Immunization rates suffered immensely during the COVID-19 pandemic. And despite efforts in recent years to bring the numbers up, still far too many children aren’t getting vaccinated for many preventable diseases such as diphtheria and measles.
The latest immunization numbers from UNICEF and the World Health Organization show that there were 21 million unvaccinated and undervaccinated children in 2023, 2.7 million more than before the pandemic. The number of children who did not receive a single dose of the vaccine for diphtheria, tetanus, and pertussis increased from 13.9 million in 2022 to 14.5 million in 2023. An additional 6.5 million children did not complete their third dose of the vaccine.
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Furthermore, only 83% of children received their first dose of the vaccine against measles, a highly contagious disease — “too low to prevent outbreaks,” says Dr. Ephrem Lemango, global chief of immunization at UNICEF. Over the past five years, measles outbreaks were reported in 103 countries with inadequate vaccine coverage, he says.
Conflicts are a major driver of low vaccination rates. In Sudan, the proportion of children receiving a first dose of the DTP vaccine plummeted significantly in just one year — from 75% in 2022 to 57% in 2023, resulting in an increase of unvaccinated children from about 110,000 in 2022 to a staggering 700,000 in 2023. Sudan now accounts for over 43% of all unvaccinated children in the Middle East and North Africa region.
Still, there are a few “bright spots,” according to Dr. Kate O’Brien, director of the WHO’s Department of Immunization, Vaccines and Biologicals. The number of unvaccinated children fell from 7.3 million in 2022 to 6.7 million in 2023 in the WHO African region. The percentage of girls globally who received at least one shot of the human papillomavirus vaccine to protect them against cervical cancer also improved — from 20% in 2022 to 27% in 2023.
These numbers, however, are still far from the actual target: No more than 6.5 million unvaccinated children by 2030.
Read: New WHO, UNICEF data reveal rise in unvaccinated children globally
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Watch out
Emerging donors such as China and those in the Middle East provide alternative funding sources for low- and middle-income countries, including for the health sector. In this latest downloadable report, our team of experts finds that health is a priority sector for China and Saudi Arabia. China committed $2.6 billion to health in 2021 from $311.5 million in 2017.
Find out what other emerging donors’ priorities are and how much they are spending.
Download the free report: Emerging donors 3.0
Breaking the cycle
Early this week, South Sudan became the second country after Côte d’Ivoire to roll out the R21 malaria vaccine. Over 645,000 doses were delivered to the country. However, none of that will go to pregnant women.
Malaria vaccines and most antimalarial treatments aren’t recommended for pregnant women, particularly those in their first trimester of pregnancy, due to a lack of data. But opportunities to generate that data are few, as pregnant women are often excluded from clinical trials due to safety concerns.
A new consortium of research experts are hoping to break this cycle. Their plan: Conduct a phase 3 clinical trial to test several antimalarial drugs in early pregnancy, starting by comparing the safety, tolerability, and efficacy of artemether-lumefantrine — a widely used antimalarial — to pyronaridine-artesunate, an antimalarial treatment currently recommended by WHO but not for pregnant women in their first trimester.
There are several steps they need to take before launching, but if all goes well, they plan to enroll pregnant women in the trial in early 2025. They hope that the data generated will lead to WHO recommending more malaria treatment options for pregnant women — but also that it will be able to support the design of future trials focused on other infectious diseases affecting pregnant women in low- and middle-income countries.
Read: In world first, consortium aims to test antimalarials in early pregnancy
Pandemic treaty 2.0
The Intergovernmental Negotiating Body mandated by the World Health Assembly to draft and negotiate a pandemic agreement resumed its meeting this week, after WHO member states agreed to extend its work during the 77th World Health Assembly last May.
Here’s what they decided on:
Who’s who: Member states elected two new INB colleagues: Fleur Davies from Australia will serve as one of the vice chairs, replacing Japanese Ambassador Honsei Kozo, and French Ambassador Anna-Claire Amprou will be the new co-chair, replacing Roland Driece from the Netherlands.
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Key dates: There will be two formal meetings of the INB in 2024, the first on Sept. 9-20, and the second on Nov. 4-15. If member states want to have a special session of the WHA in late December to consider the outcome of their negotiations, they need to decide on that by Nov. 11. However, if they haven’t yet hammered out a pandemic agreement, they can also hold meetings Dec. 2-6, Feb. 17-21, 2025, April 7-11, before the 78th WHA in May 2025.
What’s on the table: In early September, the WHO secretariat will be providing information on the “legal architecture” of the proposed pandemic agreement that includes options for member states to consider, as well as a document detailing how the amended International Health Regulations complement proposed articles in the pandemic agreement.
Who’s in the room: Several interested parties from civil society and other health experts have long asked to be able to join the INB sessions, which were mostly closed to the public. However, some member states were opposed, and the INB split the difference, deciding that relevant stakeholders can only join for a brief session in the morning.
Not again
9%
—That’s the percentage of delegates that have been denied their visas for the 25th International AIDS Conference, which is taking place next week in Munich, Germany.
The International AIDS Society posted on social media platform X that according to feedback from nearly 700 delegates, 77% have obtained their visas, while 14% are still waiting for their permit to enter the country.
Sound familiar? In 2022, many also faced visa delays and denials during the 24th International AIDS Conference in Montreal.
Related op-ed: Visa hurdles hurt global health discourse but can be overcome
Sands like a plan
In 2021, amid the COVID-19 pandemic, the Global Fund to Fight AIDS, Tuberculosis and Malaria board agreed to renew Peter Sands’ term as executive director for another four years, keeping him in charge through March 2026.
However, late last week the board decided to extend Sands’ term for a few more months, until the end of 2026.
According to a news release, the extension “will provide continuity of leadership through the Eighth Replenishment and allow for a robust selection process for the next Executive Director.” The selection of the next Global Fund head is expected in mid-2026.
What we’re reading
The EU general court wants the European Commission to disclose more details of its COVID-19 vaccine contracts with manufacturers. [The New York Times]
Gambia’s Parliament has rejected a bill aiming to overturn ban on female genital mutilation. [Reuters]
Gilead’s chief medical officer will leave next year as the drugmaker struggles to look for new areas of growth beyond HIV medicines. [STAT News]
About the author
Jenny Lei Ravelo@JennyLeiRavelo
Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.
