Immunization

All UNICEF regions reported a decline in DTP3 coverage in 2020 with the sharpest decline of 6 percentage points from 90 per cent (2019) to 84 per cent (2020) in South Asia. This substantial decline in coverage from 2019, resulting in nearly 2 million more un- or under-vaccinated children compared to 2019, was largely driven by coverage drops in India (6 percentage points), Pakistan (7 percentage points) and Nepal (9 percentage points). As a result, DTP3 coverage in South Asia backslid to levels not seen since 2014.

The latest WUENIC estimates also present a concerning picture for Latin America and the Caribbean where DTP3 coverage has been on a persistent downtrend from 93 per cent in 2012 to 80 per cent in 2019 to 77 per cent in 2020. The COVID-19 pandemic has stressed already fragile health care and immunization delivery systems throughout the region that have experienced persistent funding shortfalls, vaccine misinformation and economic and political instability.

COVID-19 has reduced access to life-saving vaccines to combat diseases such as measles and polio

Immunization is one of the most cost-effective public health interventions to date, averting an estimated 2 to 3 million deaths every year.

Yet even before the coronavirus pandemic, more than nearly 14 million children didn’t receive any vaccines and 19 million children below the age of one did not receive the recommended vaccines against measles, polio, and other preventable diseases in 2019.

Now, COVID-19 is leaving many of the world’s most marginalised children without access to immunization services. As the pandemic continues and depending upon the speed of the COVID-19 vaccine roll-out, there is a risk of lasting negative impacts on routine immunization coverage. Continued disruptions and low coverage of childhood immunizations could create pathways to disastrous outbreaks in 2021 and well beyond of diseases like measles, pertussis, diptheria, yellow fever and polio. Access our COVID-19 hub for more information.

As a direct result of immunization, the world is closer than ever to eradicating polio, with only two remaining polio endemic countries – Afghanistan and Pakistan. Deaths from measles, a major child killer, declined by 73 per cent worldwide between 2000 and 2018 preventing an estimated 23.2 million deaths. And as of today, all but 12 countries have eliminated maternal and neonatal tetanus, a disease with a fatality rate of 70 to 100 per cent among newborns.

The percentage of children receiving the diphtheria, tetanus and pertussis vaccine (DTP) is often used as an indicator of how well countries are providing routine immunization services. In 2020, global coverage rates for the third dose of the diphtheria, tetanus and pertussis vaccine (DTP3) reached 83 per cent, down from 86 per cent in 2019, but still up from 72 per cent in 2000 and 20 percent in 1980.

Multiple factors, including conflict, under-investment in national immunization programmes, vaccine stock-outs, and disease outbreaks like COVID-19, contribute to the disruption of health systems and prevent sustainable delivery of vaccination services. Approximately 42 per cent (9.6 million) of the un- and under-vaccinated infants live in fragile or humanitarian settings[1], including countries affected by conflict. These children are the most vulnerable to disease outbreaks.

In 2020, six countries had 50 per cent or less DTP3 coverage, many of which are fragile states or affected by emergencies – Central African Republic, Guinea, Papua New Guinea, Somalia, South Sudan and Syrian Arab Republic. Globally in 2020, half of children unvaccinated for DTP3 lived in just six countries: Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria and Pakistan. Note that populous developing countries contribute significantly to the number of unvaccinated children despite achieving relatively high rates of immunization coverage, as evidenced by India hosting 3.5 million of the un- and under-vaccinated with 85 per cent coverage of a cohort of more than 23 million surviving infants. Efforts to raise global immunization levels will require a strong focus on the countries where the highest numbers of unvaccinated children live – while also ensuring that countries where children are most likely to miss out on immunization are not neglected.

Through UNICEF’s joint efforts with partners and countries, vaccines have become safer and more accessible than ever before. The cost of fully immunizing children in low-income countries is just US $18 per child, down from US $24.5 in 2013. An increasing number of countries have fully introduced the pneumococcal conjugate vaccine (148 countries as of 2020) and rotavirus vaccine (113 countries as of 2020) in their immunization programmes, thus offering protection against pneumonia and diarrhoea. Human papillomavirus (HPV) is the most common viral infection of the reproductive tract, and can cause cervical cancer in women.  As of 2020, the HPV vaccine was fully introduced in 108 countries; however, school closures as a result of COVID-19 have also affected HPV immunization rates with global coverage falling from 15 per cent in 2019 to 13 per cent of girls in 2020. Use of underutilized vaccines, such as those against yellow fever and Japanese encephalitis, has also been expanded. However, while low-income countries have largely been able to close coverage gaps with assistance from Gavi, the Vaccine Alliance, vaccine introduction is lagging in middle-income countries who struggle to find both national resources and external funding sources.

No child should die from a preventable cause, and all children should be able to reach their full potential in health and well-being. The cost of a vaccine, often less than US $1, is much lower than the cost of treating a sick child or fighting a disease outbreak. Each US $1 invested in childhood vaccination produces a return on investment of US $44 in low- and middle-income countries. More details on the cost and financing of vaccination can be found here.

 

[1] World Bank Fragile and Conflict-affected Situations (FCS), FY 2022:

https://www.worldbank.org/en/topic/fragilityconflictviolence/brief/harmonized-list-of-fragile-situations