According to a recent publication in the CDC’s Morbidity and Mortality Weekly Report, in 2021 routine vaccination coverage among infants plunged to a 13-year low globally. Researchers from the CDC, World Health Organization, and United Nations International Children’s Emergency Fund revealed that globally, 25 million children (representing 19% of the target population) were unvaccinated or incompletely vaccinated with three doses of diphtheria-tetanus-pertussis–containing vaccine (DTPcv) in 2021—5.9 million more than in 2019.

Global estimates of coverage with three doses of DTPcv (DTPcv3) decreased from an average of 86% during 2015-2019 to 83% in 2020 and 81% in 2021.

The researchers also indicated that in 2021, the number of infants who did not receive any DTPcv dose by age 12 months (18.2 million) was 37% higher than in 2019 (13.3 million). Coverage with the first dose of measles-containing vaccine (MCV1) decreased from an average of 85% during 2015-2019 to 84% in 2020 and 81% in 2021. These are the lowest coverage levels for DTPcv3 and MCV1 since 2008. Global coverage estimates were also lower in 2021 than in 2020 and 2019 for bacillus Calmette-Guérin vaccine (BCG), as well as for the completed series of Haemophilus influenzae type b vaccine (Hib), hepatitis B vaccine (HepB), polio vaccine (Pol), and rubella-containing vaccine (RCV).

Global coverage during 2019-2021 decreased for all of the following recommended childhood vaccines: BCG, from 88% to 84%; the completed Hib series, from 73% to 71%; RCV, from 69% to 66%; 3-dose HepB series, from 85% to 80%; HepB birth dose, from 44% to 42%; and the third Pol dose, from 86% to 80%.

Global coverage with the first dose of human papillomavirus vaccine among females declined from 20% in 2019 to 15% in 2021, and with the last dose, from 14% in 2019 to 12% in 2021. Global PCV3 coverage was stagnant (50% in 2019, 51% in 2020, and 51% in 2021), and coverage with the final dose of rotavirus vaccine series expanded from 40% in 2019 to 49% in 2021.

The authors wrote, “The COVID-19 pandemic has resulted in disruptions to routine immunization services worldwide. Full recovery to immunization programs will require context-specific strategies to address immunization gaps by catching up missed children, prioritizing essential health services, and strengthening immunization programs to prevent outbreaks.”

The authors also indicated that the prolonged decline in vaccination coverage during 2020-2021 was linked to numerous factors, including overburdened healthcare systems triggered by the COVID-19 pandemic, combined with delivery of COVID-19 vaccines. Additionally, these stresses have led to challenges with supply chains, human resources, and financing. Other factors that may have contributed to the vaccine declines in some countries may include vaccine misinformation, disinformation, and hesitancy. The authors stressed, “ The risk of vaccine-preventable disease outbreaks is likely to persist if urgent action is not taken to recover immunization program losses.”

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