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15 July 2021

Sydney, 15 July 2021 – 23 million children missed out on basic vaccines through routine immunisation last year – the highest number in more than a decade, according to official data published today by WHO and UNICEF.

Up to 17 million are ‘zero dose children’, who did not receive a single vaccine during the year - 3.7 million more than in 2019 - widening already immense inequities in vaccine access.

The consequence of so many millions of children missing out puts them at risk from devastating, but preventable diseases such as measles, polio or meningitis with South East Asia one of the most affected regions.

The majority of children impacted 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.

Senior Vaccine Adviser to UNICEF Australia, Chris Maher, said: “COVID has placed low and middle income countries in a position where they are forced to choose between allocating health resources to COVID responses and COVID vaccinations, or enabling access to routine health services including regular childhood immunisations. They are simply not able to achieve both due to lack of facilities and lack of staff resources.

“This leaves children at risk of preventable diseases such as measles, polio or meningitis, which we have been battling for many decades to eradicate. The consequences of this could be catastrophic in countries where health systems are already near collapse.”

India, Pakistan, Indonesia and the Philippines are in the top ten worst affected countries, according to the first official figures to reflect global service disruptions due to COVID-19.

As access to health services and immunisation 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.

Disruptions in immunisation services were widespread in 2020, with the WHO Eastern Mediterranean Regions also most affected. South Asia reported a significant increase in the number of children who did not receive a single vaccine – an increase of 2.1 million children in 2020 compared with 2019, followed by East Asia and the Pacific region (477,000), and Eastern and Southern Africa region, (422,000).

Even prior to the COVID-19 pandemic, global childhood vaccination rates against diphtheria, tetanus, pertussis, measles and polio had stalled for several years at about 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.

UNICEF Executive Director, Henrietta Fore, said: “This evidence should be a clear warning – the COVID-19 pandemic and related disruptions cost us valuable ground we cannot afford to lose – and the consequences will be paid in the lives and wellbeing of the most vulnerable.

“Even before the pandemic, there were worrying signs that we were beginning to lose ground in the fight to immunise children against preventable child illness, including with the widespread measles outbreaks two years ago. 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.” 

The data shows 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%.

Concerns are not just for outbreak-prone diseases. Already at low rates, vaccinations against human papillomavirus (HPV) - which protect girls against cervical cancer later in life - have been highly affected by school closures. As a result, across countries that have introduced HPV vaccine to date, approximately 1.6 million more girls missed out in 2020. Globally only 13% girls were vaccinated against HPV, falling from 15% in 2019.

Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, said: “This is a wake-up call – we cannot allow a legacy of COVID-19 to be the resurgence of measles, polio and other killers. We all need to work together to help countries both defeat COVID-19, by ensuring global, equitable access to vaccines, and get routine immunization programmes back on track. The future health and wellbeing of millions of children and their communities across the globe depends on it.”

Agencies call for urgent recovery and investment in routine immunisation

As countries work to recover lost ground due to COVID-19 related disruptions, UNICEF, WHO and partners like Gavi, the Vaccine Alliance are supporting efforts to strengthen immunization systems by:

  • Restoring services and vaccination campaigns so countries can safely deliver routine immunization programmes during the COVID-19 pandemic;
  • Helping health workers and community leaders communicate actively with caregivers to explain the importance of vaccinations;
  • Rectifying gaps in immunization coverage, including identifying communities and people who have been missed during the pandemic.
  • Ensuring that COVID-19 vaccine delivery is independently planned for and financed and that it occurs alongside, and not at the cost of childhood vaccination services.
  • Implementing country plans to prevent and respond to outbreaks of vaccine-preventable diseases, and strengthen immunization systems as part of COVID-19 recovery efforts

The agencies are working with countries and partners to deliver the ambitious targets of the global Immunization Agenda 2030, which aims to achieve 90% coverage for essential childhood vaccines; halve the number of entirely unvaccinated, or ‘zero dose’ children, and increase the uptake of newer lifesaving vaccines such as rotavirus or pneumococcus in low and middle-income countries.