In his State of the World’s Children Report 2023, UNICEF indicates that vaccination coverage levels decreased in 112 countries during the pandemic, “the largest sustained setback in childhood immunization in 30 years”. According to the agency, a the increase in misleading information about vaccines is one of the factors gambling.
UNICEF Executive Director Catherine Russell said that at the height of the pandemic, scientists quickly developed life-saving vaccines, “despite this historic achievement, fear and misinformation about all types of vaccines have circulated as widely as the virus itself”.
UNICEF says the pandemic has halted childhood vaccinations “almost everywhere”, due to overstretched health systems and lockdowns. But new data also show a downward trend in confidence in childhood vaccines up to 44 percentage points in a number of countries.
“This data is a worrying red flagMs. Russell insisted. “We cannot allow confidence in routine vaccinations to become another casualty of the pandemic. Otherwise, the next wave of deaths could be more children with measles, diphtheria or other preventable diseases..”
Vaccination hesitancy on the rise
In its report, UNICEF warns that public perception of the importance of vaccines for children has diminished over the COVID-19 pandemic in 52 of the 55 countries studied.
China, India and Mexico were the only countries examined where the perception of the importance of vaccines remained stable or even improved. In most countries, people under 35 and women were more likely to report lower confidence in childhood vaccines after the pandemic began.
A longer term trend?
The report says that “confidence in vaccines is volatile and time-bound”, and that more sustained data collection and analysis will be needed to determine whether the decline in confidence in vaccines is indeed here to stay.
UNICEF also points out that overall support for vaccines remains strongand that in almost half of the 55 countries studied, a large majority of respondents – more than 80% – continue to perceive vaccines as “important” for children.
Misinformation at fault
However, the report warns that “the confluence of several factors suggests the threat of vaccine hesitancy may be growing”.
Among these factors, the report’s authors cite growing access to misleading information, declining trust in expertise, and political polarization.
“Child Survival Crisis”
UNICEF says children born just before or during the pandemic are now past the age at which they would normally be vaccinated. This mismatch puts children at risk of deadly outbreaks of vaccine-preventable diseases, in what UNICEF calls a “child survival crisis”.
The report recalls that in 2022, measles cases in the world doubled compared to 2021, and that the the number of children paralyzed by poliomyelitis has increased by 16% year on year. In the three-year period between 2019 and 2021, polio paralyzed eight times more children than in the previous three years.
The United Nations Children’s Fund points out that the pandemic has exacerbated existing inequalities related to vaccination. The report states that “for far too many children, especially in the most marginalized communities, vaccination is still not available, accessible or affordable”.
Almost half of the 67 million children who did not receive routine vaccinations between 2019 and 2021 live on the African continent. At the end of 2021, India and Nigeria, which are described in the report as “countries with very large birth cohorts”, had the highest number of children who had not received a single vaccination from routine.
Overall, in low- and middle-income countries, one in 10 children in urban areas and one in six in rural areas had not received a single routine vaccination.
Poverty, lack of autonomy
UNICEF says the missing children live in the “poorest and most remote” communities, located in rural areas or urban slums, and sometimes affected by conflict.
The report emphasizes the role of women’s empowerment in a family’s decision to have their children vaccinated, recalling that children deprived of routine vaccinations “often have mothers who have not been able to go to school and who have little say in family decisions “.
Underpaid health workers
UNICEF says its findings underscore the need to ensure continued immunization efforts, by strengthening primary health care and investing in health workers on the front line of immunization.
These workers are mostly women and, according to the report, they face significant challenges including low wages, informal employment, lack of formal training and career opportunities, and threats to their security.
Call to action for governments
UNICEF is calling on countries to urgently release resources so they can accelerate catch-up immunization efforts, restore lost confidence in vaccines and build resilience in health systems by supporting female health workers and local manufacture of vaccines.
“Routine vaccinations and strong health systems are our best asset to prevent future pandemics, unnecessary death and suffering. With the resources still available from the COVID-19 vaccination campaign, now is the time to redirect these funds to strengthen immunization services and investing in sustainable systems for every child,” said UNICEF’s Catherine Russell.