Latest childhood immunization data must spur renewed action

August 3, 2022 by Dr. Emmanuel Mugisha

COVID-19 brought on the worst decline in childhood vaccination rates in 30 years, underscoring the need for increased investment in health systems.

A nurse administers a COVID-19 vaccine at Entebbe Referral Hospital in Uganda, March 2021. Photo: PATH/Deogratias Agaba.

A nurse administers a COVID-19 vaccine at Entebbe Referral Hospital in Uganda, March 2021. Photo: PATH/Deogratias Agaba.

The World Health Organization and United Nations Children’s Fund (UNICEF) recently released data that show a decline in global childhood immunization coverage in 2021. Though there has been significant immunization progress in the face of many complex challenges, these new numbers are devastating.

The percentage of children around the world who received three doses of the diphtheria, tetanus, and pertussis (DTP3) vaccine dropped five percentage points—to 81 percent—from 2019 to 2021. That means 25 million children missed out on one or more DTP3 doses in 2021, and of those 25 million, 18 million did not receive a single dose.

This is the largest decline in childhood immunization rates the world has seen in 30 years. These data represent the reality that millions more children are now at risk of deadly, preventable diseases—and this information must spur action.

Of course, we can’t reverse this trend without understanding what fueled the decline and acknowledging the heroic efforts underway that have kept these numbers from dropping even lower.

Facing unprecedented challenges

The data reflect the challenges low- and middle-income countries have faced since the start of the pandemic: already overburdened, under-resourced health systems were forced to respond to a global pandemic and manage other outbreaks while maintaining ongoing essential health care services.

Meanwhile, global supply chain disruptions, economic instability, and climate change–fueled disasters such as drought and famine further complicate routine immunization.

According to UNICEF, more children are living in conflict and fragile settings, where immunization access is often challenging. Misinformation about vaccines has also increased.

All the while, the cost of delivering vaccines has gone up. One study estimated that the cost of immunization outreach in sub-Saharan Africa could increase by as much as 99 to 251 percent per dose (across different scenarios) as countries implement measures to prevent COVID-19 transmission.

If new costs for personal protective equipment, amended vaccine delivery strategies, and tailored communications to sustain demand, among other things, doubled or tripled the cost per dose during the pandemic, then dips in coverage—which occurred everywhere, including in high-income countries—are no surprise. The smaller declines in high-income countries can be attributed to the significantly higher resources available to protect against greater declines.

Global supply chain disruptions, economic instability, and climate change–fueled disasters such as drought and famine further complicate routine immunization.

Progress against all odds

Despite these unprecedented challenges, we applaud public health workers and ministries of health around the world for their innovation and resilience. By celebrating successes and learning from what works—and what doesn’t work—we can better understand how to overcome these challenges together.

For example, UNICEF notes that Uganda is one of a handful of countries that has “notably held off declines,” maintaining high levels of coverage in routine immunization while rolling out a targeted COVID-19 vaccination program.

PATH is proud to be a key partner to Uganda’s Ministry of Health, supporting crucial policies and activities that helped the country beat the odds.

It all starts with strong leadership on immunization at all levels of government. In Uganda, that leadership came from the very top, with the president taking swift action to ensure families could access health facilities for immunization services for their children, even at the height of the pandemic-related lockdowns.

An intentional community engagement strategy helped to meaningfully reach more people. By working with local community leaders, such as religious leaders, elected officials, and heads of cultural institutions, the Ministry of Health successfully encouraged more communities to seek routine immunization and vaccination against COVID-19.

And the government monitored the data and invested time and resources early on. When immunization coverage rates first began to decline in the early days of the pandemic, the Ministry of Health and its partners invested heavily in catch-up immunization campaigns. When COVID-19 vaccines were ready to roll out, Parliament took swift action to ensure routine immunization funding was not depleted to cover the cost of delivering COVID-19 vaccines.

These are just a few examples from one country, but there are many more examples of countries successfully administering vaccinations during and throughout the pandemic. Their success was due to dedicated health care workers and government officials around the world who acted quickly to adapt policies to protect immunization services, come up with innovative delivery approaches, and advocate for more funding as the cost to deliver immunizations continued to rise.

Scaling efforts and investments

Right now, one thing is clear—countries know best how to increase their immunization rates. But to do so, governments must understand the scale of the challenges that lie ahead, and they must provide increased and sustained investments to meet these needs. At the same time, bilateral donors must step up with flexible investments to match domestic resources.

With this kind of support, countries will be better positioned to strengthen immunization systems as a whole while addressing the unique challenges they face—whether that is strengthening data systems, upgrading vaccine delivery, supporting and training health care workers, or designing new ways to meet the needs of their children and communities.

As countries continue recovering and rebuilding, it’s critical that the global public health community comes together to ensure all children have access to lifesaving vaccinations.