Global immunisation coverage in biggest dip for 30 years

The World Health Organization (WHO) and UNICEF have issued a joint warning of the ‘largest sustained decline’ in childhood vaccinations for around three decades.
 
It reported a fall in the percentage of children who received three doses of the vaccine against diphtheria, tetanus and pertussis (DTP), reducing to 81% [MW1] between 2019 and 2021.
 
The organisations state that 25 million children missed out on one or more doses last year, two million more than in 2020 and six million more than in 2019.
 
The coverage of human papillomavirus (HPV) vaccines has also receded by a quarter, with the WHO saying it would have ‘grave consequences for the health of women and girls’.
 
Professor Kristine Macartney, the director of the National Centre for Immunisation Research and Surveillance (NCIRS), describes the trend as ‘absolutely devastating’.
 
‘It’s terrible for the health of children, it’s terrible for populations and communities, and it’s a tremendous challenge globally,’ she told newsGP.
 
While she said that coverage in Australia has stayed relatively constant – as shown by data published by the Department of Health (DoH) –  the pandemic has placed pressure on the system.
 
‘Our challenge in Australia is equity in terms of any vaccines, being able to catch up those who aren’t in school because they’ve dropped out early, lower socioeconomic groups,’ Professor Macartney said.
 
‘That’s an ongoing challenge … but I think the pandemic will have exacerbated that.’
 
The DoH shows that immunisation coverage among one-year-olds, two-year-olds and five-year-olds remained well above 90% in 2021, registering a very slight dip compared to 2020.
 
Of the children who missed on the DTP coverage internationally, 18 million are believed not to have had a single dose of DTP, most from low- or middle-income countries such as Australia’s nearest neighbour, Indonesia.
 
Conflict, increasing misinformation, supply issues caused by the pandemic, and depleted healthcare resources have all contributed to the decline, the organisations state, with Catherine Russell, UNICEF Executive Director, describing the trend as ‘a red alert’. She said the decline in vaccination coverage will be ‘counted in lives’.
 
While Australian vaccination rates may have largely held up so far, there is no room for complacency says Professor Julie Leask, a social scientist specialising in immunisation at the University of Sydney's School of Nursing and Midwifery.
 
‘So far when you compare us with other countries, we have done really well in sustaining high coverage of childhood vaccines,’ Professor Leask told newsGP.
 
‘The convenient sort of childhood vaccine drop-in clinic or the state-based service that took the vaccines out to people is suffering from workforce shortages, and a big shrinkage of funding.
 
‘That may also now be affecting routine immunisation access, particularly in regional and rural and remote areas.’
 
She also says disruptions to school immunisation programs due to the pandemic in Australia have caused ‘a documented drop’ in HPV vaccination coverage the country.
 
‘We need to keep an eye on our vaccination rates for children, and if we see them going lower, not assume it’s just hesitancy,’ Professor Leask said.
 
‘We need to have a full, holistic assessment based on data of why vaccination rates are low, or why they drop. The same goes for [other] countries.’
 
Professor Macartney says the same pressures affecting so many health professionals are also an issue for immunisations.
 
‘Health services are stretched across the board, we’ve got a finite number of people in our healthcare system,’ she said.
 
‘When we see that we have to respond to more COVID cases, for example, that may mean that other health programs – immunisation, but also other preventive health programs – are going to be challenged, it is inevitable.
 
‘But Australia’s adopted a lot of good strategies to try to maintain services, and we have to keep looking at what’s working well, and where we have those genuine gaps.’
 
As for the international situation, Professor Leask said the trend is disappointing but expected.
 
‘We’ve known it was coming since the pandemic began and we knew that it would disrupt immunisation services,’ she said.
 
‘There [are] very deep concerns about the return of measles epidemics in particular.’
 
She also highlighted the statistic showing the number of children missing first doses.
 
‘That’s deeply concerning, because those first doses are usually the most important ones for children,’ Professor Leask said.
 
‘The importance of building trust and community engagement is very clear. When you look at how we help you improve vaccination rates, particularly in low-and-middle income countries, having good community engagement seems to make quite a big difference.’

Professor Leask points out that, prior to the pandemic, the WHO cited vaccine hesitancy as one of the biggest threats to global health – but believes the organisation is under-resourced in their headquarters with people tasked to address hesitancy and uptake.
 
Dr Rod Pearce, an Adelaide GP and the Chair of the Immunisation Coalition, told newsGP the WHO data reveal how a drop in vaccine coverage means ‘you’re going to have those diseases you don’t need to have’.
 
He says the DoH figures show how immunisations in general practice have held up well in Australia despite the pandemic, and notes the recommendations of the WHO and UNICEF for strategies to build trust in vaccines and immunisation programs.
 
‘That’s where general practice is strong, and Australia, when it invests in general practice, that gets results,’ he said.
 
In the meantime, work being carried out through the Australian Regional Immunisation Alliance to help improve coverage in international neighbours will continue, according to Professor Macartney.
 
‘We’re genuinely trying to step up our support to the region,’ she said.
 
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