According to new data by WHO and UNICEF, these disruptions threaten to reverse hard-won progress to reach more children and adolescents with a wider range of vaccines, which has already been hampered by a decade of stalling coverage.

The latest data on vaccine coverage estimates from WHO and UNICEF for 2019 shows that improvements such as the expansion of the HPV vaccine to 106 countries and greater protection for children against more diseases are in danger of lapsing. 

For example, preliminary data for the first four months of 2020 points to a substantial drop in the number of children completing three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3), according to UNICEF. 

This is the first time in 28 years that the world could see a reduction in DTP3 coverage – the marker for immunisation  coverage within and across countries.

“Vaccines are one of the most powerful tools in the history of public health, and more children are now being immunised than ever before,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. 

“But the pandemic has put those gains at risk. The avoidable suffering and death caused by children missing out on routine immunizations could be far greater than COVID-19 itself. But it doesn’t have to be that way. Vaccines can be delivered safely even during the pandemic, and we are calling on countries to ensure these essential life-saving programmes continue.”

COVID-19 disruptions

Due to the COVID-19 pandemic, at least 30 measles vaccination campaigns were or are at risk of being cancelled, which could result in further outbreaks in 2020 and beyond. 

According to a new UNICEF, WHO and Gavi pulse survey,  conducted in collaboration with the US Centers for Disease Control, the Sabin Vaccine Institute and Johns Hopkins Bloomberg School of Public Health, three quarters of the 82 countries that responded reported COVID-19 related disruptions in their immunisation programmes as of May 2020.

The reasons for disrupted services vary. Even when services are offered, people are either unable to access them because of reluctance to leave home, transport interruptions, economic hardships, restrictions on movement, or fear of being exposed to people with COVID-19. 

Many health workers are also unavailable because of restrictions on travel or redeployment to COVID response duties as well as a lack of protective equipment.

“COVID-19 has made previously routine vaccination a daunting challenge,” said UNICEF Executive Director Henrietta Fore. 

“We must prevent a further deterioration in vaccine coverage and urgently resume vaccination programs before children’s lives are threatened by other diseases. We cannot trade one health crisis for another.” 

Stagnating global coverage rate

Progress on immunisation coverage was stalling before COVID-19 hit, at 85 percent for DTP3 and measles vaccines. 

The likelihood that a child born today will be fully vaccinated with all the globally recommended vaccines by the time she reaches the age of 5 is less than 20 percent.

In 2019, nearly 14 million children missed out on life-saving vaccines such as measles and DTP3. Most of these children live in Africa and are likely to lack access to other health services. 

Two-thirds of them are concentrated in 10 middle- and low-income countries: Angola, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan, and Philippines. Children in middle-income countries account for an increasing share of the burden.

Progress and challenges, by country and region

There has been some progress. Regional coverage for the third dose of DTP in South Asia has increased by 12 percentage points over the last 10 years, notably across India, Nepal and Pakistan. 

However, that hard-won progress could be undone by COVID-19 related disruptions. Countries that had recorded significant progress, such as Ethiopia and Pakistan, are now also at risk of backsliding if immunisation services are not restored as soon as feasible.

The situation is especially concerning for Latin America and the Caribbean, where historically high coverage has slipped over the last decade. 

In Brazil, Bolivia, Haiti and Venezuela, immunisation  coverage plummeted by at least 14 percentage points since 2010. These countries are now also confronting moderate to severe COVID-19-related disruptions.  

As the global health community attempts to recover lost ground due to COVID-19 related disruptions, UNICEF and WHO are supporting countries in their efforts to reimagine immunisation and build back better by:

Restoring services so countries can safely deliver routine immunisation services during the COVID-19 pandemic, by adhering to hygiene and physical distancing recommendations and providing protective equipment to health workers;

Helping health workers communicate actively with caregivers to explain how services have been reconfigured to ensure safety;

Rectifying coverage and immunity gaps and  expanding routine services to reach missed communities, where some of the most vulnerable children live.