Causey K, Fullman N, Sorensen RJD, et al. - In 2020, stark challenges were faced by routine immunization services because of the COVID-19 pandemic. Although some regions showed recovery in the latest coverage trajectories, millions of children still remained under-vaccinated or unvaccinated against preventable diseases at the end of 2020.

• For DTP3 and MCV1, estimated vaccine coverage was 76·7% and 78·9%, respectively, in 2020, representing relative reductions of 7·7% and 7·9% compared with expected doses delivered in the absence of the COVID-19 pandemic.

• Nearly 30·0 million children missed doses of DTP3 and 27·2 million children missed MCV1 doses from January to December, 2020.

• Globally, April 2020 had the highest monthly disruptions, across all GBD super-regions, with 4·6 million children missing doses of DTP3 and 4·4 million (3·7–5·2) children missing doses of MCV1.

• The most severe annual impacts were observed in north Africa and the Middle East, south Asia, and Latin America and the Caribbean.

• Sub-Saharan Africa showed the lowest annual reductions in vaccine delivery, where disruptions remained minimal throughout the year.

• Per estimates, monthly doses were delivered at or above expected levels during the second half of 2020 for some super-regions, including southeast Asia, east Asia, and Oceania for both DTP3 and MCV1, the high-income super-region for DTP3, and south Asia for MCV1.

• Routine immunization data system strengthening and targeting resources and outreach will be critical to attain reduction in the risk of vaccine-preventable disease outbreaks.