A whopping 25 million children missed life-saving vaccinations in 2021, increasing their risk of devastating but preventable diseases, according to a new report from WHO and UNICEF on July 15. It is the "largest sustained decline in childhood vaccinations in approximately 30 years," the report said.

Of the 25 million, more than 60 per cent lived in just 10 countries like India, Nigeria, Indonesia, Ethiopia, Philippines, the Democratic Republic of the Congo, Brazil, Pakistan, Angola, and Myanmar. India is also among countries that had children who did not receive even a single dose of vaccine against diphtheria, tetanus and pertussis (DTP3) in 2021, the report said.

DTP3 vaccinations, which is a marker for immunisation coverage within and across countries fell 5 percentage points between 2019 and 2021 to 81 per cent. "18 million of the 25 million children did not receive a single dose of DTP during the year, the vast majority of whom live in low- and middle-income countries, with India, Nigeria, Indonesia, Ethiopia and the Philippines recording the highest numbers," the report said.

Further, the report showed that the pandemic continues to affect basic vaccination among kids in 2020 about 23 million infants missed vaccination while in 2019 the figure was 19 million. Many factors, including an increased number of children living in conflict and fragile settings, and increased misinformation contributed to the decline.

COVID-19-related issues such as service and supply chain disruptions, resource diversion to response efforts, and containment measures that limited immunisation service access and availability also played a major role.

"This is a red alert for child health. We are witnessing the largest sustained drop in childhood immunisation in a generation. The consequences will be measured in lives," said Catherine Russell, UNICEF Executive Director, in a statement. "While a pandemic hangover was expected last year as a result of COVID-19 disruptions and lockdowns, what we are seeing now is a continued decline," she added.

It was hoped that 2021 would be a year of recovery during which strained immunisation programmes would rebuild and the cohort of children missing in 2020 would be caught-up. Instead, DTP3 coverage was set back to its lowest level since 2008 which, along with declines in coverage for other basic vaccines, pushed the world off track to meeting global goals, including the immunisation indicator for the sustainable development goals.

Globally, over a quarter of the coverage of human papillomavirus (HPV) vaccines that was achieved in 2019 has also been lost. This has grave consequences for the health of women and girls, as global coverage of the first dose of HPV vaccine is only 15 per cent, despite the first vaccines being licensed over 15 years ago.

"This historic backsliding in rates of immunisation is happening against a backdrop of rapidly rising rates of severe acute malnutrition. A malnourished child already has weakened immunity and missed vaccinations can mean common childhood illnesses quickly become lethal to them. The convergence of a hunger crisis with a growing immunisation gap threatens to create the conditions for a child survival crisis," the report said.

"Planning and tackling COVID-19 should also go hand-in-hand with vaccinating for killer diseases like measles, pneumonia and diarrhoea," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "It's not a question of either/or, it's possible to do both".

However, some countries notably held off declines. Uganda maintained high levels of coverage in routine immunisation programmes, whilst rolling out a targeted COVID vaccination programme to protect priority populations, including health workers. Similarly, Pakistan returned to pre-pandemic levels of coverage thanks to high-level government commitment and significant catch-up immunisation efforts, the report said.