Sharp decrease in childhood immunization in Vietnam during the Covid-19 pandemic.

A new UNICEF report shows 67 million children globally, including nearly 250,000 children from Vietnam, missed out on one or more vaccinations over three years due to service disruption caused by strained health systems and diversion of scarce resources, conflict and fragility, and decreased confidence.

Giving 5 in 1 vaccine to children at the Hoa Tri Commune Health Center, Phu Hoa District, Phu Yen Province, Vietnam. Photo: WHO Vietnam/Pham Minh

A total of 67 million, including nearly 250,000 children in Vietnam, missed out on vaccinations between 2019 and 2021, with vaccination coverage levels decreasing in 112 countries, UNICEF warned today in a new report on immunization.

The State of the World’s Children 2023: For Every Child, Vaccination reveals 48 million children globally didn’t receive a single routine vaccine, also known as “zero-dose”. Vietnam was listed among the top 20 countries in the world with the largest number of zero-dose children; 187,315 children under 1 year did not receive any vaccinations in 2021.

Worldwide, 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 doses and 1 in 6 in rural areas.

In Vietnam, data showed that the prevalence of zero-dose children in urban areas was almost 1.5 times higher than those living in rural areas (6.3%-4.2%), while the prevalence in the poorest households was almost double those in the wealthiest (13.5%-6.6%) “The pandemic interrupted childhood vaccination almost everywhere, including in Vietnam, 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.

Added to this is a current delay in procurement of vaccines. We are deeply concerned about the possibility of outbreaks of vaccine-preventable diseases - measles in particular”, said Maharajan Muthu, Chief of Child Survival and Development, UNICEF Vietnam. “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.”

The report also showed that the public perception of the importance of vaccines for children declined during the Covid-19 pandemic in 52 out of 55 countries studied. Vaccine confidence is volatile and time specific. However, the report warns the confluence of several factors suggests 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 polarization.

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.

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, 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; Prioritize funding to immunization services and primary health care; Build resilient health systems through investment in female health workers, innovation and local manufacturing.

“Vietnam’s successful experience in its mass immunization campaign against Covid-19 laid a good foundation for the country to immediately address the current delays in procurement of vaccines and fast-track catch-up for children who have missed out on routine immunizations”, said Lesley Miller, UNICEF Deputy Representative. “Routine immunization and strong health systems are our best shot at preventing future pandemics, unnecessary deaths, and suffering.”

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.