Health workers administer COVID-19 vaccine shots to residents in Los Angeles, the United States, on Dec. 17, 2022. [Photo/Xinhua]

Two UN agencies on Monday called for a catch-up in child immunization, warning global vaccinations of children stalled last year, leaving 2.7 million unvaccinated or with insufficient inoculations.

The latest World Health Organization (WHO) and the UN Children's Fund (UNICEF) estimates of national immunization coverage provide the world's largest and most comprehensive dataset on immunization trends for vaccinations against 14 diseases. The estimates "underscore the need for ongoing catch-up, recovery and system-strengthening efforts."

They said childhood immunization levels stalled in 2023, compared to pre-pandemic levels in 2019, leaving many without life-saving protection, notably from measles. New data reveals that nearly three in four infants live in countries where low vaccine coverage is driving measles outbreaks.

"The latest trends demonstrate that many countries continue to miss far too many children," said UNICEF Executive Director Catherine Russell. "Closing the immunization gap requires a global effort, with governments, partners, and local leaders investing in primary healthcare and community workers to ensure every child gets vaccinated and that overall healthcare is strengthened."

The agencies' data shows the number of children who received three doses of the vaccine against diphtheria, tetanus and pertussis (DTP) in 2023 -- a key marker for global immunization coverage -- stalled at 84 percent (108 million). However, the number of children who did not receive a single dose of the vaccine increased from 13.9 million in 2022 to 14.5 million in 2023.

"More than half of unvaccinated children live in the 31 countries with fragile, conflict-affected and vulnerable settings, where children are especially vulnerable to preventable diseases because of disruptions and lack of access to security, nutrition, and health services," they said. "Additionally, 6.5 million children did not complete their third dose of the DTP vaccine, which is necessary to achieve disease protection in infancy and early childhood."

The agencies said their data indicates, alarmingly, that global immunization coverage has been largely unchanged since 2022 and has not returned to 2019 levels. This reflects challenges with disruptions in healthcare services, logistics, vaccine hesitancy and inequities in access to services. The data shows that vaccination rates against the deadly measles disease have also stalled, leaving nearly 35 million children with no or only partial protection.

"In 2023, only 83 percent of children worldwide received their first dose of the measles vaccine through routine health services, while the number of children receiving their second dose modestly increased from the previous year, reaching 74 percent of children," the agencies said. "These figures fall short of the 95 percent coverage needed to prevent outbreaks, avert unnecessary disease and deaths, and achieve measles elimination goals."

They said that over the last five years, measles outbreaks hit 103 countries, home to roughly three-quarters of the world's infants. Low vaccine coverage -- 80 percent or less -- was a significant factor. In contrast, 91 countries with solid measles vaccine coverage did not experience outbreaks.

"Measles outbreaks are the canary in the coalmine, exposing and exploiting gaps in immunization and hitting the most vulnerable first," said Tedros Adhanom Ghebreyesus, the WHO director-general. "This is a solvable problem. Measles vaccine is cheap and can be delivered even in the most difficult places. WHO is committed to working with all our partners to support countries to close these gaps and protect the most at-risk children as quickly as possible."

On the brighter side, the agencies reported that global human papillomavirus (HPV) vaccine coverage among girls increased substantially. The steady introduction of new and under-utilized vaccines, including HPV, meningitis, pneumococcal, polio and rotavirus disease, continue to expand protection, particularly in the 57 countries supported by Gavi, the Vaccine Alliance.

For example, they said the share of adolescent girls globally who received at least one dose of the HPV vaccine, which provides protection against cervical cancer, increased from 20 percent in 2022 to 27 percent in 2023. This increase was largely driven by strong introductions in Gavi-supported countries, such as Bangladesh, Indonesia, and Nigeria, with the use of the single-dose HPV vaccine schedule helping to boost vaccine coverage.

"The HPV vaccine is one of the most impactful vaccines in Gavi's portfolio, and it is incredibly heartening that it is now reaching more girls than ever before," said Sania Nishtar, chief executive officer of Gavi. "With vaccines now available to over 50 percent of eligible girls in African countries, we have much work to be done, but today we can see we have a clear pathway to eliminating this terrible disease."

However, the agencies said that HPV vaccine coverage is well below the 90 percent target to eliminate cervical cancer as a public health problem, reaching only 56 percent of adolescent girls in high-income countries and 23 percent in low- and middle-income countries.

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