Childhood vaccination rates took a real hit during the pandemic. More than 25 million kids missed at least one vaccination in 2021 alone, and vaccination rates dropped in over 100 countries.
There’s been a push to get back on track. But a new report out this week from the World Health Organization and UNICEF shows progress has stalled – although there is a bit of good news too.
Here’s a look at the details.
Here's how we measure progress (or the lack thereof)
There is one vaccine – DTP or the diphtheria, tetanus and pertussis vaccine – that is used as the measure of how well a country does at routine childhood immunizations. In the U.S. 94% of kids get all three doses. Some countries get to 99%. The goal is to have 90% of kids vaccinated worldwide by 2030. But, the latest numbers show that, globally, the rate is stuck at 84%. There’s been no improvement from 2022 to 2023.
“What's more concerning, even than this, is that the number of zero dose children – those are children who don't receive even a single dose of vaccine through the routine immunization program – actually increased,” says Dr. Kate O’Brien, director of the World Health Organization’s Department of Immunization, Vaccines and Biologicals.
A little more than half of these “zero dose” kids live in countries that are considered fragile, including conflict zones.
“Children who are living in those settings also lack security, they lack nutrition, they lack health care, and are most likely, as a result of those things, to die from a vaccine preventable disease if they get it,” O’Brien explains.
Sudan, which is in the midst of a civil war, is a particularly stark example of a country where immunizations are in free fall. Between 2022 and 2023 the DTP coverage plummeted from about 75% to 57%. And the number of “zero dose” kids rose from almost 110,000 in 2022 to about 700,000 in 2023.
The drop in vaccine rates has dire consequences
Let’s look at measles. It’s often seen as a canary in the coalmine of diseases since it finds and exposes gaps in vaccine coverage.
There is an effective and cheap measles vaccine but the latest data show that vaccination rates have stalled year over year with only 83% of children getting their first dose of a measles vaccine – and even fewer getting the second dose. The vaccine coverage needed to prevent outbreaks is a lot higher: 95%.
The result: Over the last five years, 103 countries had measles outbreaks. And last year was particularly bad. There were more than 300,000 confirmed measles cases in 2023 – triple the number from the previous year.
Dr. Ephrem Lemango, associate director of immunization at UNICEF, points out that in 91 countries where measles vaccine coverage exceeds 90% there were no outbreaks. “This shows you the importance of achieving higher coverage,” he says.
Dr. Theopista Masenge, of Tanzania, knows about measles firsthand.
The 10th child in her family, she notes: “Unfortunately, I was born at home and my mother did not take me to the health facility.” She says “was not aware that I was not vaccinated.”
When she grew up and became a doctor, she caught measles from a patient. And then brought it home to her own infant daughter, who was too young to get the vaccine. They survived but the experience made Masenge into an advocate for boosting vaccination coverage and reaching remote communities.
She says community health workers should be a big part of the solution, traveling to places on bike or motorcycle that are unreachable by car. And she supports training for health professionals, emphasizing that they tell parents about the importance of vaccines even if the family visits a clinic for another reason.
Wait … there is some good news
Despite the discouraging news in the new report, there were a few bright spots. One example: Certain countries – like Brazil and Chad – saw gains in vaccine coverage rates.
Another example: The HPV vaccine – which helps prevent cervical cancer – is reaching more people. Coverage was 7% in 2019 and, now, it’s 27% of girls. Part of the reason for this is a big roll out effort in several large countries - like Bangladesh, Indonesia and Nigeria.
There was also a bright spot in one place it might not be expected: Ukraine.
The country has historically had relatively low vaccination rates, partly because of vaccine skepticism, but that’s changing.
Ukraine launched a vaccination campaign in February 2022, just two weeks before the war with Russia started. “And despite the war, they continued,” says Shahin Huseynov, who oversees all immunization in the European region for the World Health Organization. “The government has done everything to ensure uninterrupted supply of vaccines.”
And, this past year, vaccination rates increased across the board for all routine immunizations.
Part of the credit goes to the creative mindset: He says Ukraine has a fleet of special buses that drive around to get shots into arms.
Transcript
ARI SHAPIRO, HOST:
All right. Moving on, childhood vaccination rates took a hit during the pandemic. There has been a push to get back on track, but a new report from the World Health Organization and UNICEF out this week shows progress has stalled. Still, there is a bit of good news. NPR's Gabrielle Emanuel is here with the highs and the lows. Hey there.
GABRIELLE EMANUEL, BYLINE: Hi there.
SHAPIRO: Start with the big picture. How do we even know whether the world is doing a good job at vaccinating its children or not?
EMANUEL: Yes, so there is one vaccine that is used as a measure of how well a country does routine childhood immunizations. We call it DTP. That's diphtheria, tetanus and pertussis. Here in the U.S., 98% of kids get all three doses. The goal is 90% worldwide, but right now, we are stuck at 84% of kids globally. And what's especially worrisome is that the number of kids who get zero doses is going up.
SHAPIRO: Can you tell us anything more about those zero-dose kids and who they are?
EMANUEL: Yeah, so I asked Kate O'Brien, who oversees immunizations at WHO, and she says a little more than half of them live in countries that are considered fragile - for example, conflict zones.
KATE O'BRIEN: Children who are living in those settings also lack security. They lack nutrition. They lack health care and are most likely, as a result of those things, to die from a vaccine-preventable disease if they get it.
EMANUEL: So these are kids in places like Yemen, Sudan, Afghanistan.
SHAPIRO: And can you tell if these rates are already having an impact on outbreaks of diseases?
EMANUEL: Yes. So take measles - it's often seen as a canary in the coal mine. It exposes gaps in vaccine coverage. And last year, the world saw 300,000 confirmed measles cases. That's triple the number from the previous year. The reason is not enough kids getting those shots.
SHAPIRO: OK, so what's the solution? - how to improve vaccination rates globally.
EMANUEL: Well, I spoke with Theopista Masange. She is a doctor in Tanzania who's dedicated her career to doing just that, getting vaccination rates up. She has firsthand knowledge of measles. She told me about being born as the 10th child in her family.
THEOPISTA MASENGE: Unfortunately, I was born at home, and my mother did not take me to the health facility. And I was not aware that I was not vaccinated.
EMANUEL: So she grew up, became a doctor and got measles from a patient, and then she gave it to her own baby. They survived, and this was 20 years ago. But today, she has a couple strategies to keep measles at bay. She wants community health workers to deliver vaccines to remote places and medical facilities to tell parents about the importance of vaccines even if they visit for another reason.
SHAPIRO: Well, we mentioned at the top of this conversation that there are some bright spots in the report. What can you tell us?
EMANUEL: Yes, there is some good news. One example is the HPV vaccine, which helps prevent cervical cancer. Coverage was 7% in 2019. Now it's 27% of girls. This is because it's being rolled out in several large countries like Bangladesh, Indonesia and Nigeria.
SHAPIRO: Were there any big surprises in the report?
EMANUEL: There actually were. Ukraine was a big surprise. They've historically had relatively low vaccination rates, and that's changing. This past year, rates increased across the board for all routine immunizations. Shahin Huseynov of WHO in Europe told me Ukraine launched a vaccination campaign in February 2022.
SHAHIN HUSEYNOV: Just two weeks before the war started - and despite the war, the government has done everything to ensure uninterrupted supply of vaccines.
EMANUEL: They've even got special efforts like buses that drive around to get shots into arms.
SHAPIRO: That's Gabrielle Emanuel, who covers global health for NPR on the latest numbers surrounding vaccination of children around the world. Thanks.
EMANUEL: Thank you. Transcript provided by NPR, Copyright NPR.
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