverage rates. About 26 percent of Brazilian babies had received no vaccine in 2021, compared to 13 percent in 2018.
“30 years of work have been lost overnight,” said Dr. Carla Dominguez, an epidemiologist and former coordinator of Brazil’s national vaccination programme.
He said vaccination became a political topic in Brazil during the Covid pandemic. The federal government led by President Jair Bolsonaro downplayed the importance of the coronavirus, even as Brazil had one of the world’s highest death rates and said it would not get its 11-year-old vaccinated against the virus.
“For the first time, the federal government was not recommending a vaccine, and it created a whole atmosphere of skepticism that never existed in Brazil, where vaccination was fully accepted,” said Dr. Dominguez said.
At the same time, anti-vaccination groups that didn’t have much shopping in Brazil moved into the country during the pandemic, he said, and began circulating misinformation in Portuguese on social media.
And all this was happening, Dr. Dominguez said, at a time when Brazilians were a generation away from serious diseases, they were being urged to vaccinate their children against them, which made them question the necessity.
“Parents don’t know the impact of measles, or polio, so they start picking and choosing vaccinations,” she said. The data shows that the acceptance of the pneumonia vaccine is higher than that of polio. “Parents are choosing not to have polio. They say, ‘It’s been 30 years without polio, so do I need to do this?'”
And yet they have a clear indication of risk, she said: A handful of measles cases were found in So Paulo earlier this year, six years after Brazil reported having eliminated the disease. “Measles is spreading now – which gives us a concrete example of what can happen with diphtheria, meningitis and many other diseases,” she said.
In the Philippines, 43 percent of babies had no vaccinations in the past year. There, the problem lies partly in strict COVID public health measures, including lockdowns. “If you’re not allowed to take your kids outside except for certain hours of the day, if they can’t go to school, if the cost of living is going up, then go to the health center and leave your child’s vaccinations up to your priorities. ,” said Dr. Danielson.
But the situation in the Philippines is also complicated by distrust of vaccination following the widespread rollout of a dengue vaccine called Dengvaxia in 2016, which later proved few people had received it.
“The story of Dengvaxia increased vaccine hesitancy, especially among school children,” said Dr. Anthony LeChon, who has advised the presidency on the response to COVID. “That was the problem. We’re still dealing with it.”
UNICEF’s Ms Caprani said it would require an extraordinary amount of resources and commitment to bring vaccine levels back to where they were.
“It will not be enough to go back to business as usual and restore normal, routine vaccinations,” she said. “We really need concrete investments and catch-up campaigns, because there is a growing group of millions of children who are completely unimmunized who are living in countries with high levels of malnutrition and other stressors.”
For example, in Zimbabwe, there is currently an outbreak of measles with one in 10 children suffering from the disease dying. (The general death rate is one in 100 in low-income countries and below one in 1,000 in high-income countries.)
Dr. Fabian Diomande, a polio eradication expert on the Task Force for Global Health who has worked for years on polio campaigns in West and Central Africa, said reversing the decline in childhood vaccination will require new agility, innovation and resources.
“It’s like we’re in a new world – those emergencies are not going to disappear,” he said. “We will still have Covid. We will still have a climate crisis. We have to learn to work in the context of many public health emergencies.”
In Brazil, Dr. Dominguez said that COVID vaccination efforts may offer some lessons on how to catch up. Brazil achieved high vaccination coverage by providing pop-up vaccination posts and making shots available at night and on weekends.
Ms Caprani said that while there was an encouraging new interest in global health cooperation because of COVID, investment in new surveillance measures and other innovations risked distracting from the simple interventions needed to address the child vaccination crisis: thousands of communities Deployment of health workers.
“We’re not going to solve this with poster campaigns or social media posts,” she said. “You need outreach by credible, well-trained, appropriately compensated community health workers who, day in and day out, build trust – the kind of trust that you give them about vaccines. Hear. And there just aren’t enough of them.”
Jason Gutierrez Contributed reporting from Manila.