The State of the World’s Children in 2023: Reduced immunization rates leave many children vulnerable to preventable diseases

GABORONE—On 20^th April 2023, UNICEF launched its annual State of the World Children’s report. Each report focuses on a key issue affecting children - this year the overarching theme is immunization. The report reveals that globally a total of 67 million children missed out on vaccinations between 2019 and 2021, with vaccination coverage levels decreasing in 112 countries. Children born just before or during the COVID-19 pandemic are now moving past the age when they would normally be vaccinated, underscoring the need for urgent action to catch up for those who were missed and prevent deadly disease outbreaks.

In 2022, the number of measles cases globally was more than double the total in the previous year. The number of children paralysed by polio was up 16 per cent year-on-year in 2022. When comparing the 2019 to 2021 period with the previous three-year period, there was an eight-fold increase in the number of children paralysed by polio, highlighting the need for enhanced and sustained vaccination efforts.

Similar to these global trends, data from the Ministry of Health in Botswana show that there has been a decline in routine immunization coverage since the beginning of the COVID-19 pandemic. For example, national routine immunization coverage for the pentavalent vaccine (a critical vaccine that prevents five childhood diseases) declined from 79% in  2019 to  70% in 2021.

This continued decline in  routine immunization coverage  has recently resulted in outbreaks of vaccine-preventable diseases, including the polio outbreak declared in October 2022 which triggered two rounds of polio immunization campaigns.

“We applaud the collaboration between the Government of Botswana and its partners in rolling out two rounds of polio vaccination activities nationwide. Thanks to the leadership of the Ministry of Health Government, the campaign reached 81% of children under the age of 7. There is, however,  a need to  enhance surveillance and strengthen routine immunization to ensure that children who were missed during the campaign are reached, since the effects of polio can be irreversible “said UNICEF Representative Dr. Joan Matji.

In Botswana, the Expanded Programme on Immunization (EPI) within the Ministry of Health leads on delivering immunization services to children. While progress has been made in integrating immunization into delivery of primary healthcare services, there are children in remote, low-income and marginalized communities that have never accessed immunization services and therefore live in so-called “zero-dose communities”. Some of the causes underlying low routine immunization rates in Botswana are linked to the COVID-19 pandemic which interrupted childhood vaccination due to intense demands on health systems, the diversion of immunization resources to COVID-19 vaccination, health worker shortages and lockdowns.  In addition, the pandemic also exacerbated existing inequities for children living in hard-to-reach communities, which disproportionately suffer from limited access to services, commodities and personnel for health service delivery.

UNICEF has been supporting the Government of Botswana throughout the COVID-19 response, in particular through procurement of cold chain equipment for health facilities, regional vaccine stores and the central medical store. This was embedded within a broader strategy to strengthen all aspects of vaccine management and routine immunization systems through technical assistance.  Furthermore, UNICEF provides technical assistance to the Ministry of Health on risk communication and community engagement, especially to design targeted strategies to address vaccine-hesitancy.

To accelerate progress towards full vaccination of every child living in Botswana, UNICEF recommends the following:

• Urgently identify and reach all children, especially those who missed routine vaccinations during the COVID-19 pandemic;
• Support capacity-building at district and national levels for better immunization microplanning to map target populations and serve hard-to-reach communities with integrated PHC services, including routine immunization services;
• Strengthen demand for routine immunization and primary health care services through enhanced community engagement strategies, especially with vaccine-hesitant and zero-dose communities;
• Prioritize domestic financing for procurement and administration of both traditional and new vaccines, particularly targeting hard to reach areas and zero dose communities.