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India recorded largest drop in routine childhood immunization in 2020: report

With many resources and personnel diverted to support the covid-19 response, there have been significant disruptions to immunization service provision in many parts of the world. (REUTERS)Premium
With many resources and personnel diverted to support the covid-19 response, there have been significant disruptions to immunization service provision in many parts of the world. (REUTERS)

  • The WHO-UNICEF data showed that middle-income countries now account for an increasing share of unprotected children – that is, children missing out on at least some vaccine doses

India registered the largest drop in routine childhood immunization coverage in 2020 followed by Pakistan and Indonesia, revealed data published by the World Health Organization (WHO) and UNICEF on Thursday. The first official figures to reflect global service disruptions due to covid-19, the data showed a majority of countries last year experienced drops in childhood vaccination rates.

The data showed that middle-income countries now account for an increasing share of unprotected children – that is, children missing out on at least some vaccine doses. India is experiencing a particularly large drop, with DTP-3 coverage falling from 91% to 85%, WHO said.

Fuelled by funding shortfalls, vaccine misinformation, instability and other factors, a troubling picture is also emerging in WHO’s Region of the Americas, where vaccination coverage continues to fall. Just 82% of children are fully vaccinated with DTP, down from 91% in 2016.

The UN agencies said that 23 million children missed out on basic vaccines through routine immunization services in 2020 – 3.7 million more than in 2019. Most of these – up to 17 million children – likely did not receive a single vaccine during the year, widening already immense inequities in vaccine access. Most of these children live in communities affected by conflict, in under-served remote places, or in informal or slum settings where they face multiple deprivations including limited access to basic health and key social services, the WHO said.

“Even as countries clamour to get their hands on covid-19 vaccines, we have gone backwards on other vaccinations, leaving children at risk from devastating but preventable diseases like measles, polio or meningitis," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Multiple disease outbreaks would be catastrophic for communities and health systems already battling covid-19, making it more urgent than ever to invest in childhood vaccination and ensure every child is reached."

Disruptions in immunization services were widespread in 2020, with the WHO Southeast Asian and Eastern Mediterranean Regions most affected. As access to health services and immunization outreach were curtailed, the number of children not receiving even their very first vaccinations increased in all regions. As compared with 2019, 3.5 million more children missed their first dose of diphtheria, tetanus and pertussis vaccine (DTP-1) while 3 million more children missed their first measles dose.

“The pandemic has made a bad situation worse. With the equitable distribution of covid-19 vaccines at the forefront of everyone’s minds, we must remember that vaccine distribution has always been inequitable, but it does not have to be," said Henrietta Fore, UNICEF Executive Director.

Even prior to the covid-19 pandemic, global childhood vaccination rates against diphtheria, tetanus, pertussis, measles and polio had stalled for several years at around 86%. This rate is well below the 95% recommended by WHO to protect against measles –often the first disease to resurge when children are not reached with vaccines - and insufficient to stop other vaccine-preventable diseases.

With many resources and personnel diverted to support the covid-19 response, there have been significant disruptions to immunization service provision in many parts of the world. In some countries, clinics have been closed or hours reduced, while people may have been reluctant to seek healthcare because of fear of transmission or have experienced challenges reaching services due to lockdown measures and transportation disruptions.

Based on country-reported data, the official WHO and UNICEF estimates of national immunization coverage (WUENIC) provide the world’s largest data-set on immunization trends for vaccinations against 13 diseases given through regular health systems - normally at clinics or community centres or health worker visits. For 2020, data was provided from 160 countries.

Globally, the vaccination rate for three doses of diphtheria-tetanus and pertussis (DTP-3) vaccine fell from around 86% in 2019 to 83% in 2020, meaning 22.7 million children missed out, and for measles first dose, from 86 to 84%, meaning 22.3 million children missed out. Vaccination rates for measles second dose were at 71% (from 70% in 2019). To control measles, 95% uptake of two vaccine doses is required; countries that cannot reach that level rely on periodic nationwide vaccination campaigns to fill the gap.

In addition to routine immunization disruptions, there are currently 57 postponed mass vaccination campaigns in 66 countries, for measles, polio, yellow fever and other diseases, affecting millions more people. New modelling, also published today in The Lancet by researchers at the Washington-based Institute for Health Metrics and Evaluation (IHME), similarly shows that childhood vaccination declined globally in 2020 due to covid-19 disruptions. The IHME-led modelling is based on country-reported administrative data for DTP and measles vaccines, supplemented by reports on electronic medical records and human movement data captured through anonymized tracking of mobile phones.

Both analyses show that countries and the broader health community must ensure that new waves of covid-19 and the massive roll out of covid-19 vaccines don’t derail routine immunization and that catch-up activities continue to be enhanced.

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