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23 million children missed out on basic vaccines through routine immunization services in 2020 – 3.7 million more than in 2019 - according to official data published today by WHO and UNICEF. This latest set of comprehensive worldwide childhood immunization figures, the first official figures to reflect global service disruptions due to COVID-19, show a majority of countries last year experienced drops in childhood vaccination rates.
Concerningly, most of these – up to 17 million children – likely did not receive a single vaccine during the year, widening already immense inequities in vaccine access. Most of these children live in communities affected by conflict, in under-served remote places, or in informal or slum settings where they face multiple deprivations including limited access to basic health and key social services.
“Even as countries clamour to get their hands on COVID-19 vaccines, we have gone backwards on other vaccinations, leaving children at risk from devastating but preventable diseases like measles, polio or meningitis,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Multiple disease outbreaks would be catastrophic for communities and health systems already battling COVID-19, making it more urgent than ever to invest in childhood vaccination and ensure every child is reached.”
In all regions, rising numbers of children miss vital first vaccine doses in 2020; millions more miss later vaccines
Disruptions in immunization services were widespread in 2020, with the WHO Southeast Asian and Eastern Mediterranean Regions most affected. As access to health services and immunization outreach were curtailed, the number of children not receiving even their very first vaccinations increased in all regions. As compared with 2019, 3.5 million more children missed their first dose of diphtheria, tetanus and pertussis vaccine (DTP-1) while 3 million more children missed their first measles dose.
“This evidence should be a clear warning – the COVID-19 pandemic and related disruptions cost us valuable ground we cannot afford to lose – and the consequences will be paid in the lives and wellbeing of the most vulnerable,” said Henrietta Fore, UNICEF Executive Director. “Even before the pandemic, there were worrying signs that we were beginning to lose ground in the fight to immunize children against preventable child illness, including with the widespread measles outbreaks two years ago. The pandemic has made a bad situation worse. With the equitable distribution of COVID-19 vaccines at the forefront of everyone’s minds, we must remember that vaccine distribution has always been inequitable, but it does not have to be.”
Table 1: Countries with the greatest increase in children not receiving a first dose of diphtheria-tetanus-pertussis combined vaccine (DTP-1)20192020India1'403'0003'038'000Pakistan567'000968'000Indonesia472'000797'000Philippines450'000557'000Mexico348000454'000Mozambique97'000186'000Angola399'000482'000United Republic of Tanzania183'000249'000Argentina97'000156'000Venezuela (Bolivarian Republic of)75'000134'000Mali136'000193'000
The data shows that middle-income countries now account for an increasing share of unprotected children – that is, children missing out on at least some vaccine doses. India is experiencing a particularly large drop, with DTP-3 coverage falling from 91% to 85%.
Fuelled by funding shortfalls, vaccine misinformation, instability and other factors, a troubling picture is also emerging in WHO’s Region of the Americas, where vaccination coverage continues to fall. Just 82% of children are fully vaccinated with DTP, down from 91% in 2016.
Countries risk resurgence of measles, other vaccine-preventable diseases
Even prior to the COVID-19 pandemic, global childhood vaccination rates against diphtheria, tetanus, pertussis, measles and polio had stalled for several years at around 86%. This rate is well below the 95% recommended by WHO to protect against measles –often the first disease to resurge when children are not reached with vaccines - and insufficient to stop other vaccine-preventable diseases.
With many resources and personnel diverted to support the COVID-19 response, there have been significant disruptions to immunization service provision in many parts of the world. In some countries, clinics have been closed or hours reduced, while people may have been reluctant to seek healthcare because of fear of transmission or have experienced challenges reaching services due to lockdown measures and transportation disruptions.
“These are alarming numbers, suggesting the pandemic is unravelling years of progress in routine immunization and exposing millions of children to deadly, preventable diseases”, said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “This is a wake-up call – we cannot allow a legacy of COVID-19 to be the resurgence of measles, polio and other killers. We all need to work together to help countries both defeat COVID-19, by ensuring global, equitable access to vaccines, and get routine immunization programmes back on track. The future health and wellbeing of millions of children and their communities across the globe depends on it.”
Concerns are not just for outbreak-prone diseases. Already at low rates, vaccinations against human papillomavirus (HPV) - which protect girls against cervical cancer later in life - have been highly affected by school closures. As a result, across countries that have introduced HPV vaccine to date, approximately 1.6 million more girls missed out in 2020. Globally only 13% girls were vaccinated against HPV, falling from 15% in 2019.
Agencies call for urgent recovery and investment in routine immunization
As countries work to recover lost ground due to COVID-19 related disruptions, UNICEF, WHO and partners like Gavi, the Vaccine Alliance are supporting efforts to strengthen immunization systems by:
- Restoring services and vaccination campaigns so countries can safely deliver routine immunization programmes during the COVID-19 pandemic;
- Helping health workers and community leaders communicate actively with caregivers to explain the importance of vaccinations;
- Rectifying gaps in immunization coverage, including identifying communities and people who have been missed during the pandemic.
- Ensuring that COVID-19 vaccine delivery is independently planned for and financed and that it occurs alongside, and not at the cost of childhood vaccination services.
- Implementing country plans to prevent and respond to outbreaks of vaccine-preventable diseases, and strengthen immunization systems as part of COVID-19 recovery efforts
The agencies are working with countries and partners to deliver the ambitious targets of the global Immunization Agenda 2030, which aims to achieve 90% coverage for essential childhood vaccines; halve the number of entirely unvaccinated, or ‘zero dose’ children, and increase the uptake of newer lifesaving vaccines such as rotavirus or pneumococcus in low and middle-income countries.
Notes for editors
Access the full data set here (from 15th July 2021): https://www.who.int/data/immunization
Vaccines For All campaign page: https://www.unicef.org/vaccines
About the data
Based on country-reported data, the official WHO and UNICEF estimates of national immunization coverage (WUENIC) provide the world’s largest data-set on immunization trends for vaccinations against 13 diseases given through regular health systems - normally at clinics or community centres or health worker visits. For 2020, data was provided from 160 countries.
Globally, the vaccination rate for three doses of diphtheria-tetanus and pertussis (DTP-3) vaccine fell from around 86% in 2019 to 83% in 2020, meaning 22.7 million children missed out, and for measles first dose, from 86 to 84%, meaning 22.3 million children missed out. Vaccination rates for measles second dose were at 71% (from 70% in 2019). To control measles, 95% uptake of two vaccine doses is required; countries that cannot reach that level rely on periodic nationwide vaccination campaigns to fill the gap.
In addition to routine immunization disruptions, there are currently 57 postponed mass vaccination campaigns in 66 countries, for measles, polio, yellow fever and other diseases, affecting millions more people.
New modelling also shows significant declines in DTP, measles vaccination coverage
New modelling, also published today in The Lancet by researchers at the Washington-based Institute for Health Metrics and Evaluation (IHME), similarly shows that childhood vaccination declined globally in 2020 due to COVID-19 disruptions. The IHME-led modelling is based on country-reported administrative data for DTP and measles vaccines, supplemented by reports on electronic medical records and human movement data captured through anonymized tracking of mobile phones.
Both analyses show that countries and the broader health community must ensure that new waves of COVID-19 and the massive roll out of COVID 19 vaccines don’t derail routine immunization and that catch-up activities continue to be enhanced.
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There was a dramatic worsening of world hunger in 2020, the United Nations said today – much of it likely related to the fallout of COVID-19. While the pandemic’s impact has yet to be fully mapped, a multi-agency report estimates that around a tenth of the global population – up to 811 million people – were undernourished last year. The number suggests it will take a tremendous effort for the world to honour its pledge to end hunger by 2030.
This year’s edition ofThe State of Food Security and Nutrition in the World is the first global assessment of its kind in the pandemic era. The report is jointly published by the Food and Agriculture Organization of the United Nations (FAO), the International Fund for Agricultural Development (IFAD), the United Nations Children’s Fund (UNICEF), the UN World Food Programme (WFP) and the World Health Organization (WHO).
Previous editions had already put the world on notice that the food security of millions – many children among them – was at stake. “Unfortunately, the pandemic continues to expose weaknesses in our food systems, which threaten the lives and livelihoods of people around the world,” the heads of the five UN agencies write in this year’s Foreword.
They go on to warn of a “critical juncture,” even as they pin fresh hopes on increased diplomatic momentum. “This year offers a unique opportunity for advancing food security and nutrition through transforming food systems with the upcoming UN Food Systems Summit, the Nutrition for Growth Summit and the COP26 on climate change.” “The outcome of these events,” the five add, “will go on to shape the […] second half of the UN Decade of Action on Nutrition” – a global policy commitment yet to hit its stride.
The numbers in detail
Already in the mid-2010s, hunger had started creeping upwards, dashing hopes of irreversible decline. Disturbingly, in 2020 hunger shot up in both absolute and proportional terms, outpacing population growth: some 9.9 percent of all people are estimated to have been undernourished last year, up from 8.4 percent in 2019.
More than half of all undernourished people (418 million) live in Asia; more than a third (282 million) in Africa; and a smaller proportion (60 million) in Latin America and the Caribbean. But the sharpest rise in hunger was in Africa, where the estimated prevalence of undernourishment – at 21 percent of the population – is more than double that of any other region.
On other measurements too, the year 2020 was sombre. Overall, more than 2.3 billion people (or 30 percent of the global population) lacked year-round access to adequate food: this indicator – known as the prevalence of moderate or severe food insecurity – leapt in one year as much in as the preceding five combined. Gender inequality deepened: for every 10 food-insecure men, there were 11 food-insecure women in 2020 (up from 10.6 in 2019).
Malnutrition persisted in all its forms, with children paying a high price: in 2020, over 149 million under-fives are estimated to have been stunted, or too short for their age; more than 45 million – wasted, or too thin for their height; and nearly 39 million – overweight. A full three-billion adults and children remained locked out of healthy diets, largely due to excessive costs. Nearly a third of women of reproductive age suffer from anaemia. Globally, despite progress in some areas – more infants, for example, are being fed exclusively on breast milk – the world is not on track to achieve targets for any nutrition indicators by 2030.
Other hunger and malnutrition drivers
In many parts of the world, the pandemic has triggered brutal recessions and jeopardized access to food. Yet even before the pandemic, hunger was spreading; progress on malnutrition lagged. This was all the more so in nations affected by conflict, climate extremes or other economic downturns, or battling high inequality – all of which the report identifies as major drivers of food insecurity, which in turn interact.
On current trends, The State of Food Security and Nutrition in the World estimates that Sustainable Development Goal 2 (Zero Hunger by 2030) will be missed by a margin of nearly 660 million people. Of these 660 million, some 30 million may be linked to the pandemic’s lasting effects.
What can (still) be done
As outlined in last year’s report, transforming food systems is essential to achieve food security, improve nutrition and put healthy diets within reach of all. This year’s edition goes further to outline six “transformation pathways”. These, the authors say, rely on a “coherent set of policy and investment portfolios” to counteract the hunger and malnutrition drivers.
Depending on the particular driver (or combination of drivers) confronting each country, the report urges policymakers to:
- Integrate humanitarian, development and peacebuilding policies in conflict areas – for example, through social protection measures to prevent families from selling meagre assets in exchange for food;
- Scale up climate resilience across food systems – for example, by offering smallholder farmers wide access to climate risk insurance and forecast-based financing;
- Strengthen the resilience of the most vulnerable to economic adversity – for example, through in-kind or cash support programmes to lessen the impact of pandemic-style shocks or food price volatility;
- Intervene along supply chains to lower the cost of nutritious foods – for example, by encouraging the planting of biofortified crops or making it easier for fruit and vegetable growers to access markets;
- Tackle poverty and structural inequalities – for example, by boosting food value chains in poor communities through technology transfers and certification programmes;
- Strengthen food environments and changing consumer behaviour – for example, by eliminating industrial trans fats and reducing the salt and sugar content in the food supply, or protecting children from the negative impact of food marketing.
The report also calls for an “enabling environment of governance mechanisms and institutions” to make transformation possible. It enjoins policymakers to consult widely; to empower women and youth; and to expand the availability of data and new technologies. Above all, the authors urge, the world must act now – or watch the drivers of hunger and malnutrition recur with growing intensity in coming years, long after the shock of the pandemic has passed.
Read the full report here and the In-Brief report here.
Hunger: an uncomfortable or painful sensation caused by insufficient energy from diet. Food deprivation; not eating enough calories. Used here interchangeably with (chronic) undernourishment. Measured by the prevalence of undernourishment (PoU).
Moderate food insecurity: a state of uncertainty about the ability to get food; a risk of skipping meals or seeing food run out; being forced to compromise on the nutritional quality and/or quantity of food consumed.
Severe food insecurity: running out of food; experienced hunger; at the most extreme, having to go without food for a day or more.
Malnutrition: the condition associated with deficiencies, excesses or imbalances in the consumption of macro- and/or micronutrients. For example, undernutrition and obesity are both forms of malnutrition. Child stunting or wasting are both indicators for undernutrition.