Worst backslide in global vaccinations ‘in a generation,’ U.N. says

Worst backslide in global vaccinations ‘in a generation,’ U.N. says

The coronavirus pandemic coincided with the worst backslide in global vaccination coverage in a generation, according to new data from the United Nations. This came despite a historic effort to develop and distribute billions of coronavirus vaccines during the pandemic.
The new data, released late Thursday by UNICEF and the World Health Organization, showed that average global childhood coverage for vaccines developed for 11 key diseases had fallen from 71 percent in 2019 to 68 percent in 2021, marking the first time in over 30 years that the metric had fallen.
The decline for some key vaccine programs was worse. The full three-dose coverage for diphtheria, tetanus, and pertussis vaccine (DTP) was 81 percent in 2021, a drop of five percentage points from 2019. DTP is often used as a benchmark for vaccine coverage globally as it’s been in wide use for decades.There were similarly alarming drops in coverage of measles and polio, two diseases that can have devastating and deadly impacts.
Vaccine coverage for human papillomavirus (HPV) also declined by five percentage points since 2019. As the vaccine is relatively new and not as widely used as some others, this meant that a quarter of all global coverage has been lost, a huge setback for the health of women and children.
“This is a red alert for child health. We are witnessing the largest sustained drop in childhood immunization in a generation. The consequences will be measured in lives,” said Catherine Russell, executive director of UNICEF, the U.N. agency focused on childhood health. “Covid-19 is not an excuse.”
The number of children either not fully vaccinated with DTP, which prevents a number of potentially fatal illnesses including whooping cough, or not vaccinated at all for it rose from 19 million in 2019 to 25 million in 2021, the data shows. The spread of these children is deeply unequal, with 18 million in low and middle-income countries; India, Nigeria, Indonesia, Ethiopia and the Philippines recorded the highest numbers.
Some experts fear that with rising populations in Africa, as well as sharp demographic change in many parts of the world leading to more children, it could become even harder to catch up after the pandemic.
That the decline in these vaccinations came amid the global coronavirus vaccine effort may seem surprising. By any measure, the development of coronavirus vaccines came at a record pace. The global rollout, though rife with logistical problems and hoarding by wealthy nations, has seen an enormous 12 billion doses administered since the pandemic began.
But despite the attention given to vaccines over the past two years, the pandemic itself had many knock-on impacts on regular vaccination efforts, from lockdowns to closed borders to the general impact of huge levels of illness and death.
Even the unprecedented focus on vaccination efforts could have had a negative impact, given a prominent backlash from those anti-vaccine or vaccine hesitancy. Money that once went to vaccinations for long-standing diseases like measles and polio has in some cases been diverted.
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“There’s never been more money in global public health than there is now,” Lily Caprani, head of government advocacy for UNICEF. “But that doesn’t mean it’s going to children’s services. The opposite is true: basic essential health services and routine immunization have experienced a massive diversion [of funding].”
Caprani added that while numerous global efforts have launched to better prepare for the next pandemic, few had taken close looks at “basic frontline health,” such as community-based health care workers.
Attention on the pandemic itself has declined recently too, especially in wealthy countries in North America and Europe, where the domestic focus has been on inflation and the international focus largely confined to the war in Ukraine. Demand for doses in many countries is down, with tracking firm Airfinity recently announcing that at least 1 billion had been wasted during the pandemic.
However, the coronavirus could still cause further disruption. WHO chief Tedros Adhanom Ghebreyesus warned this week that “new waves of the virus demonstrate again that covid-19 is nowhere near over,” with concern in particular about the BA. 4 and BA. 5 subvariants.
The rapid spread of monkeypox internationally, far beyond where the disease was commonly found in the past, has also posed a new challenge to vaccination efforts. There has been heated criticism of the FDA for not ensuring there was enough supply in the United States to meet demand.
There is some hope that vaccination efforts can get back on track. Some countries managed to maintain high levels of coverage during the pandemic, including Uganda and Pakistan. Ongoing efforts to strengthen global health structures after covid-19 could be used to better ensure routine immunization goes forward.
“Planning and tackling Covid-19 should also go hand-in-hand with vaccinating for killer diseases like measles, pneumonia and diarrhea,” Tedros said in a Thursday statement. “It’s not a question of either/or, it’s possible to do both.”
Jennifer Requejo, global health data lead for UNICEF, said that while the current trends were alarming, global vaccination rates have rallied after previous periods of stagnation.” There are things that can be done,” Requejo said. “We know that it’s possible through political commitment [and] through greater resources.”
But the global rollout of coronavirus vaccines has shown that even with enormous resources, achieving high levels of immunization can be a struggle. “Even in high-income countries, you saw the huge effort it took to mobilize these armies of vaccinators,” said Caprani. “And they simply don’t have that workforce in low and middle-income countries with weaker health systems.”
Requejo said that even before the pandemic, coverage rates of vaccination for DTP had stagnated in part due to rapidly increasing population numbers in key countries. “There are some regions, like Africa, where you have an increasing birth cohort. So 85 percent coverage in 2008 is X number of people, but its X plus a couple of million more that you need to deliver just to maintain that level,” Requejo said.
The U.N. Population Division estimated Monday that the world’s population will reach 8 billion later this year. Some of the countries expected to see their population increase dramatically, such as Nigeria and the Democratic Republic of Congo, already have millions of unvaccinated children. Both are expected to see their population grow by well over 100 million by 2050.

Adam Taylor writes about foreign affairs for The Washington Post.