A sharp drop in children’s vaccinations threatens millions of lives

Millions of children around the world, most of them in the poorest countries, have missed some or all of their childhood immunizations in the past two years due to a combination of conflicts, situations. Climate emergencies, misinformation campaigns, pandemic lockdowns and Covid vaccination efforts divert resources, according to a new analysis from Unicef, the United Nations agency that immunizes half of all children in the world and the World Health Organization.

This is the biggest setback in routine immunization in 30 years, the report said. Combined with rapidly increasing rates of malnutrition, conditions have become life-threatening for millions of young children.

Lily Caprani, Unicef’s head of advocacy, said: “This is an emergency for children’s health – we have to think about the immediate risks, the number of children dying from it. hey,” said Lily Caprani, head of advocacy for Unicef. “Not in a few years; it’s quite early. “

The proportion of children worldwide who have received three doses of the diphtheria, tetanus and pertussis vaccine, known as DTP3 – which Unicef ​​uses as the standard for vaccination coverage – has fallen by 5 points from 2019 to 2021, down to 81%. Measles vaccination rates have also dropped to 81% and polio coverage has also dropped significantly. A vaccine coverage rate of 94 percent is needed for herd immunity, to disrupt the chain of transmission.

This means 25 million children do not receive basic interventions to protect against deadly diseases.

The number of what Unicef ​​calls dose-free children – those who have not yet received the most basic dose of the vaccine – has increased sharply during the pandemic, to 18 million from 13 million in 2019. This group comprises half of the population. number of children who died before the age of 5.

Dr Niklas Danielsson, senior immunization specialist at Nairobi-based Unicef, said the agency was hopeful that after a sharp drop in 2020 due to shutdowns, school closures and other measures. other Covid response measures.

But instead, the problem got worse. The report shows that DTP3 and measles are at their lowest levels since 2008.

Dr. Danielsson said vaccination coverage in 2021 was about the same as in 2008. “But since then, birth groups have increased, which means the number of children who don’t complete immunizations or don’t even begin. , is the largest in the last 30 years,” he said.

He and many others in the field of child immunization predicted a rebound last year as health systems learn to adapt to the needs of the pandemic. Instead, disinformation campaigns about Covid vaccinations, and more broadly, governments’ mistrust of public health measures, have spilled over to stop routine vaccinations, he said. .

At the same time, health systems in the poorest countries are scrambling to implement limited Covid vaccinations, diverting vital access to freezers and vaccination health workers in hand.

The world has made sustained progress in childhood immunization coverage throughout the 1990s and first decade of this century. After that, rates start to stabilize, because the remaining children are the hardest to reach, such as those in active war zones or in nomadic communities. But before the pandemic, there was a double commitment, with support from organizations like the Bill and Melinda Gates Foundation and Gavi, the global vaccine alliance, to try to reach those children who don’t have the remaining dose. . Covid has taken away much of that attention and investment.

Over the past two years, India, Nigeria, Indonesia, Ethiopia and the Philippines recorded the highest number of children missing out on vaccines.

Brazil is also on the list of the 10 worst affected countries, a stark change for a country once known for its high vaccine coverage rates. About 26% of Brazilian babies will not be vaccinated by 2021, compared with 13% in 2018.

Dr. Carla Domingues, an epidemiologist and former coordinator of Brazil’s national vaccination program, said: “The work of 30 years was lost overnight.

She said: “Immunization has become a political topic in Brazil during the Covid pandemic. The federal government, led by President Jair Bolsonaro, downplayed the importance of the coronavirus even as Brazil has the highest death rate in the world and said he would not vaccinate the 11-year-old. mine.

Dr Domingues said: “For the first time ever, the federal government did not recommend the use of vaccines and that created an environment of complete doubt that has never existed in Brazil, where vaccination is completely out of the question. accept.

At the same time, anti-vaccination groups that weren’t bought much in Brazil moved to the country during the pandemic, she said, and started spreading misinformation in Portuguese on social media.

And all of this is happening, said Dr Domingues, at a time when Brazilians are the generation to get rid of deadly diseases for which they are being urged to vaccinate their children, leading them to question Ask about the need.

“Parents don’t know the impact of measles, or polio, so they start picking and choosing vaccines,” she said. The data showing higher acceptance of the pneumonia vaccine than the polio vaccine clearly shows that. “Parents are choosing not to polio. They said, ‘It’s been 30 years without polio, so do I need to do this?’ “

Still, they have a clear indication of the risk, she said: A handful of measles cases were detected earlier this year in São Paulo, six years after Brazil announced it had eliminated the disease. “Measles is now circulating – that gives us a concrete example of what can happen with diphtheria, meningitis and so many other diseases,” she said.

In the Philippines, 43% of babies were not vaccinated last year. There, the problem lies in part with Covid’s tough public health measures, including the lockdown. “If you’re not allowed to take your kids outside of certain hours of the day, if they can’t go to school, if the cost of living is increasing, then going to the doctor to get your child vaccinated will drop to priority. yours,” says Dr. Danielsson.

However, the situation in the Philippines is also complicated by mistrust of vaccinations that persisted after the widespread deployment of a dengue vaccine in 2016 which was later shown to have caused many cases. cases of more severe illness in some people who received the injection.

Unicef’s Caprani said it would take a huge amount of resources and commitment to get the vaccine back in place.

“It will not be enough just to get back to business as usual and restore routine, routine vaccinations,” she said. “We will need really concerted investment and catch-up campaigns, because more and more cohorts of millions of children with no autonomy are living in countries with low levels of high nutrition and other stresses.”

In Zimbabwe, for example, there is currently a measles outbreak, where one in 10 children hospitalized with the disease are dying. (Typical mortality rates are 1 in 100 in low-income countries and less than 1 in 1,000 in high-income countries.)

Dr Fabien Diomande, a polio elimination expert with the Global Health Task Force, who has worked for many years on anti-polio campaigns in West and Central Africa, said the islanding Reversing the decline in childhood immunization will require new agility, innovation and resources.

“It’s like we’re in a new world – those emergencies aren’t going away,” he said. “We will still have Covid. We will still have climate crises. We have to learn how to work in the context of many public health emergencies.”

Dr Domingues in Brazil says Covid vaccination efforts could offer some lessons on how to catch up. Brazil has achieved high vaccination rates by offering vaccination pop-ups and providing injections at night and on weekends.

Ms. Caprani said that while there was renewed interest in global health cooperation because of Covid, investing in new surveillance measures and other new features risks distracting from intervention. Simple intervention needed to tackle the childhood immunization crisis: deploying thousands of community health workers.

“We are not going to solve this with poster campaigns or social media posts,” she said. “You need the access of trusted, well trained, properly compensated public health workers who work day in and day out, building trust – the kind of trust that can That means you listen to them about vaccines. And there are simply not enough of them. “

Jason Gutierrez contribution report from Manila.

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