• Additional 35.2m children at risk of measles infection

Global immunisation services reached four million more children in 2022 compared to the previous year, as countries stepped up efforts to address the historic slide in immunisation caused by COVID-19.

“But Africa, which is lagging behind in its recovery, faces extra challenge. With increasing child population, countries must scale up routine immunisation services every year to maintain coverage levels,” World Health Organisation (WHO) and United Nations Children’s Fund (UNICEF) have said.

WHO and UNICEF, in a joint statement, yesterday, noted that in 2022, some 20.5 million children missed one or more vaccines delivered through routine immunisation services, compared to 24.4 million children in 2021. Despite this improvement, the number remains higher than the 18.4 million children who missed out in 2019 before pandemic-related disruptions, underscoring the need for catch-up, recovery and system strengthening efforts.

The vaccine against Diphtheria, Tetanus and Pertussis (DTP) is used as the global marker for immunisation coverage. Of the 20.5 million children, who missed one or more doses of their DTP vaccines in 2022, 14.3 million did not receive a single dose (so-called zero-dose children). The figure represents an improvement from the 18.1 million zero-dose children in 2021, but remains higher than the 12.9 million children in 2019.

WHO Director-General, Dr. Tedros Ghebreyesus, said: “These data are encouraging, and a tribute to those who have worked so hard to restore life-saving immunisation services after two years of sustained decline in coverage. But global and regional averages do not tell the whole story and mask severe and persistent inequities. When countries and regions lag, children pay the price.”

The early stages of recovery in global immunisation have not occurred equally, with the improvement concentrated in a few countries. Progress in well-resourced countries with large infant populations, such as India and Indonesia, masks slower recovery or even continued declines in most low-income countries, especially for measles vaccination.

Of the 73 countries that recorded substantial declines in coverage during the pandemic, 15 recovered to pre-pandemic levels, 24 are on route to recovery, but 34 stagnated or continued decline. These concerning trends echo patterns seen in other health metrics. Countries must ensure they are accelerating catch-up, recovery, and strengthening efforts, to reach every child with the vaccines they need and – because routine immunisation is a fundamental pillar of primary healthcare – take the opportunity to make progress in other related health sectors.

Vaccination against measles – one of the most infectious pathogens – has not recovered as well as other vaccines, putting an additional 35.2 million children at risk of measles infection. First dose measles coverage increased to 83 per cent in 2022 from 81 per cent in 2021, but remained lower than the 86 per cent achieved in 2019.

As a result, last year, 21.9 million children missed the routine measles vaccination in their first year of life – 2.7 million more than in 2019 – while an additional 13.3 million did not receive their second dose, placing children in under-vaccinated communities at risk of outbreaks.

countries mend the gaps in routine immunisation coverage, children everywhere will remain at risk of contracting and dying from diseases we can prevent. Viruses like measles do not recognise borders. Efforts must urgently be strengthened to catch up children, who missed their vaccination, while restoring and further improving immunisation services from pre-pandemic levels.”

Countries with steady, sustained coverage in the years before the pandemic have been better able to stabilise immunisation services since, the data indicates. For example, South Asia, which reported gradual, ongoing increases in coverage in the decade prior to the pandemic, has demonstrated a more rapid and robust recovery than regions that suffered longstanding declines, such as Latin America and the Caribbean.

DTP3 vaccine coverage in the 57 lower-income countries supported by Gavi, the Vaccine Alliance, increased to 81 per cent in 2022 – a considerable increase from 78 per cent in 2021 – with the number of zero-dose children who receive no basic vaccines also dropping by two million in these countries.

However, the increase in DTP3 coverage in Gavi-implementing countries was concentrated in lower-middle income countries, with low-income countries not yet increasing coverage – indicating the work remaining to help the most vulnerable health systems rebuild.

Chief Executive Officer (CEO) of Gavi, Dr. Seth Berkley, said: “It is incredibly reassuring, after the massive disruption wrought by the pandemic, to see routine immunisation making such a strong recovery in Gavi-supported countries, especially in terms of reducing the number of zero-dose children.

“However, it is also clear from this important study that we need to find ways of helping every country protect its people, otherwise we run the risk of two tracks emerging, with larger, lower middle income countries outpacing the rest.”

For the first time, HPV vaccination coverage surpassed pre-pandemic levels. HPV vaccination programmes that began pre-pandemic reached the same number of girls in 2022 than 2019.

However, coverage in 2019 was well below the 90 per cent target, and this has remained true in 2022, with mean coverage in HPV programmes reaching 67 per cent in high income countries and 55 per cent in low- and middle-income countries. The newly launched HPV revitalisation, led by Gavi, aims to strengthen existing programme delivery and facilitate more introductions.

Many stakeholders are working to expedite recovery in all regions and across all vaccine platforms. Earlier in 2023, WHO and UNICEF, along with Gavi, The Bill & Melinda Gates Foundation and other IA2030 partners launched ‘The Big Catch-Up’, a global communications and advocacy push, calling on governments to catch up the children, who missed vaccinations during the pandemic, restore immunisation services to pre-pandemic levels, and strengthen these going forward by: doubling-down on their commitment to increase financing for immunisation and to work with stakeholders to unlock available resources, including COVID-19 funds, to urgently restore disrupted and overstretched services and implement catch-up efforts; developing new policies that enable immunisers to reach children, who were born just before or during the pandemic and who are moving past the age when they would be vaccinated by routine immunisation services; strengthening immunisation and primary health care services – including community health systems – and addressing systemic immunisation challenges to correct longer-term stagnation in vaccination and reach the most marginalised children; and building and sustaining vaccine confidence and acceptance through engagement with communities and health providers.