Childhood immunization has rebounded following a significant decline during the early years of the COVID-19 pandemic, but at an uneven rate with too many children in low-income countries still missing out on the life-saving products, according to a joint World Health Organization-UNICEF report.

The agencies say that four million more children were immunized against killer diseases in 2022 compared to the previous year.

“Last year, we rang alarm bells at the historic backsliding that we saw across countries, regions, and vaccines,” said Kate O’Brien, director, immunization, vaccines, and biologicals, WHO.

“From 2022’s data, from a global perspective, we are recovering,” she said. “But that recovery is uneven, with too many countries not yet seeing improvement.”

The report says that just eight large countries—India, Indonesia, Myanmar, Philippines, Brazil, Mexico, Pakistan, and Tanzania—account for 3.8 million of the four million additional children reached in 2022.

Of the 73 countries that recorded substantial declines of more than five percent during the pandemic, the report says “24 are on route to recovery and, most concerningly, 34 have stagnated or continued declining.”

O’Brien said a main measure of immunization program performance is how many zero-dose children exist.

“These are children who do not receive a first dose of the vaccine against diphtheria, tetanus, and pertussis. It means these are children who do not receive any vaccine through the routine immunization program.”

The good news, she said, is that global coverage of the first dose of DTP vaccine now stands at 89 percent—very close to the pre-pandemic coverage of 90 percent.

However, she noted that the data is a lot more nuanced when looked at by region and income.

“All regions, except for the Africa region, have made progress in recovery for DTP. The region’s coverage is now six percent lower than 2019 levels and this is the largest gap for any region,” she said.

The report finds some backsliding in measles vaccine coverage as well, noting that only 83 percent of children globally were vaccinated against that killer disease in 2022, below pre-pandemic levels of 86 percent.

“Fifty-nine countries reported a total of 80 measles outbreaks in 2022,” said Ephrem Tekle Lemango, UNICEF associate director of immunization.

“Since coverage levels declined, we have witnessed outbreaks of diseases such as measles, yellow fever and diphtheria increasing, and our efforts to eradicate polio have been set back,” he said.

“If we do not catch-up vaccinations of older children that were missed since 2019, quickly and urgently,” he warned, “we will inevitably witness more outbreaks and be responsible for more child deaths.”

The WHO’s Kate O’Brien expressed the urgency of vaccinating children against measles in low-income countries, noting that someone who is not immune to the disease could infect between 12 and 20 other people.

“The way children become immune is best done by vaccination, not by actually getting infected and risking severe disease or death or other consequences from measles,” she said.

Ephrem Lemango said reaching children on the African continent, which is home to 12 percent of the world’s population, is particularly challenging as “It is home to 54 percent of the un- or under-vaccinated children,” a significant proportion of whom remain unreached.

“This is because they are facing other challenges, such as conflict and crises,” he said, “but also because, over many years, they have not had the resources to build resilient health systems.”

O’Brien said the overarching, dominant reason why children do not get vaccinated is lack of access. She said families in remote, rural areas in particular have difficulty reaching a clinic where vaccines are administered.

However, she added that “We are very concerned about vaccine confidence and the awareness of families around the benefit of vaccines.

“And clearly, the information and misinformation and disinformation that is growing in size and growing in scope is having some impact in some communities at specific times on the confidence that people have in vaccines.”
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