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Pandemic worsened childhood vaccination rates globally; India, 7 other nations had over half of unvaccinated kids in 2023: study
While there has been unprecedented progress in vaccinating children against life-threatening diseases since the World Health Organization (WHO) established the Expanded Programme on Immunization (EPI) in 1974, the last two decades have also been marked by stagnating childhood vaccination rates and a wide variation in vaccine coverage. These challenges have been further exacerbated by the COVID-19 pandemic, leaving millions of children vulnerable to preventable diseases and death, according to a major new analysis from the Global Burden of Disease Study Vaccine Coverage Collaborators, published in The Lancet.
The COVID-19 pandemic exacerbated these challenges with global coverage rates of the original EPI-recommended vaccines declining sharply beginning in 2020—resulting in an estimated 15.6 million children missing the full three doses of the diphtheria-tetanus-pertussis vaccine or a measles vaccine between 2020 and 2023, as well as 15.9 million children not receiving any polio vaccine, and 9.18 million missing out on the tuberculosis vaccine.
The study estimates that disruptions to immunisation services during the COVID-19 pandemic resulted in around 12.8 million additional unvaccinated zero-dose children globally during the four pandemic years (2020-2023). Wide discrepancies remain, with markedly lower coverage and higher rates of under and unvaccinated children in low- and middle-income countries.
In 2023, more than half of the world's 15.7 million unvaccinated children were living in just eight countries, primarily in sub-Saharan Africa (53%) and South Asia (13%)—Nigeria (2.48 million), India (1.44 million), the Democratic Republic of Congo (DRC, 882,000), Ethiopia (782,000), Somalia (710,000), Sudan (627,000), Indonesia (538,000), and Brazil (452,000).
'The challenge now is how to improve vaccine delivery and uptake in areas of low coverage,' said lead author Dr Emily Haeuser in the report. 'The diversity of challenges and barriers to immunisation vary widely between countries and within communities, with rising numbers of displaced people and growing disparities due to armed conflict, political volatility, economic uncertainty, climate crises, and vaccine misinformation and hesitancy, underscoring the need for new, tailored solutions,' she added.
The success of the past 50 years is partly the result of a doubling of global coverage for the original vaccines against diphtheria-tetanus-pertussis (first dose 49% to 89%; and all three doses 40% to 81%), measles (37% to 83%), polio (42% to 80%), and tuberculosis (38% to 83%) between 1980 and 2023. Additionally, there has been a 75% drop in the number of unvaccinated zero-dose children worldwide from 58.8 million in 1980 to 14.7 million in 2019, as well as the introduction and scale-up of critical new lifesaving vaccines against pneumococcal disease, rotavirus, and a second dose of the measles vaccine.
The analysis indicates that accelerated progress will be necessary to achieve the 2030 target of halving the number of zero-dose children compared to 2019 levels, with only 18 of 204 countries and territories estimated to have already met this target as of 2023. Two-thirds (65%) of the zero-dose children that need to be reached by vaccination between 2023 and 2030 live in sub-Saharan Africa (4.28 million) and South Asia (1.33 million).
To increase vaccine acceptance and uptake, the authors call for more concerted efforts to tackle vaccine misinformation and hesitancy. As Dr. Haeuser explained, 'Successful vaccination programmes are built on understanding and responding to people's beliefs, concerns, and expectations. Vaccination services must prioritise trust-building, engage community leaders, and tailor interventions with more culturally appropriate local strategies to improve vaccine confidence and uptake.'
Anuradha Mascarenhas is a journalist with The Indian Express and is based in Pune. A senior editor, Anuradha writes on health, research developments in the field of science and environment and takes keen interest in covering women's issues. With a career spanning over 25 years, Anuradha has also led teams and often coordinated the edition.
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