Global levels for routine immunisations are still lagging behind pre-pandemic rates, with uneven progress in different countries, World Health Organization (WHO) officials said at a session of the Executive Board on Friday.

In its report to the EB, the WHO has documented that the current progress is not enough to meet the WHO’s Immunization Agenda for 2030.

Childhood vaccinations have been amongst the worst-hit, member states agreed. The number of zero-dose children who did not receive any DTP (Diphtheria, tetanus, and pertussis) vaccine doses in 2022 stood at 14.3 million, well above the 2019 level of 12.9 million children.

“In the African region, the number of zero-dose children increased from 7.64 million in 2021 to 7.78 million in 2022 − a 25% increase since baseline year 2019,” the WHO report stated.

On the positive side, many countries are preparing to roll out the HPV vaccine for protection against cervical cancer – the fourth most common cancer amongst women that killed an estimated 342,000 in 2020.

“Despite initial signs of recovering global coverage rates of DPT vaccines still hovered below pre-COVID-19 pandemic rates,” a representative of Gavi, The Global Vaccine Alliance, told member state participants at the meeting.

The Gavi representative described WHO’s target of reducing the number of zero-dose vaccine children by 50% by 2030 as “ambitious and urgent.” The Gavi delegate also encouraged countries to include the new malaria vaccine and HPV vaccines in their national immunisation programmes.

Access and cost continue to be barriers

Several countries in Africa are reporting outbreaks of measles as one in five children do not have access to vaccines.

Cameroon, speaking on behalf of 47 countries in WHO’s African Region, said that Africa needs more financing mechanisms like Gavi, transition grants, debt swaps, and development bank loans.

“It is undeniable that immunisation is worth investing in, both as core primary service as well as a key measure for pandemic preparedness and response,” the representative said.

Not just low-income countries but middle-income countries, as well, spoke of the cost of vaccinations as a major financial burden.

“The rising costs of new vaccines present a significant hurdle, impeding their seamless integration into national immunisation programs, especially in middle-income countries,” Malaysia’s representative said. “It remains critical for global partners to explore avenues that enable the provision of more affordable vaccine supplies within these regions.”

14% of Yemeni children under the age of one have received no vaccinations at all

Apart from the immunisation stalled by the pandemic, raging conflicts have meant that children are going without routine immunisation. In Gaza, there is no functioning healthcare system to speak of at the moment, as Health Policy Watch reported from an earlier session.

In Yemen, around 80% of the population and one-third of the country is controlled by the Houthis, a rebel group.

“We face several challenges,” the representative of Yemen told the board. “Fourteen percent of children under one have received no vaccine doses whatsoever in the northern region, which are not under the control of the legitimate government.

“The Houthis [rebel group] are not putting in place national vaccine campaigns, and this will have serious consequences on the children of Yemen, as well as on neighbouring countries and the world in the future.”

Backed by Iran, Houthi rebels are fighting to overthrow the recognised government in Sanaa, and now control significant swathes of the country. The group has in the past called COVID-19 vaccines “biological warfare.”

Countries prepare for HPV rollout

Several countries described their plans to roll out the HPV vaccine for adolescent girls and young women. Timor-Leste said that it plans to launch HPV vaccination later this year.

Along with Gavi, the European Society for Medical Oncology (ESMO) also made a statement supporting the ambitious HPV rollout.

“Given that prevention offers the most cost-effective, long-term strategy for cancer control, ESMO urges the WHO member states to include the routine vaccination of girls and boys against human papillomaviruses in their national programmes,” ESMO’s representative said.

While Thailand appreciated the global push, the representative from the country offered a note of caution.

“Too much confidence in the HPV vaccine can be harmful as the protection rate against cervical cancer is only 70%. Cervical cancer screening and avoiding unprotected multiple sex partners are still crucial,” the representative from Thailand said.

Image Credits: Unsplash, WHO, WHO.