Global childhood immunization coverage has nearly rebounded to pre-pandemic levels, according to a new report, with 4 million more children receiving full immunization in 2022 compared to 2021. But the report, released Monday by UNICEF and the World Health Organization (WHO), also shows that recovery is lagging in low-income countries.
Overall, 20.5 million children worldwide still missed at least one vaccine that’s a part of routine immunization in 2022 — an improvement over the 24.4 million children who missed at least one dose in 2021. And 14.5 million children didn’t receive a single dose of diphtheria, tetanus and pertussis (DTP) vaccine, which is used as the marker of overall immunization coverage, compared to 18 million who received no DTP doses in 2021.
The new coverage levels, however, remain worse than they were pre-pandemic, when 18.4 million children had missed out on at least one vaccination, and far short of the U.N.’s ambitious goal to halve the global number of so-called “zero-dose children” by 2030.
One bright spot in the report was the data on HPV vaccinations, which are given to preteens with the goal of protecting them from the infection that causes 90% of cases of cervical cancer. HPV vaccination rates surpassed pre-pandemic levels to reach 21% of girls globally in 2022, compared with 19% in 2019. That said, HPV vaccine rates have a long way to go to achieve the U.N.’s goal of reaching 90% of girls worldwide by 2030.
Yet the recovery continues to lag in low-income countries. Out of the 73 countries where immunizations declined by at least 5% in the aftermath of the pandemic, 34 — including Nigeria, the Democratic Republic of Congo, and Ethiopia — saw immunization rates continue to stagnate or even decline last year.
“For low-income countries, we are just at a 1% improvement since last year and not anywhere close to being back to where we were in 2019,” said Kate O’Brien, director of immunization, vaccines and biologicals at WHO.
Slow improvement in childhood vaccine rates is especially concerning when it comes to measles, which is extremely contagious and can be deadly, particularly in combination with other health risks faced by children in the world’s lowest-income countries, such as malnutrition and poor sanitation.
In 2019, before the pandemic, 86% of children globally had received the first of two doses of measles vaccine. In 2022, that number stood at 83%. While an improvement from 2021, that nonetheless means that last year, 22 million children did not receive their first measles vaccine dose, and 13 million skipped the second dose.
Some of the challenges keeping the countries with least resources from recovering to pre-covid vaccination levels are easy to guess, said O’Brien. People living in low-income nations are more likely to face conflict or displacement. This complicates the delivery of vaccines in many ways: People are more likely, for example, to lose their identification documents or vaccine records. In addition, health and immunization systems that were already weak pre-Covid lack the resilience to rebound quickly.
Measles vaccination, which typically happens when the child is between nine to 12 months old, presents additional logistical challenges, said O’Brien.
“By the time the child is nine months of age, the child is eating different things. It’s not only breastfeeding, is a growing child and […] it’s hard for parents to remember,” said O’Brien. She added that parents who lack easy access to vaccines may also feel their children are less vulnerable once they are no longer in the very first months of life, and thus be more likely to skip vaccinations.
Another hurdle is that some countries set the cutoff for all childhood immunization access at two years of age — a threshold many children missed during the pandemic.
The new report highlights just how much work remains to be done in ensuring equitable and convenient vaccine access, said O’Brien.
“What we’ve really learned during the pandemic is that if you make vaccines absolutely dead easy to get, people will take the vaccine,” she said. “And that’s the challenge, that access is really the thing that most communities and most programs struggle with — for high-income and low-income alike.”