Immunization of children begins recovery after the fall of COVID-19

Global immunization services reached 4 million more children in 2022 compared to the previous year, as countries stepped up efforts to address the historic setback in immunization caused by the COVID-19 pandemic.

According to data released today by the World Health Organization (WHO) and UNICEF, 20.5 million children missed one or more vaccines delivered through routine immunization services in 2022, compared to 24.4 million children in 2021. Despite this improvement, the figure remains higher than the 18.4 million children who missed out in 2019 before pandemic-related disruptions, highlighting the need for continued efforts to catch up, recover and strengthen systems.

Diphtheria, tetanus and pertussis (DTP) vaccine is used as a global marker for immunization coverage. Of the 20.5 million children who missed one or more doses of their DTP vaccine in 2022, 14.3 million did not receive a single dose, the so-called zero-dose children. The figure represents an improvement over the 18.1 million children who received a zero dose in 2021, but is still higher than the 12.9 million children in 2019.

“These data are encouraging and pay tribute to those who have worked so hard to re-establish life-saving vaccination services after two years of steadily declining immunization coverage,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “However, global and regional averages do not tell the whole story and hide serious and persistent inequalities. When countries and regions fall behind, children pay the price.”

The early stages of recovery in global immunization did not occur uniformly, with improvement concentrated in a few countries. Progress in well-resourced countries with large infant populations, such as India and Indonesia, masks a slower recovery or even continued decline in most low-income countries, particularly for measles vaccination.

Of the 73 countries that experienced a significant decline* in coverage during the pandemic, 15 have recovered to pre-pandemic levels, 24 are on the road to recovery and, most worryingly, 34 have stagnated or continued to decline. These troubling trends mirror patterns seen in other health metrics. Countries must ensure that they accelerate catch-up, recovery and strengthening efforts to reach every child with the vaccines they need and – as routine immunization is a cornerstone of primary care – seize the opportunity for progress in other, related health sectors.

Vaccination against measles – one of the most contagious diseases – has not recovered as well as other vaccines, putting an additional 35.2 million children at risk of measles infection. Coverage for the first dose of measles increased to 83% in 2022 from 81% in 2021, but remained lower than the 86% achieved in 2019. As a result, last year 21.9 million children missed routine measles vaccination in the first year of life – 2 .7 million more than in 2019 – while an additional 13.3 million have not received their second dose, putting children in under-vaccinated communities at risk of disease outbreaks.

“Beneath the positive trend lies a serious warning,” said UNICEF Executive Director Catherine Russell. “Until more countries address gaps in routine immunization coverage, children everywhere will remain at risk of contracting and dying from preventable diseases. Viruses like measles know no borders. Efforts must be urgently stepped up to catch up with children who have missed vaccinations, while restoring and further improving immunization services from pre-pandemic levels.”

The data show that countries with stable, sustainable coverage in the years before the pandemic were better able to stabilize immunization services. For example, South Asia, which reported a gradual, steady increase in coverage in the decade before the pandemic, has shown a faster and stronger recovery than regions that have suffered long-term declines, such as Latin America and the Caribbean. The African region, lagging behind in its recovery, faces an additional challenge. With a growing child population, countries need to increase routine immunization services every year to maintain coverage levels.

DTP3 vaccine coverage in 57 low-income countries supported by Gavi, the Vaccine Alliance, increased to 81% in 2022 – a significant increase from 78% in 2021 – with the number of zero-dose children not receiving core vaccines also dropped by 2 million in those countries. However, the increase in DTP3 coverage in Gavi-implementing countries has been concentrated in lower-middle-income countries, while low-income countries have yet to increase coverage—suggesting that work remains to help the most vulnerable health systems rebuild.

“It is incredibly encouraging, after the huge disruption caused by the pandemic, to see routine immunization recovering so strongly in countries supported by Gavi, particularly in terms of reducing the number of children who received a zero dose,” said Dr. Seth Berkley, CEO of Gavi. Vaccine Alliance. “However, it is also clear from this important study that we must find ways to help each country protect its people, otherwise we risk the emergence of a double track, with larger, lower-middle-income countries outperforming the rest.”

For the first time, HPV vaccination coverage exceeded pre-pandemic levels. HPV vaccination programs that began before the pandemic reached the same number of girls in 2022 than in 2019. However, coverage in 2019 was well below the 90% target, and this remained true in 2022, with average coverage in HPV programs that reached 67% in high-income countries and 55% in low- and middle-income countries. The newly launched revitalization of HPV, led by the Gavi Alliance, aims to strengthen the delivery of the existing program and enable more roll-outs.

Many stakeholders are working to accelerate recovery in all regions and across all vaccine platforms. Earlier in 2023, WHO and UNICEF, together with Gavi, the Bill & Melinda Gates Foundation and other IA2030 partners launched ‘Big catch up‘, a global communications and advocacy push, calling on governments to catch up with children who missed out on vaccinations during the pandemic, restore immunization services to pre-pandemic levels and strengthen them in the future by:

• redoubling its commitment to increasing immunization funding and working with stakeholders to release available resources, including COVID-19 funding, to urgently restore disrupted and overburdened services and implement recovery efforts;
• developing new policies that allow vaccines to reach children who were born just before or during the pandemic and who are past the age when they would be vaccinated with routine immunization services;
• strengthening immunization and primary health care services – including community health systems – and addressing the challenge of systemic immunization to correct long-standing immunization stagnation and reach the most marginalized children; and
• building and maintaining trust and acceptance of vaccines through collaboration with communities and health care providers.

Notes for editors:

* A significant decline is considered a decline of 5 percentage points or more in 2020 and/or 2021 compared to 2019. Smaller fluctuations in coverage were not uncommon before the pandemic.

The data shows how many children in the target age group for routine immunization services were reached in 2022. It is not structured to cover catch-up for those missed during the pandemic, as many of these children will ‘out-age’ local immunization services. However, some reimbursements may have been recorded as “routine” services and shown in the data.

WHO and UNICEF are working with Gavi, the Vaccine Alliance and other partners to implement the Global Immunization Agenda 2030 (IA2030), a strategy for all countries and relevant global partners to achieve set goals in disease prevention through immunization and vaccine delivery to everyone, everywhere, at every age.

In response to WUENIC’s 2022 data, IA2030 released a joint statement which can be found here.

About data

Based on country-reported data, the WHO-UNICEF Estimates of National Immunization Coverage (WUENIC) provide the largest and most comprehensive set of data on trends in vaccination against 13 diseases in the world given through regular health systems – usually in clinics, community centers , field services or visits by health workers. For 2022, data from 183 countries was submitted.

ABOUT WHO

Committed to the well-being of all people and guided by science, the World Health Organization leads and supports global efforts to give everyone, everywhere, an equal opportunity to live a safe and healthy life. We are the UN health agency that connects nations, partners and people on the front lines in more than 150 locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health problems and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable.

About UNICEF
UNICEF works in some of the most difficult places in the world to reach the most disadvantaged children. In more than 190 countries and territories, we work for every child, everywhere, to build a better world for all.

For more information about UNICEF and its work, visit: www.unicef.org

Follow UNICEF at Twitter, Facebook, Instagram and YouTube