The largest sustained decline in childhood vaccinations in approximately 30 years has been recorded in official data published by WHO and UNICEF on Friday. The percentage of children who received three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3) – a marker for immunization coverage within and across countries – fell 5 percentage points between 2019 and 2021 to 81 per cent.   As a result, 25 million children missed out on one or more doses of DTP through routine immunization services in 2021 alone. This is 2 million more than those who missed out in 2020 and 6 million more than in 2019, highlighting the growing number of children at risk from devastating but preventable diseases. The decline was due to many factors including an increased number of children living in conflict and fragile settings where immunization access is often challenging, increased misinformation and COVID-19 related issues such as service and supply chain disruptions, resource diversion to response efforts, and containment measures that limited immunization service access and availability. “This is a red alert for child health. We are witnessing the largest sustained drop in childhood immunization in a generation. The consequences will be measured in lives,” said Catherine Russell, UNICEF Executive Director. “While a pandemic hangover was expected last year as a result of COVID-19 disruptions and lockdowns, what we are seeing now is a continued decline. COVID-19 is not an excuse. We need immunization catch-ups for the missing millions or we will inevitably witness more outbreaks, more sick children and greater pressure on already strained health systems.” Up to18 million of the 25 million children did not receive a single dose of DTP during the year, the vast majority of whom live in low- and middle-income countries, with India, Nigeria, Indonesia, Ethiopia and the Philippines recording the highest numbers. Among countries with the largest relative increases in the number of children who did not receive a single vaccine between 2019 and 2021 are Myanmar and Mozambique. Read: 25 million kids missed routine vaccinations because of COVID Globally, over a quarter of the coverage of HPV vaccines that was achieved in 2019 has been lost. This has grave consequences for the health of women and girls, as global coverage of the first dose of human papillomavirus (HPV) vaccine is only 15%, despite the first vaccines being licensed over 15 years ago. It was hoped that 2021 would be a year of recovery during which strained immunization programmes would rebuild and the cohort of children missed in 2020 would be caught-up. Instead, DTP3 coverage was set back to its lowest level since 2008 which, along with declines in coverage for other basic vaccines, pushed the world off-track to meet global goals, including the immunization indicator for the Sustainable Development Goals.   This historic backsliding in rates of immunization is happening against a backdrop of rapidly rising rates of severe acute malnutrition. A malnourished child already has weakened immunity and missed vaccinations can mean common childhood illnesses quickly become lethal to them. The convergence of a hunger crisis with a growing immunization gap threatens to create the conditions for a child survival crisis.   Vaccine coverage dropped in every region, with the East Asia and Pacific region recording the steepest reversal in DTP3 coverage, falling nine percentage points in just two years.   “Planning and tackling COVID-19 should also go hand-in-hand with vaccinating for killer diseases like measles, pneumonia and diarrhea,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “It’s not a question of either/or, it’s possible to do both”. Some countries notably held off declines. Uganda maintained high levels of coverage in routine immunization programmes, whilst rolling out a targeted COVID-19 vaccination programme to protect priority populations, including health workers. Read: Children aged 5-12 to be vaccinated soon: Health Minister Similarly, Pakistan returned to pre-pandemic levels of coverage thanks to high-level government commitment and significant catch-up immunization efforts. To achieve this in the midst of a pandemic, when healthcare systems and health workers were under significant strain, should be applauded.   Monumental efforts will be required to reach universal levels of coverage and to prevent outbreaks. Inadequate coverage levels have already resulted in avoidable outbreaks of measles and polio in the past 12 months, underscoring the vital role of immunization in keeping children, adolescents, adults, and societies healthy.   First dose measles coverage dropped to 81 per cent in 2021, also the lowest level since 2008. This meant 24.7 million children missed their first measles dose in 2021, 5.3 million more than in 2019. A further 14.7 million did not receive their needed second dose. Similarly, compared to 2019, 6.7 million more children missed the third dose of polio vaccine and 3.5 million missed the first dose of the HPV vaccine- which protects girls against cervical cancer later in life.   The sharp two-year decline follows almost a decade of stalled progress, underscoring the need to not only address pandemic-related disruptions but also systemic immunization challenges to ensure every child and adolescent is reached. WHO and UNICEF are working with Gavi, the Vaccine Alliance and other partners to deliver the global Immunization Agenda 2030 (IA2030), a strategy for all countries and relevant global partners to achieve set goals on preventing diseases through immunization and delivering vaccines to everyone, everywhere, at every age. “It’s heart-breaking to see more children losing out on protection from preventable diseases for a second year in a row. The priority of the Alliance must be to help countries to maintain, restore and strengthen routine immunization alongside executing ambitious COVID-19 vaccination plans, not just through vaccines but also tailored structural support for the health systems that will administer them,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. The IA2030 partners call on governments and relevant actors to: Intensify efforts for catch-up vaccination to address backsliding on routine immunization, and expand outreach services in underserved areas to reach missed children and implement campaigns to prevent outbreaks; Implement evidence-based, people-centred, and tailored strategies to build trust in vaccines and immunization, counter misinformation and increase vaccine uptake particularly among vulnerable communities; Ensure current pandemic preparedness and response and the global health architecture strengthening efforts lead to investment in primary health care (PHC) services, with explicit support to strengthen and sustain essential immunization; Ensure political commitment from national governments and increase domestic resource allocation to strengthen and sustain immunization within PHC; Prioritize health information and disease surveillance systems strengthening to provide the data and monitoring needed for programmes to have maximum impact; and   Leverage and increase investment in research to develop and improve new and existing vaccines and immunization services that can achieve community needs and deliver on IA2030 goals.

COVID-19 vaccinations are at a critical juncture as companies test whether new approaches like combination shots or nasal drops can keep up with a mutating coronavirus — even though it’s not clear if changes are needed. Already there’s public confusion about who should get a second booster now and who can wait. There’s also debate about whether pretty much everyone might need an extra dose in the fall. “I’m very concerned about booster fatigue” causing a loss of confidence in vaccines that still offer very strong protection against COVID-19’s worst outcomes, said Dr. Beth Bell of the University of Washington, an adviser to the U.S. Centers for Disease Control and Prevention. Also raed:Beijing on alert after COVID-19 cases discovered in school Despite success in preventing serious illness and death, there’s growing pressure to develop vaccines better at fending off milder infections, too — as well as options to counter scary variants. “We go through a fire drill it seems like every quarter, every three months or so” when another mutant causes frantic tests to determine if the shots are holding, Pfizer vaccine chief Kathrin Jansen told a recent meeting of the New York Academy of Sciences. Yet seeking improvements for the next round of vaccinations may seem like a luxury for U.S. families anxious to protect their littlest children — kids under 5 who are not yet eligible for a shot. Moderna’s Dr. Jacqueline Miller told The Associated Press that its application to give two low-dose shots to the youngest children would be submitted to the Food and Drug Administration “fairly soon.” Pfizer hasn’t yet reported data on a third dose of its extra-small shot for tots, after two didn’t prove strong enough. COMBINATION SHOTS MAY BE NEXT The original COVID-19 vaccines remain strongly protective against serious illness, hospitalization and death, especially after a booster dose, even against the most contagious variants. Updating the vaccine recipe to match the latest variants is risky, because the next mutant could be completely unrelated. So companies are taking a cue from the flu vaccine, which offers protection against three or four different strains in one shot every year. Moderna and Pfizer are testing 2-in-1 COVID-19 protection that they hope to offer this fall. Each “bivalent” shot would mix the original, proven vaccine with an omicron-targeted version. Moderna has a hint the approach could work. It tested a combo shot that targeted the original version of the virus and an earlier variant named beta — and found vaccine recipients developed modest levels of antibodies capable of fighting not just beta but also newer mutants like omicron. Moderna now is testing its omicron-targeted bivalent candidate. But there’s a looming deadline. FDA’s Dr. Doran Fink said if any updated shots are to be given in the fall, the agency would have to decide on a recipe change by early summer. DON’T EXPECT BOOSTERS EVERY FEW MONTHS For the average person, two doses of the Pfizer or Moderna vaccine plus one booster — a total of three shots — “gets you set up” and ready for what may become an annual booster, said Dr. David Kimberlin, a CDC adviser from the University of Alabama at Birmingham. After that first booster, CDC data suggests an additional dose offers most people an incremental, temporary benefit. Also read: WHO recommends Pfizer's Covid pill Paxlovid Why the emphasis on three shots? Vaccination triggers development of antibodies that can fend off coronavirus infection but naturally wane over time. The next line of defense: Memory cells that jump into action to make new virus-fighters if an infection sneaks in. Rockefeller University researchers found those memory cells become more potent and able to target more diverse versions of the virus after the third shot. Even if someone who’s vaccinated gets a mild infection, thanks to those memory cells “there’s still plenty of time to protect you against severe illness,” said Dr. Paul Offit of the Children’s Hospital of Philadelphia. But some people — those with severely weakened immune systems — need more doses up-front for a better chance at protection. And Americans 50 and older are being offered a second booster, following similar decisions by Israel and other countries that offer the extra shot to give older people a little more protection. The CDC is developing advice to help those eligible decide whether to get an extra shot now or wait. Among those who might want a second booster sooner are the elderly, people with health problems that make them particularly vulnerable, or who are at high risk of exposure from work or travel. COULD NASAL VACCINES BLOCK INFECTION? It’s hard for a shot in the arm to form lots of virus-fighting antibodies inside the nose where the coronavirus latches on. But a nasal vaccine might offer a new strategy to prevent infections that disrupt people’s everyday lives even if they’re mild. “When I think about what would make me get a second booster, I actually would want to prevent infection,” said Dr. Grace Lee of Stanford University, who chairs CDC’s immunization advisory committee. “I think we need to do better.” Nasal vaccines are tricky to develop and it’s not clear how quickly any could become available. But several are in clinical trials globally. One in late-stage testing, manufactured by India’s Bharat Biotech, uses a chimpanzee cold virus to deliver a harmless copy of the coronavirus spike protein to the lining of the nose. “I certainly do not want to abandon the success we have had” with COVID-19 shots, said Dr. Michael Diamond of Washington University in St. Louis, who helped create the candidate that’s now licensed to Bharat. But “we’re going to have a difficult time stopping transmission with the current systemic vaccines,” Diamond added. “We have all learned that.”

Dangling everything from sports tickets to a free beer, President Joe Biden is looking for that extra something — anything — that will get people to roll up their sleeves for COVID-19 shots when the promise of a life-saving vaccine by itself hasn’t been enough. Biden on Wednesday announced a “month of action” to urge more Americans to get vaccinated before the July 4 holiday, including an early summer sprint of incentives and a slew of new steps to ease barriers and make getting shots more appealing to those who haven’t received them. He is closing in on his goal of getting 70% of adults at least partially vaccinated by Independence Day — essential to his aim of returning the nation to something approaching a pre-pandemic sense of normalcy this summer. “The more people we get vaccinated, the more success we’re going to have in the fight against this virus,” Biden said from the White House. He predicted that with more vaccinations, America will soon experience “a summer of freedom, a summer of joy, a summer of get togethers and celebrations. An All-American summer.” The Biden administration views June as “a critical month in our path to normal,” Courtney Rowe, the director of strategic communications and engagement for the White House COVID-19 response team, told the AP. Read: Biden’s $6T budget: Social spending, taxes on business Biden’s plan will continue to use public and private-sector partnerships, mirroring the “whole of government” effort he deployed to make vaccines more widely available after he took office. The president said he was “pulling out all the stops” to drive up the vaccination rate. Among those efforts is a promotional giveaway announced Wednesday by Anheuser-Busch, saying it will “buy Americans 21+ a round of beer” once Biden’s 70% goal is met. “Get a shot and have a beer,” Biden said, advertising the promotion even though he himself refrains from drinking alcohol. Additionally, the White House is partnering with early childhood centers such as KinderCare, Learning Care Group, Bright Horizons and more than 500 YMCAs to provide free childcare coverage for Americans looking for shots or needing assistance while recovering from side effects. The administration is also launching a new partnership to bring vaccine education and even doses to more than a thousand Black-owned barbershops and beauty salons, building on a successful pilot program in Maryland. They’re the latest vaccine sweeteners, building on other incentives like cash giveaways, sports tickets and paid leave, to keep up the pace of vaccinations. “The fact remains that despite all the progress, those who are unvaccinated still remain at risk of getting seriously ill or dying or spreading the disease to others,” said Rowe. Read: Biden orders more intel investigation of COVID-19 origin Aiming to make injections even more convenient, Biden is announcing that many pharmacies are extending their hours this month — and thousands will remain open overnight on Fridays. The White House is also stepping up its efforts to help employers run on-site vaccination clinics. Biden will also announce that he is assigning Vice President Kamala Harris to lead a “We Can Do This” vaccination tour to encourage shots. It will include first lady Jill Biden, second gentleman Doug Emhoff and Cabinet officials. Harris’ travel will be focused on the South, where vaccination rates are among the lowest in the country, while other officials will travel to areas of the Midwest with below average rates. To date 62.9% of the adult U.S. population have received at least one dose of a COVID-19 vaccine and 133.9 million are fully vaccinated. The rate of new vaccinations has slowed to an average below 555,000 per day, down from more than 800,000 when incentives like lotteries were announced, and down from a peak of nearly 2 million per day in early April when demand for shots was much higher. The lengths to which the U.S. is resorting to convince Americans to take a shot stands in contrast to much of the world, where vaccines are far less plentiful. Facing a mounting U.S. surplus, the Biden administration is planning to begin sharing 80 million doses with the world this month. “All over the world people are desperate to get a shot that every American can get at their neighborhood drugstore,” Biden said. “Incentives can work, and I think the White House’s focus on making vaccination the easy and convenient choice is important,” said Dr. Leana Wen, an emergency physician, public health professor at George Washington University and former Baltimore health commissioner. “It’s the height of American exceptionalism that we are having to beg people to get a life-saving vaccine, when healthcare workers and vulnerable people around the world are dying because they can’t get access to it,” she added. Read: Face to face: June summit for Biden, Putin as tensions rise Thanks to the vaccinations, the rate of cases and deaths in the U.S. are at their lowest since the beginning of the pandemic last March, averaging under 16,000 new cases and under 400 deaths per day. As part of the effort to drive Americans to get shots, the White House is borrowing some tools from political campaigns, including phone banks, door-knocking and texting. The administration says more than 1,000 such events will be held this weekend alone. Additionally, it is organizing competitions between cities and colleges to drive up vaccination rates. Other new incentives include a $2 million commitment from DoorDash to provide gift cards to community health centers to be used to drive people to get vaccinated. CVS launched a sweepstakes with prizes including free cruises and Super Bowl tickets. Major League Baseball will host on-site vaccine clinics and ticket giveaways at games. And Kroger will give $1 million to a vaccinated person each week this month and dozens of people free groceries for the year. The fine print on the Anheuser-Busch promotion reveals the benefits to the sponsoring company, which will collect consumer data and photos through its website to register for the $5 giveaway. The company says it will hand out credits to however many people qualify.

UNHCR, the UN Refugee Agency, has sought stronger global support for refugee vaccinations in Asia, including Rohingyas who are living in Bangladesh. In Cox’s Bazar, where almost 900,000 Rohingyas are living in the single largest and most densely populated cluster of refugee camps in the world, the number of cases has increased considerably in the last two months, said the UN agency. As of May 31, there have been over 1,188 cases confirmed among the refugee population, with more than half of these cases recorded in May alone, UNHCR said. “Some refugees, including in Nepal, have already received their first vaccine dose with COVAX-provided supplies. Among the Rohingya refugees in the camps in Bangladesh, not a single vaccine has been administered yet given the scarcity of supplies in the country,” said UNHCR spokesperson Andrej Mahecic in a regular briefing in Geneva on Tuesday. READ: UNHCR seeks adequate medical assistance for Rohingyas affected in Bhasan Char The current delays in vaccine shipments, brought about by limited supplies to COVAX, mean that some of the world’s most vulnerable people remain susceptible to the virus, said the spokesperson. With COVID-19 raging in many parts of the world, UNHCR, the UN Refugee Agency, is warning about shortages of vaccines in the Asia-Pacific region, including for refugees and asylum-seekers. "We urge immediate and stronger support for the COVAX initiative, a worldwide effort aimed at achieving equitable access to COVID-19 vaccines. This is critical to save lives and curb the impact of the virus, particularly in developing nations.  These countries host the vast majority of more than 80 million forcibly displaced people in the world. Yet so far, they have benefited from only a fraction of the world’s COVID-19 vaccines," said the UNHCR spokesperson. UNHCR stressed that no one can be left behind in the global effort against the coronavirus.  The pandemic will be defeated only when vaccinations become available everywhere on an equitable basis, it said. "We are particularly worried about the situation in the Asia and Pacific region, which in the past two months has experienced the largest increase in the number of cases globally. Over this period, there have been some 38 million recorded COVID-19 cases and more than half a million deaths," said the UNHCR spokesperson. READ: UNHCR's joint response plan to be launched Tuesday The fragile health systems in many countries in this region have struggled to cope with this recent surge.  The lack of hospital beds, oxygen supplies, limited intensive care unit (ICU) capacities and scarce health facilities and services have worsened outcomes for those infected with COVID-19, particularly in India and Nepal.  The highly infectious variant of the virus which first emerged in India threatens to rapidly spread in the sub-region, including among refugee populations. "Refugees remain especially vulnerable to the spread of COVID-19. Overcrowded settings, coupled with limited water and sanitation facilities, can contribute to increased infection rates and an exponential spread of the virus," said the UNHCR spokesperson. UNHCR said it is adding its voice to the calls for countries with surplus doses to donate to COVAX, and for manufacturers to boost supplies to the COVAX facility. UNHCR’s total financial requirements for COVID include $455m in supplementary needs and $469m in COVID-related activities that are included in its regular budget.  To date, including projected contributions, UNHCR has received $252.8m or 27% of these requirements. 

In hopes of taming a monstrous spike in COVID-19 infections, India opened vaccinations to all adults Saturday, launching a huge inoculation effort that was sure to tax the limits of the federal government, the country’s vaccine factories and the patience of its 1.4 billion people. The world’s largest maker of vaccines was still short of critical supplies — the result of lagging manufacturing and raw material shortages that delayed the rollout in several states. And even in places where the shots were in stock, the country’s wide economic disparities made access to the vaccine inconsistent. The country’s ambitious effort was also partly overshadowed Saturday by a fire in a COVID-19 ward in western India that killed 18 patients, and the death of 12 COVID-19 patients at a hospital in New Delhi after the facility ran out of oxygen for 80 minutes. Read Also: First batch of Russia's Sputnik V vaccine delivered to India Only a fraction of India’s population will be able to afford the prices charged by private hospitals for the shot, experts said, meaning that states will be saddled with immunizing the 600 million Indian adults younger than 45, while the federal government gives shots to 300 million health care and front-line workers and people older than 45. So far, government vaccines have been free, and private hospitals have been permitted to sell shots at a price capped at 250 rupees, or around $3. That practice will now change: Prices for state governments and private hospitals will be determined by vaccine companies. Some states might not be able to provide vaccines for free since they are paying twice as much as the federal government for the same shot, and prices at private hospitals could rise. Since state governments and private players compete for shots in the same marketplace, and states pay less for the doses, vaccine makers can reap more profit by selling to the private sector, said Chandrakant Lahariya, a health policy expert. That cost can then be passed on to people receiving the shots, increasing inequity. “There is no logic that two different governments should be paying two prices,” he said. Concerns that pricing issues could deepen inequities are only the most recent hitch in India’s sluggish immunization efforts. Less than 2% of the population has been fully immunized against COVID-19 and around 10% has received a single dose. Immunization rates have also fallen. The average number of shots per day dipped from over 3.6 million in early April to less than 2.5 million right now. In the worst-hit state of Maharashtra, the health minister promised free vaccines for those ages 18 to 44, but he also acknowledged that the shortage of doses meant immunization would not start as planned on Saturday. States say the paucity of shots is one reason why immunizations have declined. In a positive development, the country on Saturday received its first batch of Sputnik V vaccines, which it is importing from Russia. Moscow has signed a deal with an Indian pharmaceutical company to distribute 125 million doses. India thought the worst was over when cases ebbed in September. But mass gatherings such as political rallies and religious events were allowed to continue, and relaxed attitudes on the risks fueled a major humanitarian crisis, according to health experts. New variants of the coronavirus have partly led the surge. Read Also: India's Serum to produce Covid jabs overseas: Report The country’s shortage of shots has global implications because, in addition to its own inoculation efforts, India has promised to ship vaccines abroad as part of a United Nations vaccine-sharing program that is dependent on its supply. Indian vaccine makers produce an estimated 70 million doses each month of the two approved shots — the AstraZeneca vaccine made by the Serum Institute of India and another one made by Bharat Biotech. The federal government is buying half of those vaccines to give to states. The remaining half can then be bought by states and private hospitals to be given to anyone over 18, but at prices set by the companies. The federal government is buying shots at 150 rupees each, or $2. The Serum Institute will sell the shots to states at 300 rupees each, or $4, and to private players at 600 rupees each, or $8. Bharat Biotech said it will charge states 400 rupees, or less than $5.50 for a shot, and private players 1,200 rupees, or more than $16. By comparison, the European Union paid $2.15 per dose for the AstraZeneca vaccine. The company says that price is discounted because the EU contributed to the vaccine’s development. The strain is mounting on the Serum Institute, which in addition to being India’s main supplier is also a critical supplier of the U.N.-backed initiative known as COVAX, which more than 90 countries are depending on. The institute paused exports in March. “The urgent demand for vaccines in India is bad for the rest of the world,” said Ravi Gupta, a professor of clinical microbiology at Cambridge University. Some experts warned that conducting a massive inoculation effort now could worsen the surge in a country that is second only to the United States in its number of infections — more than 19.1 million. “There’s ample evidence that having people wait in a long, crowded, disorderly queue could itself be a source of infection,” said Dr. Bharat Pankhania, a senior clinical lecturer specializing in infectious diseases at Britain’s University of Exeter. He urged India to first stop the circulation of the virus by imposing “a long, sustained, strictly enforced lockdown.” Pankhania cautioned that immunization efforts alone would not help immediately stem the current spike of COVID-19, since shots “only start to bear fruit in about three months’ time.” Vaccination would help prevent future waves of infection, he said. Given the urgent need for vaccines, some experts said rationing available doses is critical. “Vaccines need to be delivered to the areas with the most intense transmission,” Gupta said, explaining that vaccines should be used as “emergency control measures” in specific regions of India rather than offering doses to all adults across the subcontinent. Read Also: India's COVID-19 tally crosses 19 mln with over 400000 daily cases Pankhania said the widely seen images of Indian virus patients gasping for air and smoke billowing from makeshift funeral pyres should spur rich countries to share their vaccines more freely. He criticized the approach taken by many Western countries that are attempting to vaccinate all citizens, including younger people at low risk, before sharing any doses. “It is better globally to immunize all the (vulnerable) people that need to be protected rather than to immunize entire populations in only some countries,” Pankhania said. Cheng reported from London. Associated Press writers Daria Litvinova in Moscow and Krutika Pathi in New Delhi contributed to this report.

Doctors, nurses and the elderly rolled up their sleeves across the European Union to receive the first doses of the coronavirus vaccine Sunday in a symbolic show of unity and moment of hope for a continent confronting its worst health care crisis in a century.

Italy's special commissioner for the pandemic says the vaccination campaign against COVID-19 will begin in all 27 European Union countries on the same “symbolic” day, to be followed with individual countries’ rollouts of larger inoculation programs.