What 25 million children are telling us about the next pandemic

The World Health Organization (WHO) and UNICEF just issued a dire warning: we’re witnessing the most significant decline in childhood vaccination rates in a generation. A red alert for policymakers, this signals that the health of children globally is at risk and the impacts will be measured in lives.

Decades of hard-won progress protecting the world’s children is unraveling before our eyes as vaccinations plummet to 30-year lows. New immunization data confirm that 25 million children around the world missed out on life-saving vaccines last year for diseases like measles, polio, and human papilloma virus. Of those kids, a staggering 18 million have never received a dose of any vaccine. 

The ramifications of missing vaccines are extensive and enduring. The oncoming wave of illness is likely to overwhelm health systems, especially in low- and middle-income countries. Further, an entire generation of children missing out on vaccinations will mean many millions of them are likely to experience a lifetime of poor health, resulting in missed educational and job opportunities, and lower national productivity. In addition, the economic impact of parents losing income from having to care for sickly children will be felt globally and more immediately.

This growing immunization gap, initially caused by COVID-19 and compounded now by factors including regional insecurity, conflict, and supply chain issues, comes at a bad time. Even before the pandemic, measles was on the rise among children worldwide, with the number of reported cases in 2019 reaching heights not seen for more than two decades. As of July 1, the WHO has received 25 reports of large and disruptive measles outbreaks from around the world. The number of reported measles cases for the first half of 2022 is nearly the same as the whole year reported for 2021.  However, with reports for the second year in a row of increasing numbers of kids never receiving any vaccine (5 million more kids compared to 2019), we are entering a new era of ever-growing pools of children succumbing to entirely preventable diseases.

Urgent action is needed on two fronts. We must conduct immediate outreach in lagging countries to catch-up with kids who have missed out on vaccines, while simultaneously strengthening routine immunization services to build on existing health systems in parallel to the COVID vaccine rollout. In reality, this means that national governments must enact policy changes to ensure those kids who missed out in 2019, 2020, and 2021 — some of whom are now two to three years old — are accommodated by health systems that are more attuned to reaching newborns. It also means conducting vaccine programs in parallel to each other to ensure children receive needed vaccines more effectively in batches, and not administering one vaccine (e.g., COVID) at the expense of others.

To make this happen, funding is paramount. In countries like Pakistan, the government has reversed the effect of COVID disruptions by committing to vaccine outreach in collaboration with Immunization Agenda 2030 partners like WHO, UNICEF, and Gavi, the Vaccine Alliance. In 2019, the number of unvaccinated children was 600,000, which rose to 1 million in 2020.  Thanks to concerted efforts to reach those kids who were missed, that number was back to 600,000 in 2021.

Efforts like this are encouraging, but the example of 25 million unvaccinated kids worldwide tells us that we need to fix health systems globally with an effort that puts immunization front and center. COVID has taught us many lessons, including the imperative role vaccines play to save lives and to build on immunization services to imbue more robust health systems. That is why the recently approved Financial Intermediary Fund (FIF) for Pandemic Preparedness and Response by the World Bank Board of Governors on June 30 could not have come at a more opportune time.

A total of $1.1 billion has been pledged by the US, Germany, the European Commission, the United Kingdom, Indonesia, Singapore, as well as philanthropies to help fund it. This should be used to ensure that current Pandemic Preparedness and Response and the Global Health Architecture are strengthened and lead to investment in Primary Health Care services, with explicit support to beef-up essential Immunization programs. This must also be part of future allocations so that countries can build on existing health systems to improve immunization services for existing, preventable diseases as well as those for future outbreaks of unknown pathogens.

Last week’s news is a wake-up call. With more kids susceptible to childhood disease, outbreaks are inevitable across the globe and will continue to increase, and we are headed for some very tough years ahead. To counter the backsliding that has occurred and help the increasing numbers of children who lack access to immunizations, we must draw from positive experiences and optimize efforts like the new FIF, not only to close the immunization gap in childhood diseases, but also better equip countries to prepare for the next pandemic.

Lori Sloate is the senior director for Global Health at the United Nations Foundation, a founding partner of the Measles & Rubella Initiative. She also serves as Co-chair Advocacy Group, Immunization Agenda 2030, a global partnership of UN agencies and other partners.