Routine vaccination coverage falls to 13-year low among infants

Globally, routine vaccination coverage among infants plummeted to a 13-year low in 2021, according to data published Thursday in MMWR.

Researchers from the CDC, WHO and UNICEF found that 25 million children worldwide were unvaccinated or incompletely vaccinated with three doses of diphtheria, tetanus and pertussis-containing vaccine in 2021 — 5.9 million more than in 2019.

Coverage with three doses of the vaccine decreased from an average of 86% in 2015-2019 to 81% in 2021. First-dose measles coverage also fell to 81% in 2021, down from an average of 85% in 2015-2019.

Coverage levels for these vaccines were lower than at any time since 2008, the researchers reported.

“Since the start of the COVID-19 pandemic in 2020, a widespread decline in childhood vaccinations has occurred globally, putting millions of additional children at risk for vaccine-preventable diseases,” they wrote. “Immunization outreach services were particularly affected, and the most vulnerable populations have experienced the largest impact.”

Among children who had not been vaccinated, more than 60% lived in just 10 countries: Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Myanmar, Nigeria, Pakistan and the Philippines.

Global coverage decreased across the board for the bacille Calmette-Guerin vaccine, rubella-containing vaccine, hepatitis B virus birth dose vaccine, the complete Haemophilus influenzae type b series vaccine, and the three-dose HBV series.

The rate of first dose of HPV vaccine among females declined from 20% in 2019 to 15% last year.

The declines, the authors emphasized, were likely a result of the strain placed on health systems and providers by the COVID-19 pandemic.

“These stresses have led to challenges with supply chains, human resources and financing,” they wrote. “Increasing vaccine misinformation, disinformation and hesitancy also likely contributed to declines in some countries. The risk of vaccine-preventable diseases outbreaks is likely to persist if urgent action is not taken to recover immunization program losses.”

They also noted that recovery from these disruptions will require targeted, context-specific strategies to help children catch up on missed vaccines, recover essential health services and strengthen immunization programs to prevent outbreaks.

“Reversing declining vaccination trends and addressing immunity gaps, as well as extending previous gains in vaccination coverage beyond pre-pandemic levels, requires targeted and context-specific approaches that prioritize routine vaccination as an essential health service and improve access to vaccination across the life span,” they wrote.