The world’s largest global health organizations have announced a partnership to reverse the years-long backslide in global childhood vaccination rates caused by the COVID-19 pandemic. 

An estimated 67 million children missed at least one essential vaccination between 2019 and 2021 and 50 million of these didn’t receive any vaccines – setting back childhood vaccination rates to their lowest level since 2008. 

But the “Big Catch-Up”, billed as an “extended effort” to restore vaccination levels in children to at least pre-pandemic levels and shore up essential health services for immunization programmes, does not contain any new financial commitments. 

Participants include the World Health Organization (WHO), UNICEF, the vaccine alliance Gavi, the Bill & Melinda Gates Foundation and a number of national and global health organizations. 

In the past three years, the overburdening and disruption of health services by COVID-19 containment efforts eroded over a decade of gains in routine childhood immunization levels. 

The vaccination schedules of millions of children around the world were knocked-off course, exposing them to life-threatening viruses that can be prevented by existing vaccines.

Dr Kate O’Brien, WHO director of immunization and vaccines, told reporters on Monday that preliminary estimates indicate that the backslide in childhood vaccinations has led to “at least” a five percent increase in mortality among children. 

“Every one of these lives that are lost is on top of the mortality that already exists because of the imperfection of the coverage and immunization programmes,” O’Brien said. “There will continue to be these children who are at risk going forward unless they are caught up.”

Over 100 countries recorded declines in childhood vaccination rates during the pandemic, but three-quarters of the 25 million children who missed vaccinations in 2021 live in just 20 low- and middle-income countries. These will be a “particular focus” for the global coalition. 

“Millions of children and adolescents, particularly in lower-income countries, have missed out on life-saving vaccinations, while outbreaks of these deadly [preventable] diseases have risen,” said WHO director-general Tedros Adhanom Ghebreyesus. “Catching up is a top priority. No child should die of a vaccine-preventable disease.”

Inequality is still behind vaccine access 

When UNICEF first began tracking childhood vaccination rates in 1980, just one in 10 children in the world’s poorest countries would “ever see a trained health worker or be immunized” before their first birthday. By the start of the next decade, seven in 10 children around the world were protected by vaccines – rising steadily to a height of 86% in 2019. 

Despite decades of progress, the story of children not receiving essential childhood vaccines remains one of inequality and poverty. 

One in five children in the world’s poorest households today are ‘zero-dose’, meaning they have never received a vaccine of any kind, according to UNICEF’s 2023 State of the World’s Children report released last week. In West and Central Africa, that number rises to nearly one in two, compared to one in 20 in the wealthiest countries. 

“Routine vaccines are typically a child’s first entry into their health system and so children who miss out on their early vaccines are at added risk of being cut out of healthcare in the long run,” UNICEF executive director Catherine Russel said. “The longer we wait to reach and vaccinate these children, the more vulnerable they become and the greater the risk of more deadly disease outbreaks.”

Asked about the role of vaccine scepticism in dropping child vaccination rates, O’Brien stressed that while the global proliferation of misinformation around vaccines is “deeply concerning” – UNICEF found vaccine confidence dropped in 52 out of 55 countries – it remains a minor factor compared to income. 

“The main reason that kids are unvaccinated is not anti-vax [beliefs],” O’Brien said. “The main reason why children are unvaccinated has to do with access to services, quality of services, and the full availability of programmes.”

Big ambitions, no extra funding 

No new funding to support the goal of returning childhood vaccination rates to pre-pandemic levels is included as part of the “Big Catch-Up”. 

“We’ve done an assessment of the resources that are out there, and we do feel that the resources are there,” O’Brien. “There are substantial resources already in-country and still available to countries through many different mechanisms.”

Meanwhile, Medecins sans Frontieres (MSF) highlighted that children in conflict zones were particularly affected.

“Despite the progress made in expanding global vaccination coverage, nearly 11 million of the un- and under-vaccinated infants live in fragile or humanitarian settings, including countries affected by conflict, and remain the most vulnerable to disease outbreaks,” said Dr Sharmila Shetty, Vaccines Medical Advisor for MSF’s Access Campaign.

Africa’s burden

According to estimates by WHO and UNICEF, the number of zero-dose and under-immunized African children rose by 16% between 2019 and 2021 to a cumulative total of about 33 million, nearly half the global figure.

At a WHO AFRO press briefing last Thursday, Gavi, The Vaccine Alliance, revealed it is working in Sierra Leone and Ghana to ensure that the millions of children and adolescent girls who missed out on vaccines during the pandemic are protected.

“We’re very, very happy to be marking in a few days, the 2023 edition of the Africa Vaccination Week, and it’s a really good opportunity for us to take stock and to remind ourselves of what we have achieved but also what we are dealing with in terms of recovering from a pretty unprecedented emergency during the pandemic,” said Aurelia Nguyen, Gavi’s Chief Programme and Strategy Officer.

Nguyen said that Gavi is working closely with its partners to support countries in making up lost ground and building stronger, more resilient systems. The efforts will focus on on hard-to-reach communities and implementing national programmes that are able to reach children and communities more effectively.

Gavi is also focusing on the human papillomavirus (HPV) vaccine program, which was one of the hardest hit during the pandemic. With cervical cancer being the most common cause of cancer death in nearly half of sub-Saharan African countries, Nguyen noted that the HPV vaccine can prevent up to 90% of cervical cancer cases. 

So far, Gavi said it has supported 20 African countries to produce the HPV vaccine and received $600 million in extra investment last year to revitalize the program and strengthen health systems.

“As we think about many, many challenges ahead, we also are considering the opportunities and we have a young and growing population, and so it’s really our responsibility and opportunity to make sure that we don’t leave any child behind with immunization,” said Nguyen.

• Additional reporting by Paul Adepoju.

Image Credits: WHO / Billy Miaron.