UNICEF highlights a decline in vaccination coverage that leaves children unprotected against childhood diseases

A new UNICEF report shows 67 million children globally missed out on one or more vaccinations over three years due to a disruption in services caused by strained health systems and diversion of scarce resources among other factors.

24 April 2023
Child under 5 receiving vaccination in Lusaka, Zambia

The State of the World’s Children (SOWC) 2023 released ahead of World Immunisation Week, which starts today, reveals that globally, 67 million children missed out on one or more vaccinations over the last three years. This calls for urgent catch-up and recovery to vaccinate these children, and in doing so – save lives.

In Zambia, latest data analysis from the District Health Information System 2 (DHIS2) and the 2022 Census of Population and Housing indicate that the number of zero-dose children – those who have not received any vaccinations, stands at 324,619 in 2022.

In the wake of the COVID-19 pandemic, which set back progress in childhood immunisation globally, the SOWC 2023 report focuses on the role of poverty, marginalisation, and gender in determining whether children are vaccinated. Drawing on lessons learned during the pandemic and from UNICEF’s decades-long experience in vaccinating children, the report examines the ways in which primary health care can be strengthened to better support immunisation services. It also looks at concerns around trust in vaccines and examines a range of innovations in vaccine development, delivery, and financing.

“Alarmingly, we are seeing the largest sustained backslide in childhood immunisation in 30 years, fuelled by the COVID-19 pandemic which interrupted childhood vaccination almost everywhere, including in Zambia, due to intense demands on health systems, the diversion of immunisation resources to COVID-19 vaccination, health worker shortages and stay-at home measures,” said Penelope Campbell, the UNICEF Zambia Representative.

In particular, the impact of COVID-19 on the routine immunisation programme showed that the percentage of fully immunised children nationally significantly decreased compared to the pre-COVID-19 era, from 89.1 in 2019 to 78.6 per cent in 2022. Meanwhile, the proportion of children receiving their first dose of measles declined from 90.6 percent in 2019 to 83.1 percent in 2022.

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. While there were isolated cases of measles in Zambia from 2015 to 2020, 55 cases were registered in 2021 and 2,247 in 2022.

“The Government of the Republic of Zambia, through its Ministry of Health, is committed to continue working towards improving vaccination coverage in the country, ensuring that every child, particularly the most vulnerable, have access to immunisation services. Vaccines protect families, communities and the whole nation, therefore, restoring immunity is our top priority,” explained Hon. Sylvia Masebo, MP, Minister of Health.

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.

Globally, the children who are missing out live in the poorest, urban, 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 front-line workers, who are mostly female, with the resources and support they need. To address this child survival crisis, UNICEF is calling on governments to double-down on their commitment to increase financing for immunisation 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

“Immunisations have saved millions of lives and protected communities from deadly disease outbreaks,” emphasized the UNICEF Zambia Representative. “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.”

Though support for vaccines remains relatively strong in Zambia, the global 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.

“We cannot allow poor public trust and confidence in immunisations to become another victim of the pandemic. Otherwise, the next wave of deaths could be of more children with measles, diphtheria, cholera, or other preventable diseases,” concluded Penelope Campbell, UNICEF Zambia Representative.


Notes to Editors:

The State of the World’s Children is UNICEF’s flagship report. The 2023 edition is the first edition of the report solely dedicated to routine immunization. UNICEF reaches almost half of the world's children every year with lifesaving vaccines.

After 00.01 GMT 20 April, you can explore a special interactive feature on our website and download the report here.

Multimedia assets, including new photos, b-roll and case studies, are available here.

*The Vaccine Confidence Project (VCP) at the London School of Tropical Hygiene and Medicine has been monitoring vaccine confidence since 2015 by analysing data from nationally representative country surveys. Data presented in this report comes 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 sub-set of a fuller data set gathered by the VCP. You can explore the full data set using this interactive map tool.




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UNICEF promotes the rights and wellbeing of every child, in everything we do. Together with our partners, we work in 190 countries and territories to translate that commitment into practical action, focusing special effort on reaching the most vulnerable and excluded children, to the benefit of all children, everywhere.

For more information about UNICEF and its work for children in Zambia, visit www.unicef.org/zambia.

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