Millions of children around the world, most of them in poor countries, have missed out on part or all of their childhood vaccinations over the past two years due to a combination of conflicts, climate emergencies, misinformation campaigns, pandemic lockdowns and COVID-19 vaccination efforts. According to a new analysis from UNICEF, the UN agency that vaccinates half of the world’s children, and the World Health Organization, they have shifted their resources elsewhere.

It’s the biggest rollback in routine vaccinations in 30 years, the report says. Combined with rapidly increasing malnutrition, it has created conditions that threaten the lives of millions of children.

Lily Caprani, UNICEF’s head of advocacy, said: “This is a child health emergency – we have to think about the problems and the number of children who die because of it. “Not in a few years; It’s soon.”

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The percentage of children who received three doses of the vaccine against diphtheria, tetanus and pertussis, which UNICEF uses as a measure of vaccine coverage, fell by 5 points between 2019 and 2021, to 81 percent. Measles vaccination rates have also dropped to 81 percent, and polio coverage has also dropped significantly. A vaccination coverage rate of 94% is necessary for herd immunity to break the chain of disease transmission.

This means basic intervention to prevent fatal diseases translates to 25 million children.

What UNICEF calls zero-dose children — those who have not received even the most basic immunizations — have increased dramatically during the pandemic, from 13 million to 18 million in 2019. Age 5.

The agency Following a sharp decline in 2020 due to lockdowns, school closures and other COVID-19 response measures, childhood vaccination coverage is expected to rebound in 2021, said Dr Niklas Danielson, UNICEF’s senior immunization specialist in Nairobi.

But instead, the problem worsened. DTP3 and measles coverage are at their lowest levels since 2008, the report said.

Danielson said the vaccine coverage rate in 2021 will match that of 2008. But since then, birth cohorts have increased, which means that the number of children who have not completed or started vaccinations is the largest in the last period. 30 years,” he said.

He and others in the pediatric immunization field expected a recovery last year as health systems learned to adapt to the demands of the pandemic. Instead, he said, misinformation campaigns about the Covid-19 vaccine and governments’ mistrust of public health measures have spread to prevent routine vaccinations.

At the same time, health systems in the poorest countries have struggled to carry out limited Covid-19 vaccinations, with critical access to freezers and health workers being shot.

In the year During the 1990s and the first decade of this century, the world saw steady progress in childhood immunization coverage. The remaining children were the most difficult to reach, such as those in war zones or in nomadic communities, so the rates began to increase. But before the pandemic hit, he had a double-edged commitment to reach the remaining pockets of dose-zero babies, with support from organizations like the Bill and Melinda Gates Foundation and Gavi, the global vaccine coalition. Covid-19 has taken away his focus and investment.

In the last two years, India, Nigeria, Indonesia, Ethiopia and the Philippines have recorded the highest number of children who have not missed immunization services.

Brazil was also on the list of the top 10 most affected countries, a country famous for its high vaccination coverage. In the year In 2021, 26% of Brazilian children received no vaccinations, compared to 13% in 2018.

“30 years of work disappeared overnight,” said Dr. Carla Dominguez, a public health researcher and coordinator of Brazil’s national vaccination program.

Vaccination has become a politically charged topic in Brazil during the Covid-19 pandemic, she said. The federal government led by President Jair Bolsonaro has downplayed the importance of the coronavirus and said that although Brazil has one of the highest death rates in the world, it will not vaccinate its own 11-year-old child against the virus.

“For the first time, the federal government did not recommend the vaccine and it created a general environment of uncertainty that has never been seen in Brazil, where the vaccine is fully accepted,” Dominguez said.

At the same time, anti-vaccination groups, which did not buy much in Brazil, entered the country during the outbreak and began spreading misinformation in Portuguese on social media.

And all this was happening, Dominguez said, when Brazilians were known to vaccinate their children when they were a generation removed from serious diseases, making them question the need.

“Parents don’t know the effects of measles or polio, so they start picking and choosing vaccines,” she said. The data make it clear that pneumococcal vaccination is more effective than polio vaccination. “Parents are choosing not to do polio. ‘It’s been 30 years without polio, so should I do this?’ They say.

But she says they have clear signs of danger: Six years after Brazil declared the disease eradicated, fewer cases of measles have been found in Sao Paulo. “Measles is spreading now – this gives us a concrete example of what can happen with diphtheria, meningitis and many other diseases,” she said.

In the Philippines, 43% of children have not received any vaccinations in the past year. There, the problem is partly due to severe Covid-19 public health measures, including lockdowns. “If you are not allowed to spend certain hours of the day with your children, if they cannot go to school, if the cost of living increases, going to the health center and getting your child vaccinated will reduce your priorities.” ” said Danielson.

But the situation in the Philippines has been complicated by lack of confidence in the vaccine since the widespread distribution of a dengue vaccine called Dengvaxia in 2016.

The Dengvaxia story has fueled skepticism about the vaccine, especially among school children, said Dr. Anthony Lechon, a public health advocate who has advised the president on the Covid response. “That was the problem. We are still dealing with it,” he said.

Unicef’s Kaprani says restoring vaccination levels will require an extraordinary amount of resources and commitment.

“It will not be enough to simply return to business as usual and return to routine vaccinations,” she said. With the growing number of millions of children who are not fully immunized in countries with high levels of malnutrition and other stressors, we really need concerted investment and timely campaigns.

For example, in Zimbabwe, 1 out of 10 children are dying of measles. (The typical death rate is 1 in 100 in low-income countries and less than 1,000 in high-income countries.)

Dr. Fabien Diomande, a polio eradication expert at the World Health Task Force who has worked on polio campaigns in West and Central Africa for years, says reversing the decline in childhood vaccination will require new ingenuity, innovation and resources.

“It’s like we’re in a new world — those emergencies aren’t going away,” he said. “We will still have Covid-19. We will still have climate crises. We must learn how to act in the face of many public health emergencies.

Dominguez said the Covid-19 vaccine efforts could provide some lessons for how to handle it. Brazil has achieved high vaccination coverage by providing pop-up vaccination posts and making vaccinations available at night and on weekends.

Caprani said that despite the renewed interest in global health cooperation due to COVID-19, investing in new monitoring measures and other innovations could distract from the simple intervention needed to tackle the childhood immunization crisis: the deployment of thousands of community health workers.

“We’re not going to solve this with poster campaigns or social media posts,” she said. “It means honest, well-trained, properly compensated community health workers who are building trust – day in and day out – will listen to you about vaccines. And they are not enough.

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