Infant vaccination coverage has plummeted worldwide since the pandemic

The State of the World’s Children 2023: For Every Child, Vaccination report shows that the perception of the importance of vaccination for children has dropped by more than a third in countries such as the Republic of Korea, Papua New Guinea, Ghana, Senegal and Japan since the start of the pandemic. In the new data, collected by The Vaccine Confidence Project and published today by UNICEF, China, India and Mexico were the only countries studied where the perception of the importance of vaccines remained unchanged or even improved. In most countries, people under 35 and women reported less confidence in vaccines for children after the start of the pandemic.*

Vaccine confidence is volatile and time-specific. Additional data collection and further analysis are needed to determine whether the results indicate a long-term trend. Despite the decline, overall support for vaccines remains relatively high. In almost half of the 55 countries surveyed, more than 80 per cent of respondents considered vaccines to be important for children. 

However, the report warns about the confluence of multiple factors that suggest the threat of vaccine hesitancy may be growing. These factors include: 

-    uncertainty about the response to the pandemic, 
-    increasing access to misleading information, 
-    diminishing confidence in expertise, and 
-    political polarization.

“At the height of the pandemic, scientists rapidly developed vaccines that saved countless lives. But despite this historic achievement, fear and disinformation about all types of vaccines circulated as widely as the virus itself,” said Catherine Russell, UNICEF Executive Director. “This data is a worrying warning signal. We cannot allow confidence in routine immunizations to become another victim of the pandemic. Otherwise, the next wave of deaths could be of more children with measles, diphtheria or other preventable diseases.”

Confidence in vaccine protection further diminished by the pandemic
Alarmingly, the decline in confidence in childhood immunization over the past 30 years has been further fueled by the COVID-19 pandemic. The pandemic disrupted childhood vaccination coverage almost everywhere, mainly due to heavy demands on health systems, the diversion of vaccination resources to COVID-19 vaccination, shortages of health workers and the measures taken to avoid home visits. 

The report, which was published today, warns that 67 million children missed out on some or all of their routine vaccinations between 2019 and 2021, with coverage rates falling in 112 countries. Children born just before or during the pandemic are now moving past the age when they would normally be vaccinated, highlighting the need for urgent action to catch up on their missed vaccinations and prevent deadly outbreaks of disease. 

In 2022, for example, the number of measles cases was more than double that of the previous year. The number of children paralyzed by polio increased by 16 per cent year on year in 2022. Comparing 2019 to 2021 with the previous three-year period, there was an eight-fold increase in the number of children paralyzed by polio, highlighting the need to continue immunization efforts.

The pandemic also exacerbated existing inequalities. For far too many children, especially in the most marginalized communities, immunization remains unavailable, inaccessible or unaffordable. Even before the pandemic, progress on immunization had stalled for nearly a decade as the world struggled to reach its most disadvantaged children.

Lowest immunization coverage in India and Nigeria
Of the 67 million children who missed out on routine vaccination between 2019 and 2021, 48 million did not receive a single routine vaccine, also known as “zero-dose”. As of the end of 2021, India and Nigeria (both countries with very large birth cohorts) had the largest numbers of zero-dose children, while Myanmar and the Philippines also saw especially large increases in the numbers of children who had not received any vaccines.

The children who are missing out live in the poorest, most remote and marginalized communities, some of which are affected by conflict. New data compiled for the report by the International Center for Equity in Health shows that in the poorest households, one in five children are unvaccinated, compared with just one in 20 in the wealthiest households. According to the report, unvaccinated children often live in hard-to-reach communities such as rural areas or urban slums. They often have mothers who have not had the chance to go to school and have little say in family decisions. These challenges are greatest in low and middle-income countries, where about one in ten children in urban areas are zero-dose and one in six in rural areas. In upper-middle-income countries, there is almost no difference between urban and rural children.

For all children to be immunized, primary health care needs to be strengthened and the mostly female staff need to be provided with the necessary resources and support. The report notes that women are at the forefront of vaccine delivery, but they face low pay, informal employment, a lack of formal training and career opportunities, and threats to their safety.

To address the child survival crisis, UNICEF is calling on governments to double their pledge to increase funding for immunization and to work with stakeholders to release available resources, including remaining COVID-19 funds, to urgently implement and accelerate catch-up immunization efforts to protect children and prevent disease outbreaks. 

UNICEF’s demands
The report calls on governments to:

• Urgently identify and reach all children, especially those who were not vaccinated during the COVID-19 pandemic;
• Strengthen demand for vaccines, especially by building confidence;
• Prioritize funding for immunization services and primary health care;
• Build resilient health systems by investing in female health workers, innovation and local production.

“Immunizations have saved millions of lives and protected communities from deadly disease outbreaks,” said Catherine Russell. “We know all too well that diseases do not respect borders. Routine immunizations and strong health systems are our best shot at preventing future pandemics, unnecessary deaths and suffering. With resources still available from the COVID-19 vaccination drive, now is the time to redirect those funds to strengthen immunization services and invest in sustainable systems for every child.”

Notes to editors:

The State of the World’s Children (SOWC) is UNICEF’s flagship report. The 2023 edition is the first edition of the report dedicated exclusively to routine immunization. UNICEF reaches almost half of the world’s children every year with lifesaving vaccines. 

From 2:00 am on 20 April, you can discover a special interactive feature on our website and download the report here.

Multimedia content, including new photos, B-rolls and case studies, is available here.

*The Vaccine Confidence Project (VCP) at the London School of Hygiene & Tropical Medicine has been monitoring vaccine confidence since 2015 by analyzing data from nationally representative country surveys. The data presented in this report comes from a large-scale retrospective study of changes in vaccine confidence between 2015 and November 2019, and since 2021. The data in this report represents a subset of a fuller data set gathered by the VCP. You can explore the full data set using this interactive map tool.