Health and Healthcare Systems

World Immunization Week: 1 in 5 children still aren't vaccinated against life-threatening diseases

The COVID-19 pandemic has set back child vaccination rates around the world.

The COVID-19 pandemic has set back child vaccination rates around the world. Image: Unsplash/diana_pole

Shyam Bishen
Head, Centre for Health and Healthcare; Member of the Executive Committee, World Economic Forum
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This article is part of: Centre for Health and Healthcare

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  • 67 million children worldwide missed out on one or more routine vaccinations over the past three years, according to a new UNICEF report.
  • The share of fully vaccinated children globally has fallen five percentage points to 81%.
  • The UN agency says reasons for the decline include the COVID-19 pandemic, political instability, and conflict.
  • Confidence in vaccines for children has declined in 52 out of 55 countries where data was available.
  • The organization is calling for concerted action to increase vaccine uptake.

“The COVID-19 pandemic has been a disaster for childhood immunization.”

So says UNICEF’s State of the World’s Children 2023 report, which reveals that millions of children missed out on one or more routine vaccinations over the past three years. The world must act now, says the UN fund, to make sure children receive protection against potentially life-threatening diseases such as measles and polio.

More children at risk from preventable diseases

Between 2019 and 2021, 67 million children worldwide missed out partially or entirely on receiving routine vaccinations, with the share of fully vaccinated children globally falling five percentage points to 81%. That’s almost one in every five children in the world, according to the report.

UNICEF says the pandemic pushed back vaccination rates globally to 2008 levels, which has consequently left millions at risk of contracting some of the most dangerous childhood diseases.

The COVID-19 pandemic has significantly set back child vaccination rates globally.
The COVID-19 pandemic has significantly set back child vaccination rates globally. Image: UNICEF

Reasons for this include often scarce resources being diverted from routine care, the pressure it puts on health workers and their ability to operate effectively, and vaccine supply chains coming under strain.

Inequality also hinders child vaccination

Vulnerable children are most at risk, says UNICEF. Children from the poorest families and those with incomes in the bottom 10% of the population are less likely to be vaccinated than those from the wealthiest 10% of households. In the poorest households, 22.6% of children were “zero-dose”, compared to just 4.9% in the wealthiest ones.

Geography is also an issue, with rates varying around the world, the report notes. “Among the 10 countries with the highest gaps in vaccination coverage between rich and poor, seven were in sub-Saharan Africa.”

Income inequality within and between countries also affects child vaccination rates.
Income inequality within and between countries also affects child vaccination rates. Image: UNICEF

But these are not the only factors that have depressed child vaccination rates, as “instability, violence and disruption ... can wreak havoc on health systems and hinder children’s opportunities to be immunized. In 2018, some 40% of the world’s children who had not been immunized lived in fragile or conflict-affected settings,” says UNICEF.

And education levels, particularly among mothers, also affect immunization rates – the prevalence of zero-dose children goes down as education levels increase, it says.

Effective, equitable vaccine access is essential. Vaccines have to be readily available in all regions with good supply chains and manufacturing. To this end, working with the Coalition for Epidemic Preparedness & Innovations and the US National Academy of Medicine, the World Economic Forum has established a Regionalized Vaccine Manufacturing Collaborative in order to ensure regional vaccine supply and access.

Higher education levels among mothers lead to higher child vaccination rates.
Higher education levels among mothers lead to higher child vaccination rates. Image: UNICEF

Decline in vaccine confidence

One of the report’s major concerns is that take-up rates for childhood vaccines are dropping in many parts of world. Recent research suggests that in all but three of 55 countries for which data is available, confidence in vaccinating children has declined. But the authors also point out that “a lack of trust in vaccines is as old as the practice of immunization itself. And the reasons for it are multiple and mutable”.

Chart displaying the confidence in childhood vaccination.
Confidence in childhood vaccination has dropped in 52 of 55 countries. Image: UNICEF

Levels of vaccine confidence are influenced by a variety of factors, including misinformation, political polarization and trust in governments - and efforts must be made to counter this, says UNICEF.

“Maintaining and building confidence requires close contact with communities to understand what they are hearing about vaccines and their concerns, and engaging with them to build the kind of trust and confidence parents and caregivers need to vaccinate their children,” it says.

Trust in healthcare provision is addressed in the World Economic Forum’s latest Global Health and Healthcare Strategic Outlook. The authors write: “The COVID-19 pandemic has exacerbated public scepticism towards technology and innovation in healthcare.

“Following the large volumes of misinformation about the pandemic and vaccinations, there is a need to improve healthcare literacy and rebuild and reinforce trust in the healthcare industry.”


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The consequences of vaccine failure

If there is a failure to protect against main childhood diseases, many children will die and others will have to live with lifelong disabilities, warns UNICEF. The number of measles outbreaks in 2022, for example, was double those of the year before.

The report also points to the return of the polio virus in the United States, United Kingdom and Israel last year, which served as “a reminder that even remarkable progress against a disease like polio can be put at risk if we fail to vaccinate every child”.

Low vaccination rates may lead to a variety of consequences in future with the increasing likelihood of extreme weather events. “Climate change risks exposing new communities to infectious diseases such as malaria, dengue and cholera, and may alter seasonal disease patterns,” the report says.

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Making sure vaccines reach every child

It’s vital that countries do not fall behind in the recent immunization progress they have made, says UNICEF. In 1990, one in 11 children in the world died before reaching their fifth birthday. Less than 30 years later that figure had fallen to one in 27 children as a result of vaccination.

The organization is calling for greater political will to make child vaccination a priority in every country around the world. Its report makes four key recommendations:

  • Vaccinate every child through effective immunization programmes and catch-up campaigns.
  • Strengthen confidence in vaccination
  • Invest in immunization and healthcare
  • Build resilient health systems

“Achieving the change needed to vaccinate every child will not be easy. But the achievements of the past 80 years should give us hope,” says Catherine Russell, UNICEF’s Executive Director.

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