New data shows confidence in childhood vaccines falling by up to 44 percentage points in some countries during the COVID-19 pandemic

NEW YORKApril 20, 2023 The public Perceptions of the importance of vaccines for children have declined during the COVID-19 pandemic in 52 of 55 countries studied, UNICEF warned today in a new report on immunization.

The State of the Worlds Children 2023: For every child, vaccination reveals that perceptions of the importance of vaccines for children have decreased by more than a third in the Republic of Korea, Papua New Guinea, Ghana, Senegal and Japan since the start of the pandemic. In the new data, compiled by The Vaccine Confidence Project and released today by UNICEF, China, India and Mexico were the only countries studied where the data indicate that perceptions of the importance of vaccines have remained steadfast or even improved. In most countries, people under 35 and women were more likely to report lower confidence in children’s vaccines after the pandemic began.*

Confidence in vaccines is volatile and time-specific. More data collection and analysis will be needed to determine if the results are indicative of a long-term trend. Despite the declines, overall support for vaccines remains relatively strong. In almost half of the 55 countries studied, more than 80% of respondents perceived vaccines as important for children.

However, the report cautions that the confluence of several factors suggests the threat of vaccine hesitancy may be growing. These factors include uncertainty about the pandemic response, growing access to misleading information, declining trust in expertise, and political polarization.

At the height of the pandemic, scientists rapidly developed vaccines that saved countless lives. But despite this historic achievement, fear and misinformation about all types of vaccines have circulated as much as the virus itself, said Catherine Russell, UNICEF Executive Director. This data is a worrying alarm signal. We cannot allow reliance on routine vaccinations to become another casualty of the pandemic. Otherwise, the next wave of deaths could be more children with measles, diphtheria or other preventable diseases.

Alarmingly, the decline in confidence comes amid the largest sustained decline in childhood immunization in 30 years, fueled by the COVID-19 pandemic. The pandemic has disrupted childhood vaccination almost everywhere, notably due to intense demands on health systems, the diversion of immunization resources towards COVID-19 vaccination, shortages of health workers and stay-at-home measures.

Today’s report warns that a total of 67 million children have missed out on vaccinations between 2019 and 2021, with vaccination coverage levels declining in 112 countries. Babies born shortly before or during the pandemic are now past the age at which they would normally have been vaccinated, underscoring the need for urgent action to recover those who have been lost and prevent deadly disease outbreaks. In 2022, for example, the number of measles cases was more than double the previous year’s total. The number of children paralyzed by polio increased 16 percent year-on-year in 2022. When comparing 2019 to 2021 with the previous three-year period, there was an eightfold increase in the number of children paralyzed by polio, underscoring the need for ensure vaccination efforts are sustained.

The pandemic has also exacerbated existing inequalities. For too many children, especially in the most marginalized communities, vaccination is not yet available, accessible or affordable. Even before the pandemic, progress on vaccination had stalled for nearly a decade as the world struggled to reach the most marginalized children.

Of the 67 million children who missed out on routine vaccination between 2019 and 2021, 48 million did not receive a single routine vaccine, also known as a zero dose. At the end of 2021, India and Nigeria (both countries with very large birth cohorts) had the largest number of dose-free babies, but increases in the number of dose-free babies were particularly notable in Myanmar and the Philippines.

Lost children live in the poorest, most remote and marginalized communities, sometimes affected by conflict. New data produced for the report by the International Center for Equity in Health found that in the poorest households, 1 in 5 children are dose-free, while in the wealthiest households it is only 1 in 20. It found that unvaccinated children often they live in difficult conditions. reach communities such as rural areas or urban slums. They often have mothers who have been unable to go to school and who have little say in family decisions. These challenges are greatest in low- and middle-income countries, where about 1 in 10 children in urban areas are dose-free and 1 in 6 in rural areas. In upper-middle-income countries, there is almost no gap between urban and rural children.

To vaccinate every child, it is critical to strengthen primary health care and provide its frontline workers, mostly women, with the resources and support they need. The report finds that women are at the forefront of delivering vaccinations but face low wages, informal work, a lack of formal training and career opportunities, and threats to their safety.

To address this child survival crisis, UNICEF is calling on governments to redouble their efforts to increase funding for immunization and to work with stakeholders to unlock available resources, including COVID-19 funds, to implement and urgently accelerate vaccination recovery efforts to protect children and prevent epidemics.

The report urges governments to:

• Urgently identify and reach all children, especially those who have missed their vaccinations during the COVID-19 pandemic
• Strengthen demand for vaccines, including by building confidence
• Prioritize funding for immunization services and primary health care
• Build resilient health systems by investing in female health workers, innovation and local manufacturing

Vaccinations have saved millions of lives and protected communities from deadly epidemics, said Catherine Russell. We know all too well that disease does not respect borders. Routine vaccinations and robust health systems are our best weapon in preventing future pandemics, deaths and unnecessary suffering. With resources still available from the COVID-19 vaccination campaign, now is the time to redirect those funds to strengthen immunization services and invest in sustainable systems for every child.

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Notes to editors:

The state of the world’s children is the flagship report from UNICEF. The 2023 edition is the first edition of the report exclusively dedicated to routine immunisation. UNICEF reaches nearly half of the world’s children each year with life-saving vaccines.

*The Vaccine Confidence Project (VCP) at the London School of Hygiene & Tropical Medicine has been monitoring vaccine confidence since 2015 by analyzing data from nationally representative national surveys. The data presented in this report is from a large-scale retrospective study of changes in vaccine confidence between 2015 and November 2019 and since 2021. The data in this report represents a subset of a more comprehensive dataset collected by the VCP. You can explore the entire data set using this interactive map tool.