Apr 20, 2023 - World

A worrying sign in the global effort to vaccinate every child

A health worker gives a dose of the polio vaccine to a child during a vaccination campaign against polio in Kabul, Afghanistan, in December 2022. Photo: Saifurahman Safi/Xinhua via Getty Images

The UN children's agency is raising the alarm on what it says are worrying signs in the global effort to vaccinate every child.

The big picture: Public perception of the importance of childhood vaccines declined during the pandemic in more than 50 countries, including the United States, UNICEF said in a report published on Wednesday.

  • At the same time, the world saw the biggest backslide in childhood vaccination in nearly 30 years. About 67 million children missed out entirely or partially on routine vaccines between 2019 and 2021, UNICEF estimated.
  • Of those children, 48 million didn’t receive a single routine vaccine during that time period, with many of the "zero-dose" children living in marginalized and underserved communities.
  • It was right to prioritize the COVID-19 response, including diverting resources and scaling back other health services, during the onset of the pandemic, but "what's not right is that coming out of the pandemic, we're now seeing children paying the consequences for those actions," Lily Caprani, a senior advisor-advocacy for UNICEF, told Axios.

By the numbers: In nearly half of the 55 countries studied, more than 80% of respondents said vaccines are important for children, according to the report, which analyzed data from The Vaccine Confidence Project (VCP) at the London School of Hygiene & Tropical Medicine.

  • But there are "worrying signs" that vaccine hesitancy may be on the rise in many nations. Fifty-two of the 55 countries examined saw a decline in public perception of the importance of childhood vaccines, the report found.
  • South Korea, Papua New Guinea, Ghana, Senegal and Japan each saw a decline of more than 33 percentage points

The vast majority (79%) in the U.S. still perceived childhood vaccines as important after the onset of the pandemic, but that was a 13.6% decline from before COVID-19 devastated the world.

  • China, India and Mexico were the only countries examined where perceptions of the importance of childhood vaccines improved or didn't change.
  • UNICEF noted that "vaccine confidence is also notoriously volatile, and any trends are time and location specific," but the decline seen in many countries during the pandemic is cause for concern.

Driving the news: Several factors have likely contributed to that decline, UNCIEF said.

  • Vaccine hesitancy is as old as vaccines themselves. But vaccine misinformation and disinformation today spread more quickly and have a wider reach than ever before.
  • "That implies to us that we've got a bigger job to do here than simply go out and reach the missed children, but we also have like to take proactive steps now to really tackle that misinformation, whether it's at the community level or online," Caprani said.

Additionally, many countries have experienced increasing political polarization and, as a result, declining trust in certain institutions and experts, the report noted.

  • There are also growing concerns that a generation of new parents may have become complacent about childhood vaccination due to the perception that the risk of contracting a certain disease or dying from it is low.
  • In most of the countries studied, people under the age of 35 were more likely to report less confidence in childhood vaccines after the start of the pandemic than older adults, according to the report.
  • "Memories are short. A generation ago, there were people living in iron lungs," due to polio," Caprani said. "I think it's easy to forget that and then think it doesn't matter anymore, but those things can come back."

There are some indications this may already be happening.

  • The "discovery of poliovirus in Israel, the United Kingdom of Great Britain and Northern Ireland, and the United States of America last year was a reminder that even remarkable progress against a disease like polio can be put at risk if we fail to vaccinate every child," the report's authors write.
  • In 2022, the number of measles outbreaks worldwide was double that of the previous year. Diseases like measles are dangerous — and can be deadly — for children, but Caprani said it's "also a risk for the whole community because these are such infectious illnesses, they can spread like wildfire."
  • A measles outbreak that began in Zimbabwe in April 2022 had killed more than 700 people, mostly children, by the end of September of that year, according to the World Health Organization. More than 7,700 cases had been recorded during that time period.

State of play: Governments and communities must take a proactive approach to get children who have missed vaccines or may not have an opportunity to get them immunized, UNICEF said.

  • This includes not only public outreach but rethinking planning, implementation and funding mechanisms as well. It also includes empowering women, who are often on the front line of vaccination efforts, and thinking about immunization in equity terms.
  • Childhood immunization schedules vary by region and country, but it's recommended that many children receive at least the initial doses of a number of vaccines within their first 18 months of life, including those offering protection from measles, polio, diphtheria, whooping cough and Hepatitis B, among other diseases and infections.

The bottom line: "There's a kind of warning from history here," Caprini said.

  • "These are really awful illnesses that used to be common in our societies just a generation ago. It's quite a scary thought actually ... just how casually we throw away progress."
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