Efforts to vaccinate children worldwide against deadly diseases such as measles and diphtheria began to recover in 2022 after a historic backslide caused by the Covid-19 pandemic, according to new figures from the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).
But the recovery remains uneven, with strong bounce backs in large lower-middle income countries such as India and Indonesia masking ongoing problems in many smaller and poorer countries, the agencies said in a statement.
In 2022, 20.5m children missed out on one or more routine childhood vaccines, down from 24.4m children in 2021. Despite the progress, the numbers are still higher than in 2019, when 18.4m children were reported to have missed out.
The numbers are estimated from 183 countries, using data based on the take-up of the three-dose diphtheria, tetanus and pertussis (whooping cough) jab, and include children who got no vaccines at all as well as those who missed any of the doses necessary for full protection.
Globally, coverage rates were at 86% pre-pandemic, and 84% in 2022.
WHO Director-General Tedros Adhanom Ghebreyesus said the numbers were "encouraging", but there were concerns that the most vulnerable were being left behind.
"When countries and regions lag, children pay the price," he said.
Of the 73 countries that saw substantial declines in routine coverage during the pandemic, 34 – including countries such as Angola to Syria - have seen no improvement since, or even got worse. 15 countries have recovered to pre-pandemic levels, and 24 were on the route to recovery, the WHO and UNICEF said.
The agencies also warned that measles vaccinations have not recovered as quickly, with 21.9m children globally missing their first dose in 2022 – 2.7m more than in 2019– and 13.3m their second.
In low-income countries, coverage rates for measles actually continued to decline last year, to 66% compared with 67% in 2021, WHO head of immunisation Kate O'Brien said.
"When children are not vaccinated, that means they are not immune to life-threatening diseases. Children are going to die," she said.
Measles outbreaks are already on the rise, and only rates of the HPV vaccination, which prevents cervical cancer, have recovered to pre-pandemic levels.
But they remain below the 90% target, at 67% in the high-income countries and 55% in the low and middle-income countries where the shot has been introduced.
Alongside Gavi, the Bill and Melinda Gates Foundation and other partners, the WHO and UNICEF launched a push earlier this year to help countries catch-up on childhood vaccination.
