Amid challenges, signs of recovery in routine immunisation as countries administer record volumes of vaccines in 2021

By Gavi, the Vaccine Alliance

Amid challenges, signs of recovery in routine immunisation as countries administer record volumes of vaccines in 2021

Routine childhood immunization experienced another challenging year in 2021 across the 57 countries supported by Gavi, the Vaccine Alliance, as basic vaccine coverage fell 1 percentage point to 77%, according to Gavi’s 2021 Annual Progress Report, which is published. However, preliminary data for the first five months of 2022 suggests health systems may be recovering from the strains placed on them by the pandemic.

With 65 million children in Gavi-supported countries immunized through routine systems in 2021, Gavi’s work managed to generate more than US$ 18.9 billion in economic benefits, according to the Report. Another highlight of 2021 was the record US$ 161 million in co-financing contributed by Gavi-supported countries, which indicates further progress towards sustainability and the country’s commitment to protecting childhood immunization.

The report also considers the fact that, with Gavi countries also administering more than 2 billion COVID-19 vaccines, their respective health systems were able to protect more people than ever before in 2021.

One area of strategic focus for the Vaccine Alliance in 2022 and beyond highlighted in the report is the increase in the number of zero-dose children, infants who have not received the first dose of diphtheria, tetanus, and pertussis-containing vaccine (DTP1), which grew by 570,000 to 12.5 million – leaving them vulnerable to some of the world’s deadliest diseases, and making Gavi’s 5.0 mission to locate and reach them even more pressing.

Preliminary data from WHO suggests that countries’ immunization programs may be starting to recover. Among the 16 countries having reported data for January–May 2022, the data suggests a 2% increase. Gavi and its Alliance partners will be studying this data keenly in the coming months, to understand how countries are restoring their immunization systems.

“We have faced significant challenges,” said Prof José Manuel Barroso, Chair of the Gavi Board. “Routine immunization continued to suffer in many countries in 2021 as a result of the pandemic. However, we are encouraged that the countries Gavi support administered a record number of vaccine doses, both through routine programs and also in their fight against COVID-19. Many countries did already begin to recover, which is a testament to heroic efforts made by their health systems and workers. As we move forward, we must maintain our focus on supporting routine immunization and reaching zero-dose children with life-saving vaccines.”

2021 also saw a significant change for Gavi. In December 2021, the Gavi Board made history by approving funding to support the roll-out of the world’s first malaria vaccine in sub-Saharan Africa in 2022–2025. In addition, the first doses of licensed Ebola vaccine were shipped from a Gavi-funded global emergency stockpile of 500,000 doses. COVAX – which Gavi co-leads alongside the Coalition for Epidemic Preparedness Innovations (CEPI), the World Health Organization (WHO), and UNICEF – shipped nearly 1 billion doses of COVID-19 vaccines to 144 countries and territories around the world by the end of the year; that figure reached nearly1.8 billion in September 2022.

“Since 2019, we have seen the biggest sustained drop in routine immunization in a generation, and millions of children are still missing out,” said UNICEF Executive Director Catherine Russell. “Immunisation is one of the world’s most effective and cost-effective public health interventions. Working alongside Gavi and other key partners, we need to catch up on missed children – especially ‘zero-dose’ children who have yet to receive a single immunization against killer childhood diseases – and make sure lost ground does not become lost lives.”

“One of the great ironies of the COVID-19 pandemic is that while it has spurred the largest vaccination campaign in history, it has also disrupted routine immunization for many vaccine-preventable diseases,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Together with Gavi and other COVAX partners, WHO is committed to delivering vaccines against COVID-19 to end the pandemic, while scaling up routine immunization services to reach every last child with life-saving vaccines.”

“I am proud that health workers and the health system in Chad have succeeded in increasing the number of vaccinations by more than six percentage points and reducing the number of zero-dose children by 2021 despite the challenges of the pandemic and the global climate, in collaboration with Gavi and Vaccine Alliance partners, including WHO and UNICEF,” added Dr. Abdelmadjid Abderahim, Minister of Health and National Solidarity of the Republic of Chad.

“While we saw 65% of Gavi-supported countries restore routine immunisation to pre-pandemic levels, we must accept the fact that the recovery in 2021 was not as strong as we would have liked,” stressed Dr Seth Berkley, Gavi CEO. “The same can be said for zero-dose children, who, as a cohort, tragically by grew by 570,000 in 2021. Early indications are that 2022 started strongly and this gives grounds for optimism. Likewise, we continue to look to high-performing countries such as Chad and Pakistan to identify learnings that can be applied in other countries and apply special attention to those countries where improvement continues to be elusive. There is no higher priority for the Alliance in 2022 than keeping routine immunisation progress on track.”

Between 2000 and 2021, Gavi’s achievements included:

  • 981 million children were vaccinated through routine programs
  • 1.4 billion vaccinations through vaccination campaigns
  • 16.2 million future deaths prevented
  • 561 vaccine introductions and campaigns
  • US$ 185.3 billion in economic benefits generated in the countries we support
  • US$ 1.3 billion in co-financing contributions from Gavi-supported countries since 2018

The vision of Gavi’s 5.0 strategic period, “Leaving no one behind with immunization” remains the driving force. Gavi core vaccine programs and the COVID-19 work have continued through 2022 and will carry on into 2023 and beyond.