Sixty-seven million children were not fully or partially immunized against preventable diseases such as measles, tetanus, whooping cough or diphtheria between 2019 and 2021, UNICEF warned in a report on Thursday. Globally, the percentage of fully vaccinated children fell by 5% and stood at 81% after these three years, in which the pandemic caused confinements and interruption of health services, while resources were directed to curb the coronavirus.
And while the world was facing covid-19, something was changing in the minds of millions of citizens, who lost confidence in childhood immunizations, despite the fact that they save 4.4 million lives annually. in his report World state of the childhood, Unicef concludes that in 55 countries analyzed, only three (China, India and Mexico) maintained or increased their perception of the importance of vaccines. In the rest, confidence was reduced. In Spain, for example, it decreased by almost 8% and stood at 88%. In other countries, including South Korea, Ghana, Senegal, Japan and Papua New Guinea, it fell by 33% to 44%, according to data compiled for this report by The Vaccine Confidence Project. in English) from the London School of Hygiene and Tropical Medicine, which has been making this type of measurement since 2015.
The WHO already warned last year that the largest sustained decline in childhood immunization in 30 years due to the pandemic and now Unicef insists that vaccination coverage levels decreased in 112 countries around the world in the three years studied. According to the calculations of the UN Children’s Fund, in 2019, 19.1 million children did not receive their corresponding vaccines, in 2020, the figure rose to 22.9 million and in 2021, to 25. Of the 67 million children deprived of vaccination (that is, one in five children in the world), 48 million did not receive any type of immunization. They are called “zero dose”. For these studies, three doses of the diphtheria, tetanus, and pertussis (DPT3) vaccine are used as a marker. And the Unicef figures speak for themselves: in 2019 there were 13 million children without any protection against these diseases and in 2021 they reached 18 million. In absolute terms, India and Nigeria are the countries that register the most zero dose children, although the increases registered in Burma and the Philippines are alarming.
“These data represent a worrying alarm signal. We cannot allow the reliance on routine immunization to become another casualty of the pandemic. If this were to happen, the next wave of deaths could be due to an increase in the number of children with measles, diphtheria or other preventable diseases,” Catherine Russell, UNICEF’s executive director, said in a statement. Russell stresses that at the height of the pandemic, scientists rapidly developed vaccines that saved countless lives, but despite this historic achievement, “fear and misinformation about all kinds of vaccines circulated as widely as the virus itself.”
The next wave of deaths could be due to an increase in the number of children with measles, diphtheria or other preventable diseases
Catherine Russell, director of UNICEF
The rich and the poor
Boys and girls born just before or during the pandemic are already exceeding the age at which they should normally have received the main vaccines, which makes the situation urgent, UNICEF warns, because the consequences are already beginning to appear. Measles is one of the clearest examples. One in five children in the world has no protection against this disease, which, before the arrival of the vaccine, in 1963, killed 2.6 million people every year, especially children. In 2021, there were 128,000 deaths from this disease, a figure that is still high, but that shows the progress made. In 2022, Unicef points out, the number of infections doubled compared to 2021.
Nasro Dire, a 23-year-old girl who lives in a displacement camp in central Somalia, experienced it firsthand. Her two sons, Aanas, two, and Masude, one, fell ill. First they had a fever, then a rash. At the health center they could not do anything for them and they died within a month of each other. The woman has since vaccinated her three surviving children, ages three, four and six, and she will do the same with her newborn, one month old. She also encourages other parents to do the same. “The death of my children makes me encourage others to get vaccinated,” says Dire, in a testimony collected by Unicef in her report.
The death of my children makes me encourage others to get vaccinated
Nasro Dire, 23, displaced in Somalia
The pandemic also exacerbated existing inequalities. Being a child in a family with few resources, with parents, especially mothers, who did not go to school, in a marginal neighborhood or a remote rural town and perhaps plagued by violence means having a much lower chance of being vaccinated. According to data obtained for this report by the International Center for Equity in Health, in the poorest households, one in five children receive zero doses, while in the richest, only one in 20 receive zero doses. In some regions of the world, this gap is even more painful: in countries of central and western Africa, one in two children from poor households has not received any vaccine in their lifetime, compared to one in 16 from families with more resources.
More educated mothers, more vaccinated children
How to increase the number of immunized children and restore confidence in vaccines? UNICEF calls for more funding, including excess funds from covid-19, to promote primary care and work to make vaccines available and affordable. In addition, the UN Fund calls for more and better information to parents and caregivers so that they learn again to trust the government, the health system, vaccine producers and the vaccines themselves. All this with the mind set on the international target to halve by 2030 the number of children who do not receive essential vaccines and achieve 90% coverage for immunizations considered essential. If the goal is achieved, 50 million lives will have been saved in the current decade.
In 2022, the number of measles cases doubled compared to 2021.
UNICEF
When her daughter Aila was born, vaccinated with the first doses in her first days of life, Meerim Omurkanova, who lives in Kaiyrma, a town in Kyrgyzstan, hesitated. “I read on the internet that vaccines could cause paralysis and autism and I finally decided I didn’t want to,” she told UNICEF. In this country, the number of children who received the third dose of the diphtheria, tetanus and whooping cough (DTP3) vaccine stood at 87% in 2020, compared to 95% registered in 2019. These figures made Unicef and Gavi, the Vaccine Alliance, will launch a campaign with parents, healthcare professionals and religious leaders to explain the protection provided by childhood immunizations and bury misconceptions. At the end of these informative sessions, Omurkanova decided to vaccinate her little girl.
“Routine immunization and strong health systems are our best bet to prevent future pandemics, unnecessary death and suffering. With the resources still available from the covid-19 vaccination campaign, now is the time to redirect those funds to strengthen immunization services and invest in sustainable systems for all children,” Russell insisted.
Unicef also points out in its conclusions the importance of women in reversing this process. First, because the majority of health workers are female, but they need better wages, job security, training, and protection from the risks they are exposed to in some places. And secondly, because mothers are primarily responsible for the health of children, but “the social and cultural norms of homes and communities can limit their authority to make decisions.” Specifically, the report stresses that the “prevalence of unvaccinated children decreases as the educational level of the mother increases.” For example, in Nigeria, the percentage of unvaccinated children with mothers with a low level of education was 53.2% and around 10% in the case of children with mothers with a high level of education.
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