The ‘Big Catch Up’: The Race to Get Childhood Vaccinations Back on Track

In Turugucho, Ecuador, María Ortencia Catucuago (right) visits Allison and her 1-month-old son, Ángel, to check that the boy is up to date on his vaccination schedule. PHOTO: Santiago Arcos / UNICEF

Vaccinations could determine whether a child lives or dies. COVID-19 set back vaccination rates to levels not seen in a generation. Now the World Health Organization is rallying the world around “The Big Catch-Up,” a global push to make up for the pandemic losses so every kid gets the vaccines they need. Megan Rabbitt and Dynahlee Padilla-Vasquez talked with Lori Sloate, Senior Director for Global Health at the UN Foundation, to learn more.

We often hear that we can’t afford to let kids skip routine vaccinations. But what exactly is at stake? What kinds of diseases do these vaccines prevent?

Simply stated, vaccines save kids’ lives. Every year, over 4 million lives – most of them children’s – are saved with vaccines. Vaccines are some of our best tools to fight diseases like diphtheria, tetanus, whooping cough, measles, polio, and yellow fever. And there are newer vaccines that protect kids from diseases like rotavirus and pneumococcal, which can cause severe diarrhea and dehydration.

What’s especially tragic about these diseases is that they can not only cause sickness and death, but they can lead to debilitating lifelong conditions like paralysis or blindness. It’s just unacceptable that kids continue to experience these horrific symptoms and long-term impacts when it’s entirely preventable.

Many of these vaccines only cost cents; some a few dollars. Even the more expensive vaccines are made available to countries for roughly $10 [per dose], thanks to global efforts by Gavi, the Vaccine Alliance. This is a small price to pay to save a child’s life.

If you look ahead to 2030, WHO [the World Health Organization] estimates that 50 million lives can be saved by vaccines. That’s incredible. Vaccines are one of the greatest public health successes of our time because they don’t cost very much, and they have a huge impact.

Women bring their children to the Batasan Hills Super Health Center, in Quezon City, Philippines for their regular vaccination program. PHOTO: Veejay Villafranca / Asian Development Bank

Before the outbreak of COVID-19, what was the global picture like when it came to vaccine access?

Before the outbreak of COVID-19, we had been making progress expanding vaccine access and uptake. Eighty-six percent of the world’s children were able to get a vaccine.

In 1963, for example, when the first measles vaccine was introduced, 2.5 million people worldwide — most of whom were children — were dying every year. Fast forward to 2021, and that number was brought down to 128,000 kids dying from measles per year. That’s still too many, but it demonstrates the progress that can be made with vaccines.

Polio is a similar success story. Cases of wild poliovirus have decreased 99% since 1988 when a coordinated push for global eradication began. We’ve gone from seeing 350,000 cases per year to just 30 cases in 2022. We are so close to eradicating polio, thanks to vaccines.

What impact did the COVID-19 pandemic have on childhood vaccination rates?

COVID-19 was a massive disruption that diverted resources away from routine vaccination efforts and caused kids to miss routine health visits. Health care workers who would normally be helping to get more kids vaccinated were redeployed to focus on COVID-19 — and were also getting sick themselves.

As a result, we saw a sharp decline in global immunization rates during the pandemic. By the end of 2021, that 86% coverage rate — which we had worked so hard to reach — dropped to 81%. That may not seem like much, but it translates to 67 million kids around the world who missed routine vaccines entirely or partially between 2019 and 2021.

There are now 5 million more kids who have never received a vaccine – for anything. More unvaccinated kids leads to more outbreaks, which could derail progress made against diseases like measles and polio — diseases that we have worked so hard to reduce. WHO and UNICEF [the United Nations Children’s Fund] called this the most significant backsliding in a generation.

A vaccinator in Sudan marks a boy's hand to show he's received the polio vaccines. The Federal Ministry of Health – with support from UNICEF, WHO and others – launched a nationwide polio outbreak response with a house-to-house campaign. PHOTO: Mojtba Moawia Mahmoud / UNICEF

When vaccination rates lag in a community, who suffers?

The impact that lagging vaccination rates have on communities is real. When kids are sick, they miss school. Parents and caregivers often have to miss work to care for a sick child. So we see losses in education, productivity, and household incomes. Local economies are also impacted.

This is part of the reason why vaccines provide such a great return on investment. They produce a ton of positive knock-on effects, from saving lives to ensuring healthier, happier, and more productive kids, families, and communities. A study covering 94 low- and middle-income countries estimated that for every $1 invested in immunization between 2021 and 2030, there is a $20 return – that accounts for savings from health care costs, lost wages, and lost productivity due to illness and death. Yet another reason why vaccines are one of the most powerful public health successes we’ve ever seen.

What will it take to get back on track and reverse this decline?

This World Immunization Week — which takes place every year at the end of April — WHO is launching “The Big Catch-Up.” This global push complements the work already happening in many countries to ramp up vaccination efforts. In essence, it aims to do exactly what it sounds like: catch kids up on the vaccines they missed during the pandemic. The Big Catch-Up also has a particular focus on reaching those kids who have never received a single dose of any vaccine. As I mentioned, because of the pandemic, there are 5 million more kids who are completely unprotected from dangerous, deadly diseases. To be most effective, The Big Catch-Up is focusing on those countries that saw the steepest declines during the past few years.

On top of this short-term goal, The Big Catch-Up is designed to help strengthen local health systems so that immunization is integrated into primary health care so we don’t see disruptions on the scale of what we saw with COVID-19 ever again.

UNICEF staff member Malembe Domingos inspects boxes containing vials of hepatitis B vaccine inside a cold storage room at the Angolan vaccine depot in Luanda. PHOTO: Karel Prinsloo / UNICEF

Are there any new innovations being made in the vaccine space that have potential for impact at scale?

Yes! There are two new advancements I’m excited about. The first is the new generation of vaccines that can be made with mRNA technology, the technology that produced many of the COVID-19 vaccines. And because of the urgency brought on by the pandemic, we learned how to make these vaccines and produce them at scale in record time. It also has the potential to open new and more manageable vaccines for diseases like tuberculosis.

The second is the new malaria vaccine. Implementation of a new malaria vaccine called RTS,S was piloted in Ghana, Kenya, and Malawi, which have high rates of transmission. These pilots are nearing completion, and the impact has been phenomenal. In places with high rates of seasonal malaria transmission we’ve seen a 75% reduction in cases. Malaria kills one African child every minute, so this is a huge breakthrough. It has the potential to save tens of thousands of lives per year.

And an added benefit of this new vaccine rollout — which has been extremely well-received in the communities where it’s been available thus far — is that it creates another opportunity to ensure kids are caught up on all of their vaccines. We saw this happening with parents who brought their children for the malaria vaccine — excitement about its availability brought them to vaccination sites, and then their kids were vaccinated against other diseases, too. So it’s an opportunity to ensure that a child is also caught up on other routine vaccines, which is especially critical right now as we try to make up for COVID losses.

How can we help ensure that we don’t see this kind of backsliding again the next time we experience a disruptive event like COVID-19?

There is a global vision and strategy for immunization in coordination with countries and partners worldwide. It’s called Immunization Agenda 2030 [IA2030] and it was adopted by all countries at the World Health Assembly in 2020, which is an annual convening hosted by WHO.

Registered nurse Vanie Boyajian vaccinates a child for polio at the Howard Karagheusian primary health care center, in Beirut, Lebanon. PHOTO: Dominic Chavez / World Bank

What exactly does IA2030 aim to achieve?

Among the topline goals of IA2030 is reducing the number of kids who have never received a vaccine by 50%. We know we’re way off track with this target because of the pandemic, so now we’re looking at how we can tailor interventions so that we can find and reach kids who need vaccines. A lot of this work is focused on fragile settings, places experiencing conflict or humanitarian emergencies, because we know about 40% of the kids who have never received a vaccine live in these contexts. They’re some of the hardest places to get to in the world, so we’re working closely with humanitarian partners to identify and reach these kids.

One of the goals that we’re on track to achieve is the introduction of new vaccines in more countries. I mentioned at the top of the interview that there are newer vaccines for things like rotavirus and pneumococcal, as well as the human papillomavirus, or HPV. We want more countries to be able to deploy these vaccines. There’s a big push to ramp up vaccine coverage for HPV, and so under IA2030, we’re working with more schools to reach girls between the ages of 9 and 13. We’re really focused on scaling up access to these vaccines where girls need them most in low and middle-income countries.

Integration is really the secret sauce to IA2030. It’s enabling us to better leverage existing health systems for multiple uses across the full spectrum of vaccine deployment. In many countries, existing polio infrastructure, like labs and trained health workers, were retasked to work on COVID-19. So now we’re looking at how we can harness the infrastructure and lessons learned during COVID to accelerate progress on other vaccine-preventable diseases.

I’m optimistic. We’re not going to achieve all of these goals tomorrow, but it is the right vision and strategy for all of us to work toward. We have a plan.

So, what is the big takeaway here?

That vaccines are incredible! They are safe, cost-effective, and they save kids’ lives. There is no reason why vaccines should not be getting to every child in the world.