In its State of the World’s Children 2023 report, UNICEF says that vaccination coverage levels decreased in 112 countries during the pandemic, “the largest sustained backslide in childhood immunization in 30 years”. According to the agency, a rise in misleading information on vaccines is one of the factors at play.

UNICEF’s Executive Director Catherine Russell said that while at the height of the pandemic, scientists rapidly developed life-saving vaccines, “despite this historic achievement, fear and disinformation about all types of vaccines circulated as widely as the virus itself”.

Warning signal

UNICEF says the pandemic interrupted childhood vaccination “almost everywhere”, due to stretched health systems and stay-at-home measures. But new data also shows a trend of declining confidence in childhood vaccines of up to 44 percentage points in a number of countries.

“This data is a worrying warning signal,” Ms. Russell insisted. “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.”

Vaccine hesitancy on the rise

In its report, UNICEF warns that the public perception of the importance of vaccines for children declined during the COVID-19 pandemic in 52 out of 55 countries studied.

China, India and Mexico were the only countries examined where the perception of the importance of vaccines remained stable or even improved. In most countries, people under 35 and women were more likely to report less confidence about vaccines for children after the start of the pandemic.

A longer-term trend?

The report says that “vaccine confidence is volatile and time-specific”, and that more sustained data gathering and analysis, will be necessary to determine if declining vaccine confidence is indeed here to stay.

UNICEF also emphasizes that overall support for vaccines remains strong, and that in almost half of the 55 countries studied, a vast majority of respondents – over 80 per cent – continue to perceive vaccines as “important” for children.

Misinformation at fault

However, the report warns that “the confluence of several factors suggests the threat of vaccine hesitancy may be growing”.

Among these factors, the report’s authors cite growing access to misleading information, declining trust in expertise, and political polarization.

‘Child survival crisis’

UNICEF says that children born just before or during the pandemic are now moving past the age when they would normally be vaccinated. This lag puts children at the risk of deadly outbreaks of vaccine-preventable diseases, in what UNICEF calls a “child survival crisis”.

The report recalls that in 2022, measles cases worldwide doubled compared to 2021, and the number of children paralyzed by polio was up 16 per cent year-on-year. In the three-year period between 2019 and 2021, polio paralyzed eight times more children than during the previous three years.  

Deepening inequalities

The UN Children’s Fund stresses that the pandemic exacerbated existing inequalities related to vaccination. The report says that “for far too many children, especially in the most marginalized communities, vaccination is still not available, accessible or affordable”.

Almost half of the 67 million children who missed out on routine vaccination between 2019 and 2021 live on the African continent. As of the end of 2021, India and Nigeria, which are described in the report as “countries with very large birth cohorts”, had the highest numbers of children who hadn’t received a single routine vaccination.

Overall, in low and middle-income countries, one in 10 children in urban areas and one in six in rural areas had not received a single routine vaccination.

Poverty, lack of empowerment

UNICEF says the children who are missing out live in the “poorest and most remote” communities, located in rural areas or urban slums, and at times impacted by conflict.

The report underscores the role of women’s empowerment in a family’s decision to vaccinate their children, pointing out that the children deprived of routine vaccinations “often have mothers who have not been able to go to school and who are given little say in family decisions”.

Underpaid health workers

UNICEF says its findings highlight the need to ensure vaccination efforts are sustained, by strengthening primary healthcare and investing in the health workers at the front line of immunization.

These workers tend to be predominantly women, and according to the report, they face significant challenges including low pay, informal employment, lack of formal training and career opportunities, as well as threats to their security.

Call to action for governments

UNICEF is calling on countries to urgently unlock resources so that they can accelerate catch-up vaccination efforts, rebuild lost confidence in vaccines, and strengthen the resilience of health systems by supporting female health workers and local vaccine manufacturing.

“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”, UNICEF’s Catherine Russell said.