Millions of children at risk due to global decline in vaccinations

Thanks to vaccinations, in particular to the Essential Immunization Program (EPI), launched by the World Health Organization (WHO) in 1974, approximately 154 million children have been saved between 1974 and 2024. Childhood vaccinations are considered one of the most effective and cost-effective public health strategies, with an estimated return on investment that can reach 44 times the cost of vaccination. Yet, although this success is there for all to see, the risk now is that of going backwards. And leaving millions of children at the mercy of diseases that, if not prevented by vaccination, can lead to their death.

This is the alarm that is raised on the pages of The Lancet which publishes the photograph of vaccination adherence worldwide that emerges from the Global Burden of Disease Study of 2023. Starting from these data the authors also outline future scenarios.

Reversal of trend

Between 2010 and 2019, progress in immunization coverage slowed or even reversed in many areas. For example, coverage for vaccines distributed by the EPI, such as the first and third doses of diphtheria, tetanus and pertussis (DTP1 and DTP3), the first dose of measles (MCV1) and the third dose of polio (POL3), declined in many countries, with the largest declines observed in Latin America and the Caribbean.

Impact of the pandemic on vaccinations

As if the decline recorded before 2019 was not already worrying, the pandemic arrived and worsened the situation by causing a sharp decline in global vaccination coverage starting in 2020. A situation that had not yet been compensated for in 2023: it is estimated that between 2020 and 2023, the Covid-19 pandemic caused tens of millions of children to not be vaccinated with routine doses, including 12.8 million "zero-dose" children, that is, young children who did not receive any doses of diphtheria, tetanus and whooping cough. The global number of zero-dose children rose to a peak of 18.6 million in 2021, falling to 15.7 million in 2023, but still higher than the 14.7 million in 2019. The uptake of newer vaccines, such as those against pneumococcal disease (PCV3) and rotavirus (RotaC), has also slowed.

Countries that vaccinate the least

Despite the overall reduction in children with no vaccines since 1980, there are still places in the world where access to immunization is very difficult. As of 2023, more than 50% of the 15.7 million children with no vaccines globally live in just eight countries: Nigeria, India, Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia and Brazil. The regions of sub-Saharan Africa and South Asia face the greatest challenges, with sub-Saharan Africa hosting more than 52.6% of global children with no vaccines. Sudan, for example, has seen its DTP1 coverage nearly halved due to civil war.

The goals for 2030

With the document called Immunization Act, the WHO has set ambitious goals to improve global vaccination coverage. Such as halving the number of zero-dose children compared to 2019 levels, bringing it to 7.35 million by 2030; reaching 90% global coverage for some vaccines considered essential throughout life, such as DTP3, PCV3, the second dose of the measles vaccine (MCV2), and the HPV vaccine. Objectives that today, in light of the cuts in US funding for Gavi and WHO, seem even more difficult to achieve. And here the experts' concern arises: the reductions in global funding for immunizations will not only disproportionately affect low- and middle-income countries, but will also increase the risk of epidemics in high-income countries.