The sharp decline in childhood vaccination threatens millions of lives

Millions of children around the world, most of whom live in the poorest countries, combine conflicts, climate emergencies, false information campaigns, pandemic blockades, and resource-diversified Covid vaccination efforts. According to a new analysis by UNICEF, a UN agency that vaccinates half of the world’s children, has missed some or all of its childhood vaccinations in the last two years.

The report states that this is the largest retreat of regular immunity in 30 years. Coupled with the rapid increase in malnutrition, it has created a potentially life-threatening condition for millions of infants.

Lily Kaplani, Head of Advocacy for UNICEF, said: “It’s not a few years later. It’s coming soon.”

The proportion of children worldwide who have been vaccinated three times against diphtheria, tetanus and whooping cough, known as DTP3, which UNICEF uses as a benchmark for immunization coverage, fell by 5 points between 2019 and 2021. It became 81%. The measles vaccination rate has dropped to 81%, and the polio vaccination rate has dropped significantly. Herd immunity requires a vaccination rate of 94% to block the chain of disease transmission.

This represents 25 million children who have not received basic interventions to protect themselves from fatal illness.

The number of children who have not received a single dose of the most basic vaccine, which UNICEF calls Zero Doze children, surged from 13 million in 2019 to 18 million during the pandemic. This group includes half of all previously dead children, 5 years old.

Authorities expected a recovery in childhood vaccination rates in 2021 after a sharp decline in 2020 caused by blockades, school closures and other Covid countermeasures, UNICEF said. Dr. Niclas Danielson, senior immune specialist based in Nairobi, said.

But instead, the problem got worse. According to the report, the range of measles with DTP3 is the lowest level since 2008.

Dr. Danielson said the 2021 vaccination rate is consistent with the 2008 vaccination rate. For the last 30 years, “he said.

He and many others in the field of childhood immunity expected a recovery last year as the health system learned to adapt to pandemic demands. Instead, false information campaigns on Covid vaccination, and the government’s broader distrust of public health measures, spilled over to thwart regular immunity, he said.

At the same time, the poorest health care system scrambled to carry out limited Covid vaccination, circumventing important access to freezers and health workers, and shooting bullets.

The world has made continuous progress in the coverage of childhood immunization from the 1990s to the first decade of this century. After that, prices began to level off as the rest of the children were the most difficult to reach, including active war zones and nomadic communities. However, prior to the pandemic, the dual commitment to reach the remaining pockets of zero-dose children with support from organizations such as the Bill & Melinda Gates Foundation and the global vaccine alliance Gabi. had. Covid has separated much of that attention and investment.

In the last two years, India, Nigeria, Indonesia, Ethiopia and the Philippines have the highest number of children who missed the vaccine.

Brazil was also on the list of the 10 most affected countries. This is a tough change for countries that were famous for their high vaccination rates. Approximately 26% of Brazilian infants were unvaccinated in 2021, compared to 13% in 2018.

“30 years of work was lost overnight,” said Dr. Carla Dominguez, an epidemiologist and former coordinator of Brazil’s national immune program.

During the Covid pandemic, she said vaccination became a politicized subject in Brazil. The federal government, led by President Jail Borsonaro, downplayed the importance of the coronavirus, even though Brazil was one of the highest mortality rates in the world, and vaccinated his own 11-year-old child with the virus. He said he would not inoculate.

“For the first time, the federal government did not recommend vaccines, and it created an entire suspicious environment that never existed in Brazil, where vaccination was fully accepted,” Dr. Dominguez said.

At the same time, a less-purchased vaccination group in Brazil moved to the country during the pandemic and began disseminating false information in Portuguese on social media, she said.

And all this was happening, Dr. Dominguez said. When Brazilians were a generation away from serious illness, they were urged to vaccinate their children and questioned their need.

“Parents are unaware of the effects of measles and polio, so they start choosing vaccinations,” she said. Data showing that pneumococcal vaccine acceptance is higher than that of polio reveals that. “Parents choose not to have polio. They say,” Thirty years have passed without polio, do we need to do this? “

Still, they have clear signs of risk, she said: six years after reporting that Brazil had eradicated the disease, a small number of measles cases were found earlier this year in São Paulo. “Measles is now prevalent, which gives concrete examples of what can happen with diphtheria, meningitis, and many other illnesses,” she said.

In the Philippines, 43% of babies were not vaccinated last year. The problem there is partly in the strict Covid public health measures, including blockades. “If you are not allowed to take your child out outside of certain hours of the day, if you cannot go to school, or if your living expenses are increasing, you can go to health care and get your child vaccinated. It’s a priority, said Dr. Danielson.

However, the situation in the Philippines is also complicated by the prolonged distrust of vaccination after the widespread deployment of the dengue vaccine in 2016.

UNICEF’s Kaplani said that returning vaccine levels to their previous state would require an extraordinary amount of resources and commitment.

“It’s not enough to go back to business as usual and restore normal routine immunity,” she said. “As the cohort of millions of fully immunized children living in malnourished and other stressful countries grows, we really need a coordinated investment and catch-up campaign. prize.”

In Zimbabwe, for example, there is currently an outbreak of measles that kills one in ten children hospitalized for the disease. (Typical mortality is less than 1 in 100 in low-income countries and less than 1 in 1,000 in high-income countries.)

Dr. Fabian Diomande, a polio eradication expert at the Global Health Task Force, who has worked on polio campaigns in West and Central Africa for many years, needs new agility, innovation and resources to reverse the decline in pediatric immunity. Said that.

“It’s like we’re in a new world — those emergencies never go away,” he said. “We still have Covid. We still have a climate crisis. We need to learn how to work in multiple public health emergencies.”

Dr. Dominguez of Brazil said the Covid vaccination effort could provide some lessons on how to catch up. Brazil has achieved high vaccination rates by offering pop-up vaccination posts and making shots available at night and on weekends.

While Covid has given rise to new interest in global health cooperation, Caprani said investing in new surveillance tools and other novelties is a simple intervention needed to address a child’s immune crisis. He said there was a risk of distracting from the placement of thousands of community health workers.

“I’m not going to solve this with poster campaigns or social media posts,” she said. “We need reliable, well-trained and well-compensated outreach by community health professionals. They build trust every day. It listens to their opinions about vaccines. It’s a kind of trust that means. And they’re just not enough. “

Jason Gutierrez Contributed to the report from Manila.