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A quick look: the state of routine immunization in Europe and Central Asia

https://www.unicef.org/eca/quick-look-state-routine-immunization-europe-and-central-asia

Immunization allows children everywhere to live lives free of many forms of disability and illness. UNICEF's The State of the World’s Children 2023 highlights the current situation of immunization for children globally. UNICEF's regional brief for Europe and Central Asia demonstrate that public demand, scientific innovations and – perhaps above all – political will can drive rapid change. Now is a time for determination. Now is a time for political will. Now is the time to protect the health of every child. Girl receiving a HPV vaccine. 67 million children Between 2019 and 2021, 67 million children across the world missed out on routine vaccinations. 2-month-old gets vaccinated by Nurse as part of his routine childhood immunization session. 327,400 children 327,400 are “zero-dose” and “under-vaccinated” children. That means they have not received any vaccinations or the third required dose of the diphtheria-pertussis-tetanus (DPT3) vaccine. Nurse in office 29 countries 29 countries in the region found a decrease in the perception of the importance of vaccines for children. 3-month-old gets vaccinated in Tajikistan One million Nearly one million of children who missed one or several routine vaccinations live in Europe and Central Asia.

Maintaining routine immunization services vital during the COVID-19 pandemic – WHO and UNICEF

https://www.unicef.org/eca/node/5936

GENEVA/COPENHAGEN, 20 April 2020 - The COVID-19 pandemic is a stark reminder that infectious diseases know no borders. All countries are vulnerable, regardless of income levels or the strength of their health care systems. Across the European Region, where tens of millions of people have been living in lockdown for weeks, and over 100,000 people have died, the speed and devastation of the novel coronavirus has completely upended lives. The urgent need for a COVID-19 vaccine underscores the pivotal role immunizations play in protecting lives and economies. As scientists around the world work to develop a vaccine against the novel coronavirus and health care capacities are stretched in responding to COVID-19, national routine immunization programmes are more critical than ever before. Governments across the Region must use every opportunity possible to protect people from the many diseases for which vaccines are already available. When routine vaccinations are missed, the risk of disease outbreaks increases. In 2018, approximately 527 000 children missed their first-dose of measles-containing vaccine in the WHO European Region. One year later in 2019, the measles virus exposed immunity gaps in Europe, infecting over 100 000 people, across all age-groups. Protecting children, adolescents and adults from vaccine-preventable diseases through vaccination is a must for the sustainability of health care systems. “We know that vulnerability to infectious diseases anywhere is a threat to public health everywhere,” said Ms. Afshan Khan, UNICEF Regional Director for Europe and Central Asia. “It is critical that routine immunization programmes continue during this crisis, while adequately protecting health workers and individuals receiving vaccinations. Reaching the most vulnerable children who have missed routine immunizations in the past should be prioritized.” If, during these unprecedented times, local COVID-19 response measures cause temporary interruptions of routine immunization services, countries should plan to resume immunization services as quickly as possible after the situation stabilizes. Countries should be prepared to vaccinate those at higher risk and ensure everyone, including the most marginalized, will have equal access to a COVID-19 vaccine when it becomes available. “ We can prevent further impact of COVID-19 on our healthcare systems by assuring that individuals of all ages remain vaccinated according to national schedules. I urge countries to maintain immunization service delivery and drive demand for vaccination, through the life-course even at this difficult time. Prioritizing immunization is one of my four flagship areas and central to WHO’s vision for health in the new European Programme of Work” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. WHO and UNICEF will continue to support governments’ efforts to strengthen their immunization programmes, including through strategic planning for equitable provision of immunization, strengthening vaccine-preventable disease surveillance and community engagement and education. As we step into a new future, vaccines will continue to serve as a foundation for health and wellbeing for all. It is through solidarity, joint action and tireless commitment to leaving no one behind that we can create a healthier future together. #Vaccineswork Georgia immunization UNICEF/UN0326765/Georgia

Immunization services begin slow recovery from COVID-19 disruptions, though millions of children remain at risk from deadly diseases – WHO, UNICEF, Gavi

https://www.unicef.org/eca/press-releases/immunization-services-begin-slow-recovery-covid-19-disruptions-though-millions

GENEVA/NEW YORK, 26 April 2021 --- While immunization services have started to recover from disruptions caused by COVID-19, millions of children remain vulnerable to deadly diseases, the World Health Organization (WHO), UNICEF and Gavi, the Vaccine Alliance warned today during World Immunization Week , highlighting the urgent need for a renewed global commitment to improve vaccination access and uptake. “Vaccines will help us end the COVID-19 pandemic but only if we ensure fair access for all countries, and build strong systems to deliver them,” said Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General. “And if we’re to avoid multiple outbreaks of life-threatening diseases like measles, yellow fever and diphtheria, we must ensure routine vaccination services are protected in every country in the world.” A WHO survey has found that, despite progress when compared to the situation in 2020, more than one third of respondent countries (37%) still report experiencing disruptions to their routine immunization services. Mass immunization campaigns are also disrupted. According to new data, 60 of these lifesaving campaigns are currently postponed in 50 countries, putting around 228 million people - mostly children - at risk for diseases such as measles, yellow fever and polio. Over half of the 50 affected countries are in Africa, highlighting protracted inequities in people’s access to critical immunization services. Campaigns to immunize against measles, which is one of the most contagious diseases and can result in large outbreaks wherever people are unvaccinated, are the most impacted. Measles campaigns account for 23 of the postponed campaigns, affecting an estimated 140 million people. Many have now been delayed for over a year. “Even before the pandemic, there were worrying signs that we were beginning to lose ground in the fight against preventable child illness, with 20 million children already missing out on critical vaccinations,” said Henrietta Fore, UNICEF Executive Director. “The pandemic has made a bad situation worse, causing millions more children to go unimmunized. Now that vaccines are at the forefront of everyone’s minds, we must sustain this energy to help every child catch up on their measles, polio and other vaccines. We have no time to waste. Lost ground means lost lives.” As a result of gaps in vaccination coverage, serious measles outbreaks have recently been reported in countries including the Democratic Republic of the Congo, Pakistan and Yemen, while likely to occur elsewhere as growing numbers of children miss out on lifesaving vaccines, the agencies warn. These outbreaks are happening in places already grappling with conflict situations as well as service disruptions due to ongoing response measures to COVID-19. The supply of vaccines and other equipment is also essential for child vaccinations. Due to disruptions at the onset of the COVID -19 pandemic, UNICEF delivered 2.01 billion vaccine doses in 2020, compared to 2.29 billion in 2019. “Millions of children across the world are likely to miss out on basic vaccines as the current pandemic threatens to unravel two decades of progress in routine immunization”, said Dr Berkley, CEO of Gavi, the Vaccine Alliance. “To support the recovery from COVID-19 and to fight future pandemics, we will need to ensure routine immunization is prioritized as we also focus on reaching children who do not receive any routine vaccines, or zero-dose children. To do this, we need to work together – across development agencies, governments and civil society – to ensure that no child is left behind”.

New data indicates declining confidence in childhood vaccines of up to 44 percentage points in some countries during the COVID-19 pandemic

https://www.unicef.org/eca/press-releases/sowc-2023

NEW YORK, 20 April 2023 – The public perception of the importance of vaccines for children declined during the COVID-19 pandemic in 52 out of 55 countries studied, UNICEF warned today in a new report on immunization. The State of the World’s Children 2023: For Every Child, Vaccination reveals the perception of the importance of vaccines for children declined by more than a third in the Republic of Korea, Papua New Guinea, Ghana, Senegal and Japan after the start of the pandemic. In the new data, collected by The Vaccine Confidence Project and published today by UNICEF, China, India and Mexico were the only countries studied where the data indicates the perception of the importance of vaccines held firm or even improved. In most countries, people under 35 and women were more likely to report less confidence about vaccines for children after the start of the pandemic.* Vaccine confidence is volatile and time specific. Additional data collection and further analysis will be required to determine if the findings are indicative of a longer-term trend. Despite the falls, overall support for vaccines remains relatively strong. In almost half the 55 countries studied more than 80 per cent of respondents perceived vaccines as important for children. However, the report warns the confluence of several factors suggest the threat of vaccine hesitancy may be growing. These factors include uncertainty about the response to the pandemic, growing access to misleading information, declining trust in expertise, and political polarisation. “At the height of the pandemic, scientists rapidly developed vaccines that saved countless lives. But despite this historic achievement, fear and disinformation about all types of vaccines circulated as widely as the virus itself,” said Catherine Russell, UNICEF Executive Director. “This data is a worrying warning signal. We cannot allow confidence in routine immunizations to become another victim of the pandemic. Otherwise, the next wave of deaths could be of more children with measles, diphtheria or other preventable diseases.” “This data is a worrying warning signal. We cannot allow confidence in routine immunizations to become another victim of the pandemic. Otherwise, the next wave of deaths could be of more children with measles, diphtheria or other preventable diseases.” Alarmingly, the decline in confidence comes amid the largest sustained backslide in childhood immunisation in 30 years , fuelled by the COVID-19 pandemic. The pandemic interrupted childhood vaccination almost everywhere, especially due to intense demands on health systems, the diversion of immunization resources to COVID-19 vaccination, health worker shortages and stay-at-home measures. Today’s report warns 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 pandemic are now moving past the age when they would normally be vaccinated, underscoring the need for urgent action to catch up on those who were missed and prevent deadly disease outbreaks. In 2022, for example, the number of measles cases 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 to ensure vaccination efforts are sustained. The pandemic also exacerbated existing inequities. For far too many children, especially in the most marginalised communities, vaccination is still not available, accessible or affordable. Even before the pandemic, progress on vaccination had stalled for almost a decade as the world struggled to reach the most marginalised children. Of the 67 million children who missed out on routine vaccination between 2019 and 2021, 48 million didn’t receive a single routine vaccine, also known as “zero-dose”. As of the end of 2021, India and Nigeria (both countries with very large birth cohorts) had the largest numbers of zero-dose children but increases in the numbers of zero-dose children were especially notable in Myanmar and the Philippines. The children who are missing out live in the poorest, most remote and marginalized communities, at times impacted 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 zero-dose while in the wealthiest, it is just 1 in 20. It found unvaccinated children often live in hard-to-reach communities such as rural areas or urban slums. They often have mothers who have not been able to go to school and who are given 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 zero dose 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 vital to strengthen primary health care and provide its mostly female front-line workers with the resources and support they need. The report finds women are at the front line of delivering vaccinations, but they face low pay, informal employment, lack of formal training and career opportunities and threats to their security. “We know all too well that diseases do not respect borders. Routine immunizations and strong health systems are our best shot at preventing future pandemics, unnecessary deaths and suffering." To address this child survival crisis, UNICEF is calling on governments to double-down on their commitment to increase financing for immunization and to work with stakeholders to unlock available resources, including leftover COVID-19 funds, to urgently implement and accelerate catch-up vaccination efforts to protect children and prevent disease outbreaks. The report is urging governments to: Urgently identify and reach all children, especially those who missed vaccinations during the COVID-19 pandemic Strengthen demand for vaccines, including by building confidence Prioritise funding to immunization services and primary health care Build resilient health systems through investment in female health workers, innovation and local manufacturing “Immunizations have saved millions of lives and protected communities from deadly disease outbreaks,” said Catherine Russell. “We know all too well that diseases do not respect borders. Routine immunizations and strong health systems are our best shot at preventing future pandemics, unnecessary deaths and suffering. With resources still available from the COVID-19 vaccination drive, now is the time to redirect those funds to strengthen immunization services and invest in sustainable systems for every child.” A baby is inoculated against rotavirus in a clinic in Hopital Immaculée Conception, the largest hospital in Les Cayes, Departement du Sud, Haiti. UNICEF/U.S. CDC/UN0695667/Roger LeMoyne

UNICEF reaches almost half of the world’s children with life-saving vaccines

https://www.unicef.org/eca/press-releases/half-children-life-saving-vaccines

NEW YORK, 26 April 2017 – UNICEF procured 2.5 billion doses of vaccines to children in nearly 100 countries in 2016, reaching almost half of the world’s children under the age of five. The figures, released during World Immunization Week, make UNICEF the largest buyer of vaccines for children in the world. Nigeria, Pakistan and Afghanistan, the three remaining polio-endemic countries, each received more doses of vaccines than any other country, with almost 450 million doses of vaccines procured to children in Nigeria, 395 million in Pakistan and over 150 million in Afghanistan. UNICEF is the lead procurement agency for the Global Polio Eradication Initiative. Access to immunization has led to a dramatic decrease in deaths of children under five from vaccine-preventable diseases, and has brought the world closer to eradicating polio. Between 2000 and 2015, under five deaths due to measles declined by 85 per cent and those due to neonatal tetanus by 83 per cent. A proportion of the 47 per cent reduction in pneumonia deaths and 57 per cent reduction in diarrhea deaths in this time is also attributed to vaccines. Yet an estimated 19.4 million children around the world still miss out on full vaccinations every year. Around two thirds of all unvaccinated children live in conflict-affected countries. Weak health systems, poverty and social inequities also mean that 1 in 5 children under five is still not reached with life-saving vaccines. “All children, no matter where they live or what their circumstances are, have the right to survive and thrive, safe from deadly diseases,” said Dr. Robin Nandy, Chief of Immunization at UNICEF. “Since 1990, immunization has been a major reason for the substantial drop in child mortality, but despite this progress, 1.5 million children still die from vaccine preventable diseases every year.” Inequalities persist between rich and poor children. In countries where 80 per cent of the world’s under-five child deaths occur, over half of the poorest children are not fully vaccinated. Globally, the poorest children are nearly twice as likely to die before the age of five as the richest. “In addition to children living in rural communities where access to services is limited, more and more children living in overcrowded cities and slum dwellings are also missing out on vital vaccinations,” said Nandy. “Overcrowding, poverty, poor hygiene and sanitation as well as inadequate nutrition and health care increase the risk of diseases such as pneumonia, diarrhea and measles in these communities; diseases that are easily preventable with vaccines.” By 2030, an estimated 1 in 4 people will live in urban poor communities, mainly in Africa and Asia, meaning the focus and investment of immunization services must be tailored to the specific needs of these communities and children, UNICEF said. NOTES TO EDITORS: UNICEF works with World Health Organization (WHO), Gavi, the Vaccine Alliance, the Bill & Melinda Gates Foundation and others to ensure that vaccines protect all children – especially those who are the hardest to reach and the most vulnerable. World Immunization Week runs from 24 – 28 April 2017. For more information visit: www.unicef.org/immunization Immunisation session at Family Medicine Center #1 of Osh city, Kyrgyzstan UNICEF/UN041255/Pirozzi

Confidence in childhood vaccines declines across Europe and Central Asia – new UNICEF report

https://www.unicef.org/eca/press-releases/confidence-childhood-vaccines-declines-across-europe-and-central-asia-new-unicef

NEW YORK, 20 April 2023 – The public perception of the importance of childhood vaccines has declined across Europe and Central Asia since the onset of the COVID-19 pandemic, according to a new analysis of data from 55 countries worldwide – 29 of which are in Europe and Central Asia. The analysis is featured in a new report published today by UNICEF. The State of the World’s Children 2023: For Every Child, Vaccination is the most comprehensive assessment of routine immunization ever produced by UNICEF. It notes that in the 29 countries in Europe and Central Asia featured in the analysis, the perception of the importance of vaccines for children has declined by more than 10 percentage points. In the majority of countries analysed, people under 35-years-old and women were most likely to have reported less confidence in childhood vaccines. “The decline in confidence in childhood vaccines is deeply concerning. Immunization is one of humanity’s most remarkable success stories. Too many lives are at stake to let it fall prey to a wave of fear and misinformation fuelled by the pandemic.” “The decline in confidence in childhood vaccines is deeply concerning. Immunization is one of humanity’s most remarkable success stories. Too many lives are at stake to let it fall prey to a wave of fear and misinformation fuelled by the pandemic,” said Philippe Cori, UNICEF Deputy Regional Director for Europe and Central Asia. The decline in confidence comes amid the largest sustained backslide in childhood immunisation in 30 years . The pandemic interrupted childhood vaccination almost everywhere, largely due to intense demands on health systems, the diversion of immunization resources to COVID-19 vaccination, health worker shortages and stay-at-home measures. As a result, 67 million children globally missed out on routine vaccinations between 2019 and 2021, with vaccination coverage levels decreasing in 112 countries. Nearly one million of children who missed one or several routine vaccinations live in Europe and Central Asia. Among whom, 327,400 are “zero-dose” – children who have not received any vaccinations, and “under-vaccinated” children – those who have not received the third required dose of the diphtheria-pertussis-tetanus (DPT3) vaccine – critical markers in immunization coverage. Bosnia and Herzegovina, Kyrgyzstan, Moldova, North Macedonia and Ukraine have among the highest rates of zero-dose children in the region. Bosnia and Herzegovina, Georgia, Montenegro, Romania and Ukraine have among the highest rates of under-vaccinated children. The pandemic also exacerbated existing inequities. Vast gaps in immunization coverage exist among Roma children, one of Europe’s largest and most marginalised minority groups. UNICEF is calling on governments to double-down on their commitment to increase financing for immunization and to work with stakeholders to unlock available resources, including leftover COVID-19 funds, to urgently implement and accelerate catch-up vaccination efforts to protect children and prevent disease outbreaks. The report features a set of recommendations for governments including: Urgently identify and reach all children, especially those who missed vaccinations during the COVID-19 pandemic Strengthen confidence in and demand for vaccines, including by working closely with communities to address their vaccination needs and concerns Prioritise funding to immunization services and primary health care Build resilient health systems through investment in female health workers, innovation and local manufacturing “Immunization is central in protecting children’s health and well-being. To minimize outbreaks of vaccine-preventable disease, and unnecessary suffering, we urge governments and donors to redirect leftover COVID-19 funds to strengthen immunization services and ensure that routine immunization reach all children, wherever they are,” said Cori. A small child gets vaccinated. UNICEF/U.S. CDC/UN0749657/Christina Pashkina

UNICEF and WHO warn of ‘perfect storm’ of conditions for measles outbreaks, affecting children

https://www.unicef.org/eca/press-releases/unicef-and-who-warn-perfect-storm-conditions-measles-outbreaks-affecting-children

NEW YORK/ GENEVA, 27 April 2022 – An increase in measles cases in January and February 2022 is a worrying sign of a heightened risk for the spread of vaccine-preventable diseases and could trigger larger outbreaks, particularly of measles affecting millions of children in 2022, warn WHO and UNICEF. Pandemic-related disruptions, increasing inequalities in access to vaccines, and the diversion of resources from routine immunization are leaving too many children without protection against measles and other vaccine-preventable diseases. The risk for large outbreaks has increased as communities relax social distancing practices and other preventive measures for COVID-19 implemented during the height of the pandemic. In addition, with millions of people being displaced due to conflicts and crises including in Ukraine, Ethiopia, Somalia and Afghanistan, disruptions in routine immunization and COVID-19 vaccination services, lack of clean water and sanitation, and overcrowding increase the risk of vaccine-preventable disease outbreaks. Almost 17,338 measles cases were reported worldwide in January and February 2022, compared to 9,665 during the first two months of 2021. As measles is very contagious, cases tend to show up quickly when vaccination levels decline. The agencies are concerned that outbreaks of measles could also forewarn outbreaks of other diseases that do not spread as rapidly. Apart from its direct effect on the body, which can be lethal, the measles virus also weakens the immune system and makes a child more vulnerable to other infectious diseases like pneumonia and diarrhoea, including for months after the measles infection itself among those who survive. Most cases occur in settings that have faced social and economic hardships due to COVID-19, conflict, or other crises, and have chronically weak health system infrastructure and insecurity. “Measles is more than a dangerous and potentially deadly disease. It is also an early indication that there are gaps in our global immunization coverage, gaps vulnerable children cannot afford,” said Catherine Russell, UNICEF Executive Director. “It is encouraging that people in many communities are beginning to feel protected enough from COVID-19 to return to more social activities. But doing so in places where children are not receiving routine vaccination creates the perfect storm for the spread of a disease like measles.” In 2020, 23 million children missed out on basic childhood vaccines through routine health services, the highest number since 2009 and 3.7 million more than in 2019. Top 5 countries with reported measles cases in the last 12 months, until April 2022 [1] Country Reported Measles cases Rate per million cases First dose measles coverage (%), 2019 [2] First dose measles coverage (%), 2020 [3] Somalia 9,068 554 46 46 Yemen 3,629 119 67 68 Afghanistan 3,628 91 64 66 Nigeria 12341 58 54 54 Ethiopia 3039 26 60 58 As of April 2022, the agencies report 21 large and disruptive measles outbreaks around the world in the last 12 months. Most of the measles cases were reported in Africa and the East Mediterranean region. The figures are likely higher as the pandemic has disrupted surveillance systems globally, with potential underreporting. Countries with the largest measles outbreaks since the past year include Somalia, Yemen, Nigeria, Afghanistan, and Ethiopia. Insufficient measles vaccine coverage is the major reason for outbreaks, wherever they occur. “The COVID-19 pandemic has interrupted immunization services, health systems have been overwhelmed, and we are now seeing a resurgence of deadly diseases including measles. For many other diseases, the impact of these disruptions to immunization services will be felt for decades to come,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Now is the moment to get essential immunization back on track and launch catch-up campaigns so that everybody can have access to these life-saving vaccines.” As of 1 April 2022, 57 vaccine-preventable disease campaigns in 43 countries that were scheduled to take place since the start of the pandemic are still postponed, impacting 203 million people, most of whom are children. Of these, 19 are measles campaigns, which put 73 million children at risk of measles due to missed vaccinations. In Ukraine, the measles catch-up campaign of 2019 was interrupted due to the COVID-19 pandemic and thereafter due to the war. Routine and catch-up campaigns are needed wherever access is possible to help make sure there are not repeated outbreaks as in 2017-2019, when there were over 115,000 cases of measles and 41 deaths in the country – this was the highest incidence in Europe. Coverage at or above 95 per cent with two doses of the safe and effective measles vaccine can protect children against measles. However, COVID-19 pandemic-related disruptions have delayed the introduction of the second dose of the measles vaccine in many countries. As countries work to respond to outbreaks of measles and other vaccine-preventable diseases, and recover lost ground, UNICEF and WHO, along with partners such as Gavi, the Vaccine Alliance, the partners of the Measles & Rubella Initiative (M&RI), Bill & Melinda Gates Foundation, and others are supporting efforts to strengthen immunization systems by: Restoring services and vaccination campaigns so countries can safely deliver routine immunization programmes to fill the gaps left by the backsliding; Helping health workers and community leaders communicate actively with caregivers to explain the importance of vaccinations; Rectifying gaps in immunization coverage, including identifying communities and people who have been missed during the pandemic; Ensuring that COVID-19 vaccine delivery is independently financed and well-integrated into overall planning for immunization services so that it is not carried out at the cost of childhood and other vaccination services; Implementing country plans to prevent and respond to outbreaks of vaccine-preventable diseases and strengthening immunization systems as part of COVID-19 recovery efforts. ###### Notes to Editors For more information on the 24-30 April WHO World Immunization Week campaign and all resources . [1] Source: Provisional data based on monthly data reported to WHO as of April 2022 [2] Source: WHO/UNICEF estimates of national immunization coverage, 2020 revision. [3] Source: WHO/UNICEF estimates of national immunization coverage, 2020 revision. Vaccination of children UNICEF Skopje, 17 January 2022: With a smile on her face, four-year-old Izabela is sitting in her mum’s lap waiting for MMR (measles, mumps, rubella) re-vaccination in “Gjorce Petrov” Polyclinic.

WHO and UNICEF warn of a decline in vaccinations during COVID-19

https://www.unicef.org/eca/press-releases/who-and-unicef-warn-decline-vaccinations-during-covid-19

GENEVA/NEW YORK, 15 July 2020 – The World Health Organization and UNICEF warned today of an alarming decline in the number of children receiving life-saving vaccines around the world. This is due to disruptions in the delivery and uptake of immunization services caused by the COVID-19 pandemic. According to new data by WHO and UNICEF , these disruptions threaten to reverse hard-won progress to reach more children and adolescents with a wider range of vaccines, which has already been hampered by a decade of stalling coverage. The latest data on vaccine coverage estimates from WHO and UNICEF for 2019 shows that improvements such as the expansion of the HPV vaccine to 106 countries and greater protection for children against more diseases are in danger of lapsing. For example, preliminary data for the first four months of 2020 points to a substantial drop in the number of children completing three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3). This is the first time in 28 years that the world could see a reduction in DTP3 coverage – the marker for immunization coverage within and across countries. “Vaccines are one of the most powerful tools in the history of public health, and more children are now being immunized than ever before,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But the pandemic has put those gains at risk. The avoidable suffering and death caused by children missing out on routine immunizations could be far greater than COVID-19 itself. But it doesn’t have to be that way. Vaccines can be delivered safely even during the pandemic, and we are calling on countries to ensure these essential life-saving programmes continue.” COVID-19 disruptions Due to the COVID-19 pandemic, at least 30 measles vaccination campaigns were or are at risk of being cancelled, which could result in further outbreaks in 2020 and beyond. According to a new UNICEF, WHO and Gavi pulse survey , conducted in collaboration with the US Centers for Disease Control, the Sabin Vaccine Institute and Johns Hopkins Bloomberg School of Public Health, three quarters of the 82 countries that responded reported COVID-19 related disruptions in their immunization programmes as of May 2020. The reasons for disrupted services vary. Even when services are offered, people are either unable to access them because of reluctance to leave home, transport interruptions, economic hardships, restrictions on movement, or fear of being exposed to people with COVID-19. Many health workers are also unavailable because of restrictions on travel or redeployment to COVID response duties as well as a lack of protective equipment. “COVID-19 has made previously routine vaccination a daunting challenge,” said UNICEF Executive Director Henrietta Fore. “We must prevent a further deterioration in vaccine coverage and urgently resume vaccination programs before children’s lives are threatened by other diseases. We cannot trade one health crisis for another.” Stagnating global coverage rate Progress on immunization coverage was stalling before COVID-19 hit, at 85 per cent for DTP3 and measles vaccines. The likelihood that a child born today will be fully vaccinated with all the globally recommended vaccines by the time she reaches the age of 5 is less than 20 per cent. In 2019, nearly 14 million children missed out on life-saving vaccines such as measles and DTP3. Most of these children live in Africa and are likely to lack access to other health services. Two-thirds of them are concentrated in 10 middle- and low-income countries: Angola, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan, and Philippines. Children in middle-income countries account for an increasing share of the burden. Progress and challenges, by country and region There has been some progress. Regional coverage for the third dose of DTP in South Asia has increased by 12 percentage points over the last 10 years, notably across India, Nepal and Pakistan. However, that hard-won progress could be undone by COVID-19 related disruptions. Countries that had recorded significant progress, such as Ethiopia and Pakistan, are now also at risk of backsliding if immunization services are not restored as soon as feasible. The situation is especially concerning for Latin America and the Caribbean, where historically high coverage has slipped over the last decade. In Brazil, Bolivia, Haiti and Venezuela, immunization coverage plummeted by at least 14 percentage points since 2010. These countries are now also confronting moderate to severe COVID19-related disruptions. As the global health community attempts to recover lost ground due to COVID-19 related disruptions, UNICEF and WHO are supporting countries in their efforts to reimagine immunization and build back better by: Restoring services so countries can safely deliver routine immunization services during the COVID-19 pandemic, by adhering to hygiene and physical distancing recommendations and providing protective equipment to health workers; Helping health workers communicate actively with caregivers to explain how services have been reconfigured to ensure safety; Rectifying coverage and immunity gaps; Expanding routine services to reach missed communities, where some of the most vulnerable children live. ### Notes to editors Download photos , the report, data files and b-roll from UNICEF here or from WHO here . After 2pm CET 15 July, read the analysis of the data in this report, Are we losing ground? . Review presentation and graphs related to the data here . Nurses in Kosovo immunizing children when vaccination programme was resumed UNICEF/2020/S.Karahoda Nurses in Kosovo immunizing children when vaccination programme was resumed

19 October 2020

UNICEF to stockpile over half a billion syringes by year end, as part of efforts to prepare for eventual COVID-19 vaccinations

https://www.unicef.org/eca/press-releases/unicef-stockpile-over-half-billion-syringes-year-end-part-efforts-prepare-eventual

NEW YORK, 19 October 2020 – As the world awaits a COVID-19 vaccine, UNICEF has begun laying the groundwork for the rapid, safe and efficient delivery of the eventual vaccine by purchasing and pre-positioning syringes and other necessary equipment. As soon as COVID-19 vaccines successfully emerge from trials and are licensed and recommended for use, the world will need as many syringes as doses of vaccine. To begin preparations, this year, UNICEF will stockpile 520 million syringes in its warehouses, part of a larger plan of 1 billion syringes by 2021, to guarantee initial supply and help ensure that syringes arrive in countries before the COVID-19 vaccines. During 2021, assuming there are enough doses of COVID-19 vaccines, UNICEF anticipates delivering over 1 billion syringes to support COVID-19 vaccination efforts on top of the 620 million syringes that UNICEF will purchase for other vaccination programmes against other diseases such as measles, typhoid and more. “Vaccinating the world against COVID-19 will be one of the largest mass undertakings in human history, and we will need to move as quickly as the vaccines can be produced,” said Henrietta Fore, UNICEF Executive Director. “In order to move fast later, we must move fast now. By the end of the year, we will already have over half a billion syringes pre-positioned where they can be deployed quickly and cost effectively. That’s enough syringes to wrap around the world one and a half times.” In line with the longstanding collaboration between the two partners, Gavi will reimburse UNICEF for the procurement of the syringes and safety boxes, which shall then be used for the COVID-19 Vaccine Global Access Facility (COVAX Facility) and for other Gavi-funded immunization programmes if necessary. Besides syringes, UNICEF is also buying 5 million safety boxes so that used syringes and needles can be disposed in a safe manner by personnel at health facilities, thus preventing the risk of needle stick injuries and blood borne diseases. Every safety box carries 100 syringes. Accordingly, UNICEF is “bundling” the syringes with safety boxes to ensure enough safety boxes are available to go along with the syringes. Injection equipment such as syringes and safety boxes have a shelf life of five years. Lead-times for such equipment are also long as these items are bulky and need to be transported by sea freight. Vaccines , which are heat sensitive, are normally transported more quickly by air freight. In addition to saving time, early purchase of syringes and safety boxes also reduces pressure on the market and pre-empts potential early spikes in demand when vaccines do become available. As the key procurement coordinator for Gavi, the Vaccine Alliance, UNICEF is already the largest single vaccine buyer in the world , procuring more than 2 billion doses of vaccines annually for routine immunization and outbreak response on behalf of nearly 100 countries. Every year, UNICEF provides vaccines for almost half of the world’s children and procures and supplies around 600-800 million syringes for regular immunization programmes. COVID-19 vaccines will likely treble or quadruple that number, depending on the number of COVID-19 vaccines that are ultimately produced and secured by UNICEF. “Over two decades, Gavi has helped an additional 822 million children from the world’s most vulnerable countries access critical, life-saving vaccines,” said Seth Berkley, CEO of Gavi. “This would not have been possible without our partnership with UNICEF, and it is this same collaboration that will be essential to Gavi’s work with the COVAX Facility.” To make sure that vaccines are transported and stored at the right temperature , UNICEF, along with WHO, is also mapping out existing cold chain equipment and storage capacity – in the private as well as public sector – and preparing necessary guidance for countries to receive vaccines. “We are doing everything we can to deliver these essential supplies efficiently, effectively and at the right temperature, as we already do so well all over the world,” Fore said. Even prior to the COVID-19 pandemic, with support from Gavi and in partnership with WHO, UNICEF has been upgrading the existing cold chain equipment across health facilities in countries to ensure that vaccines remain safe and effective throughout their journey. Since 2017, over 40,000 cold-chain fridges, including solar fridges, have been installed across health facilities, mostly in Africa. In most countries, UNICEF is promoting solar technologies to help countries maintain supply chains. In South Sudan , the least electrified country in the world, where temperatures frequently exceed 40 degrees Celsius, more than 700 health facilities have been equipped by UNICEF with solar power fridges, approximately 50 per cent of health facilities in the country. A health volunteer fills a syringe UNICEF/UN070241/Hatcher-Moore

Record number of infants vaccinated in 2017

https://www.unicef.org/eca/press-releases/record-number-infants-vaccinated-2017

New York, 16 July 2018: A record 123 million infants were immunized globally in 2017, according to data released today by the World Health Organization and UNICEF. The data shows that: 9 out of every 10 infants received at least one dose of diphtheria-tetanus-pertussis (DTP) vaccine in 2017, gaining protection against these deadly diseases. An additional 4.6 million infants were vaccinated globally with three doses of the diphtheria-tetanus-pertussis vaccine in 2017 compared to 2010, due to global population growth. 167 countries included a second dose of measles vaccine as part of their routine vaccination schedule and 162 countries now use rubella vaccines. As a result, global coverage against rubella increased from 35 per cent in 2010 to 52 per cent. The human papillomavirus (HPV) vaccine was introduced in 80 countries to help protect women against cervical cancer. Newly available vaccines are being added as part of the life-saving vaccination package – such as those to protect against meningitis, malaria and even Ebola. Despite these successes, almost 20 million children did not receive the benefits of full immunization in 2017. Of these, almost 8 million (40 per cent) live in fragile or humanitarian settings, including countries affected by conflict. In addition, a growing share are from middle-income countries, where inequity and marginalization, particularly among the urban poor, prevent many from getting immunized. As populations grow, more countries need to increase their investments in immunization programmes. To reach all children with much-needed vaccines, the world will need to vaccinate an estimated 20 million additional children every year with three doses of the diphtheria-tetanus-pertussis vaccine (DTP3); 45 million with a second dose of measles vaccine; and 76 million children with 3 doses of pneumococcal conjugate vaccine. In support of these efforts, WHO and UNICEF are working to expand access to immunization by: Strengthening the quality, availability and use of vaccine coverage data. Better targeting resources. Planning actions at sub-national levels and Ensuring that vulnerable people can access vaccination services. Notes to Editors Since 2000, WHO and UNICEF have jointly produced national immunization coverage estimates for each of the 194 WHO Member States on an annual basis. In addition to producing the immunization coverage estimates for 2017, the WHO and UNICEF estimation process revises the entire historical series of immunization data with the latest available information. The 2017 revision covers 37 years of coverage estimates, from 1980 to 2017. Related links WHO/UNICEF 2017 country and regional immunization coverage data Global Vaccine Action Plan 2012-2020 A baby girl receives her vaccination at a clinic in Serbia. UNICEF/UN040869/Bicanski A baby girl receives her vaccination at a clinic in Serbia.

More than 117 million children at risk of missing out on measles vaccines, as COVID-19 surges

https://www.unicef.org/eca/press-releases/more-117-million-children-risk-missing-out-measles-vaccines-covid-19-surges

ATLANTA/GENEVA/NEW YORK, 14 April 2020: “As COVID-19 continues to spread globally, over 117 million children in 37 countries may miss out on receiving life-saving measles vaccine. Measles immunization campaigns in 24 countries have already been delayed; more will be postponed. “During this challenging period, the Measles & Rubella Initiative (M&RI) expresses solidarity with families, communities, governments and emergency responders and joins our global immunization and health partners, including those within Gavi, the Vaccine Alliance and the Global Polio Eradication Initiative (GPEI) in our collective focus and fight against the threat of COVID-19. The pandemic sweeping the globe requires a coordinated effort and commitment of resources to ensure frontline health workers around the world are protected, as they face and respond to this new threat. At the same time, we must also champion efforts to protect essential immunization services, now and for the future. “The World Health Organization (WHO) has issued new guidelines endorsed by the Strategic Advisory Group of Experts on Immunization -- to help countries to sustain immunization activities during the COVID-19 pandemic. The guidelines recommend that governments temporarily pause preventive immunization campaigns where there is no active outbreak of a vaccine-preventable disease. M&RI partners, which include the American Red Cross, the U.S. Centers for Disease Control and Prevention, UNICEF, the United Nations Foundation and WHO, strongly agree with these recommendations. We also urge countries to continue routine immunization services, while ensuring the safety of communities and health workers. The recommendations also ask governments to undertake a careful risk-benefit analysis when deciding whether to delay vaccination campaigns in response to outbreaks, with the possibility of postponement where risks of COVID-19 transmission are deemed unacceptably high. “If the difficult choice to pause vaccination is made due to the spread of COVID-19, we urge leaders to intensify efforts to track unvaccinated children, so that the most vulnerable populations can be provided with measles vaccines as soon as it becomes possible to do so. While we know there will be many demands on health systems and frontline workers during and beyond the threat of COVID-19, delivering all immunization services, including measles vaccines, is essential to saving lives that would otherwise be lost to vaccine-preventable diseases. “The M&RI supports the need to protect communities and health workers from COVID-19 through a pause of mass campaigns, where risks of the disease are high. However, this should not mean that children permanently miss out. Urgent efforts must be taken now at local, national, regional and global levels to prepare to close the immunity gaps that the measles virus will exploit, by ensuring that vaccines are available and that they reach children and vulnerable populations, as quickly as possible, to keep them safe. “Despite having a safe and effective vaccine for over 50 years, measles cases surged over recent years and claimed more than 140,000 lives in 2018, mostly of children and babies – all of which were preventable. Against this already dangerous backdrop, preventive and responsive measles vaccination campaigns have now been paused or postponed in 24 countries to help avert further spread of COVID-19. Campaigns expected to take place later in 2020 in an additional 13 countries may not be implemented. Together, more than 117 million children in 37 countries, many of whom live in regions with ongoing measles outbreaks, could be impacted by the suspension of scheduled immunization activities. This staggering number does not include the number of infants that may not be vaccinated because of the effect of COVID-19 on routine immunization services. Children younger than 12 months of age are more likely to die from measles complications, and if the circulation of measles virus is not stopped, their risk of exposure to measles will increase daily. “The M&RI salutes the heroism of health and emergency workers across the globe, and we recognize the vital role they play in delivering clear, trusted information, as well as preventive and supportive care within their communities. We must invest in health workers and ensure they are protected from infection and empowered as part of sustainable and functioning primary health systems. They are the first line of defense against global epidemics. We also recognize the role of parents and caregivers in ensuring their children are vaccinated by following physical distancing recommendations in line with national guidance. Finally, we call on countries and local leaders to implement effective communication strategies to engage communities, ensure supply and demand for vaccination remains strong, and help assure a healthy life for every child especially in this challenging time.” ##### Notes to Editor About Measles & Rubella Initiative: The Measles & Rubella Initiative (M&RI) is a global partnership, founded by the American Red Cross, the U.S. Centers for Disease Control and Protection, UNICEF, the United Nations Foundation and WHO, that is committed to achieving and maintaining a world without measles, rubella and congenital rubella syndrome. Founded in 2001, the Initiative has helped vaccinate over 2.9 billion children and save over 21 million lives by increasing vaccination coverage, improving disease response, monitoring and evaluation, and building public confidence and demand for immunization. The Initiative works closely with Gavi, the Vaccine Alliance to achieve these goals. For more information, visit us at www.measlesrubellainitiative.org and follow us on Twitter . More information on measles: WHO factsheet ; CDC measles updates; Latest WHO measles surveillance data For WHO guidelines for immunization during COVID-19, click here For more information about COVID-19, visit https://www.unicef.org/coronavirus/covid-19 For UNICEF’s work immunization, visit https://www.unicef.org/immunization Kyrylo UNICEF/UN0201071/Krepkih

18 December 2020

UNICEF outlining plans to transport up to 850 tonnes of COVID-19 vaccines per month on behalf of COVAX, in ‘mammoth and historic’ logistics

https://www.unicef.org/eca/press-releases/unicef-outlining-plans-transport-850-tonnes-covid-19-vaccines-month-behalf-covax

NEW YORK, 18 December 2020 – UNICEF could potentially transport up to 850 tonnes of COVID-19 vaccines per month in 2021, should such quantities become available, according to a new assessment. This is more than double the average weight of vaccines UNICEF transports every month. The assessment is part of UNICEF’s work to lead on the procurement and delivery of COVID-19 vaccines for 92 low- and lower middle-income countries on behalf of the COVAX Facility , in collaboration with the Pan American Health Organization (PAHO). “This is a mammoth and historic undertaking,” said Henrietta Fore, UNICEF Executive Director. “The scale of the task is daunting, and the stakes have never been higher, but we are ready to take this on.” The UNICEF assessment looked at global airfreight capacity and transport routes to better understand the challenges of delivering COVID-19 vaccines in 2021. It found that commercial airlines will be able to deliver vaccines to almost all 92 low- and lower-middle-income countries, which are among the 190 economies participating in the COVAX Facility, at an estimated cost of up to US$70 million. Comparing vaccine volume estimates against commercial and cargo routes across the globe, the assessment also found that current air cargo capacity would be sufficient to make deliveries covering 20 per cent of the population for most of the 92 countries. COVID-19 vaccines are expected to be primarily shipped using existing passenger and cargo flight capacity, although charters or alternative transport options may still be needed for some small countries and others with access issues. UNICEF is working with airlines and the wider logistics industry to prioritise the delivery of COVID-19 vaccines around the world. One major challenge in the COVID-19 vaccine operation is local cold chain capacity for vaccine storage within some low- and lower-middle-income countries. UNICEF, WHO and Gavi, the Vaccine Alliance, developed a guidance note on supply and logistics to help countries develop their supply chain strategies to receive, store, distribute and manage COVID-19 vaccines and related products. Given the range of storage temperatures required for COVID-19 vaccines, countries will continue to train logisticians and health workers on how to keep COVID-19 vaccines at the right temperatures. As part of a programme that started in 2017 , with support from Gavi, UNICEF continues to procure and support the installation of 70,000 cold-chain fridges in lower-income countries by the end of 2021, which will help in the roll-out of COVID-19 vaccines that need to be stored at 2 to 8 degrees Celsius. Almost half of these will be solar powered. UNICEF, WHO and Gavi are also working to help countries prepare and develop national deployment and vaccination plans for the large-scale roll out of COVID-19 vaccines. Currently, countries are continuing to monitor their readiness against key milestones, which include expediting regulatory approvals and putting in place ways to monitor vaccine safety. In addition, a UNICEF meeting this week with more than 300 vaccine procurement experts globally, including government officials, looked at ways to procure and roll-out COVID-19 vaccines and strengthen regulatory systems and supply chains. Funding is critical. UNICEF has called for US$410 million to help countries with the delivery of vaccines, therapeutics and diagnostic tools in 2021. Further, UNICEF estimates a funding gap of US$133 million to cover in-country vaccine logistics and the required cold chain equipment for the poorest 92 countries. “With the imminent arrival of globally approved COVID-19 vaccines, we can begin to see signs of hope. But hope will not be restored by the vaccine alone,” said Fore. “Countries need urgent technical and financial support to strengthen their capacities for cold and supply chains, to train health workers, and to work with communities in combatting misinformation and building trust in vaccines. Without urgent funding and support, many of the poorest countries still risk being left behind.” ###### About COVAX COVAX is the vaccines pillar of the ACT-Accelerator . It is co-led by the Coalition for Epidemic Preparedness Innovation (CEPI), Gavi, the Vaccine Alliance, and the World Health Organization (WHO) – working in partnership with developed and developing country vaccine manufacturers, UNICEF, the World Bank, Civil Society Organisations and others. COVAX is the only global initiative that is working with governments and manufacturers to ensure COVID-19 vaccines are rapidly available worldwide to economies of all financial means. Find out more about UNICEF’s work on the COVID-19 vaccines here , or about UNICEF’s work on immunization here . Download photos and broll here: UNICEF shipment UNICEF/UNI319459/Rocio Ortega