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The application of calendar vaccines across 184 countries in the past year reveals alarmingly low percentages. Children’s vaccination coverage in Argentina remains low, threatening to prevent outbreaks of preventable diseases. This trend, highlighted in a new report by the **World Health Organization** (WHO) and **UNICEF**, serves as a wake-up call for health authorities and parents or guardians.
Both United Nations organizations concluded that **childhood vaccination coverage “stagnated” last year** in all countries. They also claim that **pre-COVID pandemic levels have not fully recovered**, according to data provided by Member State Ministries of Health or, in their absence, at least one documented source.
“There will be 2.7 million more children who have not been vaccinated or have not received all their vaccinations compared to 2019 levels,” projected the WHO and UNICEF working team for the shared database (Wueinc), which they updated on Monday, 2023. Measles, meningitis, pneumonia, hepatitis B, rubella, polio, diphtheria, mumps, whooping cough, and the human papillomavirus (HPV) are among the 14 diseases with scheduled vaccines.
“These trends, which show that global immunization coverage has remained virtually unchanged since 2022 and, more alarmingly, has still not returned to 2019 levels, reflect the continuing challenges posed by **disruptions to healthcare services, logistical challenges, vaccine hesitancy, and inequalities in access to services.** The latest trends show that in many countries there are too many unvaccinated children,” said **Catherine Russell**, executive director of UNICEF.
In Argentina, the estimate indicates that coverage fell last year compared to 2022, though they clarify this might be an underestimation due to changes in registration methods reported by the **Ministry of Health of the Nation**. Both organizations have altered their registration procedures. “In 2023, the country made a transition to electronic [and nominalized] vaccination registration nationwide, which affected the integrity of the reports,” they warn.
However, the **National Nominalized Vaccination Registry** (Nomivac), managed by the national health portfolio within the online health surveillance system, was officially implemented in 2013. In practice, as published by **LA NACIÓN**, there are provinces that, despite reporting to WHO and UNICEF, are still recording applications on paper forms or have difficulties transferring data from their records to Nomivac.
“Since 2023 was a year of transition for calculating national calendar coverage, it implied a certain delay in loading and differences with some provincial systems, as there are records that have not yet impacted the national system and are being reviewed,” the Ministry of Health responded to this media when asked regarding coverage percentages for the country reported in Wueinc and those officially estimated, not yet released. “Work is underway to improve the records. It was an issue that was requested in the **Federal Health Council** (Cofesa) to the ministers,” they added.
Comparing the data reported by WHO and UNICEF with those provided by the ministry **LA NACIÓN** regarding 2023 coverage for the vaccines included in the international estimate, the percentages vary, but in both cases, they are below those of 2022. The UNICEF office in the country, when consulted, clarified that it did not participate in preparing the global report.
For the single BCG dose indicated on the newborn calendar, WHO and UNICEF estimated 69% coverage, while official records indicate 72.3% coverage last year. In the case of the pentavalent vaccine (combined to prevent diphtheria, tetanus, whooping cough, hepatitis B, and *Haemophilus Influenzae* b), the international estimate indicates 77% coverage for the first dose recommended at two months of age and 66% for completing the scheme with the third dose at six months. Health data shows, respectively, 79.5% and 68.1% coverage.
The hepatitis B vaccine had 66.84% coverage in official data and 64% in the international estimate. For measles and rubella prevention, which in the national calendar corresponds to the triple viral vaccine (including mumps), WHO and UNICEF estimated coverage with the first dose at one year and the second at 5 years as 80% and 54%, respectively.
The polio vaccine’s application does not exceed 78% with the first dose at two months of age, according to Wueinc database, while it is 80.32% in the Health data, just to cite a few examples.
“The decline in coverage is a global phenomenon that is occurring in most countries, which have not yet recovered the pre-pandemic level of coverage. The information that was published [by the WHO and UNICEF report] comes from data taken from what is uploaded to the Joint Reporting Forms of the Pan American Health Organization (PAHO). **This means that there are still records of coverage pending impact,”** they added from the portfolio in charge of **Mario Russo**.
They requested clarification that the provision of vaccines to jurisdictions **”is sustained in a timely manner.”** This depends on the national portfolio. “This year, we delivered 100%, but the immunization rate depends on the jurisdictions,” they concluded.
The **Argentine Society of Pediatrics** (SAP) expressed its concern three months ago regarding the drop in vaccinations up to adolescence, but especially in the first year of life and upon entering school. “Undoubtedly, this is due to multiple factors, such as economic difficulties to access the health center, the shortage of human resources, limited hours, the decrease in consultations and health checks that allow the indication of the corresponding vaccines, false contraindications, lack of knowledge or low perception of risk by the population and the lack of confidence,” explained Miriam Calvari, member of the Infectology Committee of the entity.
Recalling that vaccines are one of the main tools for controlling diseases such as measles, polio, tetanus, diphtheria, whooping cough, pneumonia, meningitis, and rotavirus diarrhea, “with high levels of coverage, they prevent the reappearance of those that are under control,” said the SAP. “One of the most important challenges – the pediatricians stated – continues to be maintaining adequate coverage to achieve effective control.”
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Vaccine Coverage Stagnates in Argentina, Raising Concerns About Disease Outbreaks
A Global Trend of Stagnant Vaccination Rates
A new report from the World Health Organization (WHO) and UNICEF reveals alarming trends in global vaccination coverage, with rates remaining largely unchanged since 2022 and failing to return to pre-pandemic levels. This stagnation, impacting 184 countries, translates to an estimated 2.7 million more children globally who have not received their vaccinations compared to 2019.
The reasons behind this worrying trend are multifold:
- Disruptions to healthcare services: Pandemic-related disruptions have impacted access to healthcare, particularly in low- and middle-income countries.
- Logistical challenges: Challenges in vaccine supply chains and distribution have hindered delivery in some regions.
- Vaccine hesitancy: Misinformation and distrust in vaccines continue to present a significant barrier to vaccination efforts.
- Inequalities in access to services: Disparities in access to healthcare services, including vaccination programs, persist across various regions and socioeconomic groups.
Argentina: A Case Study of Coverage Decline
Argentina, while striving for universal access to vaccination, has also experienced a decline in coverage rates, according to the WHO and UNICEF report. Though the Ministry of Health of Argentina has implemented a national electronic registration system (Nomivac) for vaccination data, the transition to this system has led to reporting inconsistencies.
The Wueinc database, a joint project of WHO and UNICEF, indicates that Argentina’s coverage rates for several key vaccines have fallen compared to 2022. These include:
- BCG: 69% coverage (Wueinc data) vs. 72.3% (national data) for the first dose at birth.
- Pentavalent vaccine (DTP-HepB-Hib): 77% for the first dose at two months (Wueinc) and 79.5% (national data), and 66% for the third dose at six months (Wueinc) and 68.1% (national data).
- Hepatitis B: 64% (Wueinc) vs. 66.84% (national data).
- Measles, mumps, and rubella (MMR): 80% for the first dose at one year and 54% for the second dose at 5 years (Wueinc). National data were not readily available for comparison in this case.
- Polio: 78% for the first dose at two months (Wueinc) vs. 80.32% (national data).
Challenges in Data Collection and Interpretation
Discrepancies between the Wueinc data and Argentina’s official figures highlight challenges in data collection and interpretation. The Ministry of Health acknowledges delays in data upload and discrepancies with some provincial systems.
Furthermore, the transition to Nomivac, while a positive step towards improved data management, has affected the completeness and timeliness of reporting. Provinces still rely on paper-based registrations or face difficulties transferring data to Nomivac.
The Importance of Maintaining High Vaccination Coverage
The Argentine Society of Pediatrics (SAP) emphasizes the critical importance of maintaining high vaccination coverage to prevent the resurgence of diseases previously under control. They attribute the decline in vaccination rates to a complex interplay of factors including:
- Financial constraints: Access to healthcare and vaccination services can be challenging for some due to economic difficulties.
- Human resource shortages: Limited healthcare personnel and restricted clinic hours can impede access to vaccination services.
- Misinformation and distrust: Misinformation regarding vaccines persists, leading to hesitancy and reluctance to vaccinate.
- Limited awareness: Lack of knowledge regarding the importance of vaccination and the risks of vaccine-preventable diseases can contribute to low coverage rates.
Moving Forward: A Multi-pronged Approach to Address the Challenge
Addressing the decline in vaccination coverage calls for a multifaceted approach. This involves:
- Improving access to vaccination services: Expanding access through increased healthcare personnel, longer clinic hours, and improved accessibility for marginalized communities.
- Tackling vaccine hesitancy: Public health campaigns aimed at promoting accurate information, addressing concerns, and building trust in vaccines.
- Strengthening data collection and reporting systems: Enhancing data management infrastructure, including Nomivac, to ensure accurate, timely, and comprehensive reporting.
- Addressing logistical challenges: Ensuring consistent vaccine supply chains and efficient distribution networks.
Collaboration and Commitment are Key
Protecting children and communities from vaccine-preventable diseases requires a collaborative effort. Government agencies, healthcare professionals, parents, and communities must work together to promote vaccination, ensure access, and counter misinformation. Only then can we collectively achieve the goal of high vaccination coverage and safeguard public health once morest preventable diseases.