WHO and UNICEF call for immediate efforts to vaccinate all children as new data shows that, before the COVID-19 pandemic, vaccine coverage stalled at 85 per cent for nearly a decade, with 14 million unvaccinated infants yearly

Geneva/New York, 15 July 2020 – The World Health Organization and UNICEF warned today of an alarming decline in the number of children receiving life-saving vaccines around the world. This is due to disruptions in the delivery and uptake of immunization services caused by the COVID-19 pandemic. According to new data by WHO and UNICEF, these disruptions threaten to reverse hard-won progress to reach more children and adolescents with a wider range of vaccines, which has already been hampered by a decade of stalling coverage.

The latest data on vaccine coverage estimates from WHO and UNICEF for 2019 shows that improvements such as the expansion of the HPV vaccine to 106 countries and greater protection for children against more diseases are in danger of lapsing. For example, preliminary data for the first four months of 2020 points to a substantial drop in the number of children completing three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3). This is the first time in 28 years that the world could see a reduction in DTP3 coverage – the marker for immunization coverage within and across countries.

“Vaccines are one of the most powerful tools in the history of public health, and more children are now being immunized than ever before,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But the pandemic has put those gains at risk. The avoidable suffering and death caused by children missing out on routine immunizations could be far greater than COVID-19 itself. But it doesn’t have to be that way. Vaccines can be delivered safely even during the pandemic, and we are calling on countries to ensure these essential life-saving programmes continue.”

COVID-19 disruptions

Due to the COVID-19 pandemic, at least 30 measles vaccination campaigns were or are at risk of being cancelled, which could result in further outbreaks in 2020 and beyond. According to a new UNICEF, WHO and Gavi pulse survey,  conducted in collaboration with the US Centers for Disease Control, the Sabin Vaccine Institute and Johns Hopkins Bloomberg School of Public Health, three quarters of the 82 countries that responded reported COVID-19 related disruptions in their immunization programmes as of May 2020.

The reasons for disrupted services vary. Even when services are offered, people are either unable to access them because of reluctance to leave home, transport interruptions, economic hardships, restrictions on movement, or fear of being exposed to people with COVID-19. Many health workers are also unavailable because of restrictions on travel or redeployment to COVID response duties as well as a lack of protective equipment.

“COVID-19 has made previously routine vaccination a daunting challenge,” said UNICEF Executive Director Henrietta Fore. “We must prevent a further deterioration in vaccine coverage and urgently resume vaccination programs before children’s lives are threatened by other diseases. We cannot trade one health crisis for another.” 

Stagnating global coverage rate

Progress on immunization coverage was stalling before COVID-19 hit, at 85 per cent for DTP3 and measles vaccines. The likelihood that a child born today will be fully vaccinated with all the globally recommended vaccines by the time she reaches the age of 5 is less than 20 per cent.

In 2019, nearly 14 million children missed out on life-saving vaccines such as measles and DTP3. Most of these children live in Africa and are likely to lack access to other health services. Two-thirds of them are concentrated in 10 middle- and low-income countries: Angola, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan, and Philippines. Children in middle-income countries account for an increasing share of the burden.

Progress and challenges, by country and region

There has been some progress. Regional coverage for the third dose of DTP in South Asia has increased by 12 percentage points over the last 10 years, notably across India, Nepal and Pakistan. However, that hard-won progress could be undone by COVID-19 related disruptions. Countries that had recorded significant progress, such as Ethiopia and Pakistan, are now also at risk of backsliding if imunization services are not restored as soon as feasible.

The situation is especially concerning for Latin America and the Caribbean, where historically high coverage has slipped over the last decade. In Brazil, Bolivia, Haiti and Venezuela, immunization coverage plummeted by at least 14 percentage points since 2010. These countries are now also confronting moderate to severe COVID19-related disruptions.  

As the global health community attempts to recover lost ground due to COVID-19 related disruptions, UNICEF and WHO are supporting countries in their efforts to reimagine immunization and build back better by:

• Restoring services so countries can safely deliver routine immunization services during the COVID-19 pandemic, by adhering to hygiene and physical distancing recommendations and providing protective equipment to health workers;
• Helping health workers communicate actively with caregivers to explain how services have been reconfigured to ensure safety;
• Rectifying coverage and immunity gaps;
• Expanding routine services to reach missed communities, where some of the most vulnerable children live.

About the data

2019 IMMUNIZATION COVERAGE ESTIMATES

Every year, UNICEF and the World Health Organization (WHO) produce a new round of immunization coverage estimates for 195 countries, enabling a critical assessment of how well we are doing in reaching every child with life-saving vaccines.  In addition to producing the immunization coverage estimates for 2019, the WHO and UNICEF estimation process revises the entire historical series of immunization data with the latest available information. The 2019 revision covers 39 years of coverage estimates, from 1980 to 2019. DTP3 coverage is used as an indicator to assess the proportion of children vaccinated and is calculated for children under one year of age. The estimated number of vaccinated children are calculated using population data provided by the 2019 World Population Prospects (WPP) from the UN.Fact sheet.

IMMUNIZATION PULSE SURVEY, JUNE 2020

The new UNICEF, WHO and Gavi pulse survey was conducted in collaboration with US Centers for Disease Control, the Sabin Vaccine Institute and Johns Hopkins Bloomberg School of Public Health, in June 2020. Respondents from 82 countries, including 14 with lower than 80 per cent vaccination coverage rates in 2019, reported on disruptions in immunization services due to COVID-19 as of May 2020.  The online immunization pulse survey received responses from 260 immunization experts, including representatives of Ministries of Health, academia and global health organizations across 82 countries. A previous pulse poll, conducted in April received 801 responses from 107 countries, showed that disruption to the routine immunization programs were already widespread and affected all regions. 64 per cent of countries represented in that poll indicated that routine immunizations had been disrupted or even suspended.

The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing. For updates on COVID-19 and public health advice to protect yourself from coronavirus, visit www.who.int and follow WHO on Twitter, Facebook, Instagram, LinkedIn, TikTok, Pinterest, Snapchat, YouTube.

More on vaccines and immunization

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How WHO is supporting ongoing vaccination efforts during the COVID-19 pandemic

The vaccines success story gives us hope for the future

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. For more information about UNICEF and its work for children, visit www.unicef.org. For more information about COVID-19, visit www.unicef.org/coronavirus. Information on UNICEF’s Immunization programme, available here. Follow UNICEF on Twitter and Facebook.