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Global childhood immunization levels stalled in 2023 leaving many without life-saving protection

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BY UNICEF

What’s new: New data reveal nearly 3 in 4 infants live in countries where low vaccine coverage driving measles outbreaks

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Global childhood immunization coverage stalled in 2023, leaving 2.7 million additional children un- and under-vaccinated compared to pre-pandemic levels in 2019, according to data published today by the World Health Organization (WHO) and UNICEF.

The latest WHO and UNICEF estimates of national immunization coverage (WUENIC) – which provide the world’s largest and most comprehensive dataset on immunization trends for vaccinations against 14 diseases – underscore the need for ongoing catch-up, recovery and system-strengthening efforts.

“The latest trends demonstrate that many countries continue to miss far too many children,” said UNICEF Executive Director Catherine Russell. “Closing the immunization gap requires a global effort, with governments, partners, and local leaders investing in primary healthcare and community workers to ensure every child gets vaccinated, and that overall healthcare is strengthened.”

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According to the findings, the number of children who received three doses of the vaccine against diphtheria, tetanus, and pertussis (DTP) in 2023 – a key marker for global immunization coverage – stalled at 84 per cent (108 million). However, the number of children who did not receive a single dose of the vaccine increased from 13.9 million in 2022 to 14.5 million in 2023.

More than half of unvaccinated children live in the 31 countries with fragile, conflict-affected and vulnerable settings, where children are especially vulnerable to preventable diseases because of disruptions and lack of access to security, nutrition, and health services.

Additionally, 6.5 million children did not complete their third dose of the DTP vaccine, which is necessary to achieve disease protection in infancy and early childhood.

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These trends, which show that global immunization coverage has remained largely unchanged since 2022 and – more alarmingly – has still not returned to 2019 levels, reflect ongoing challenges with disruptions in healthcare services, logistical challenges, vaccine hesitancy and inequities in access to services.

Low vaccine coverage already driving measles outbreaks

The data further show that vaccination rates against the deadly measles disease stalled, leaving nearly 35 million children with no or only partial protection.

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In 2023, only 83 per cent of children worldwide received their first dose of the measles vaccine through routine health services, while the number of children receiving their second dose modestly increased from the previous year, reaching 74 per cent of children. These figures fall short of the 95 per cent coverage needed to prevent outbreaks, avert unnecessary disease and deaths, and achieve measles elimination goals.

Over the last five years, measles outbreaks hit 103 countries – home to roughly three-quarters of the world’s infants. Low vaccine coverage (80 per cent or less) was a major factor. In contrast, 91 countries with strong measles vaccine coverage did not experience outbreaks.

“Measles outbreaks are the canary in the coal mine, exposing and exploiting gaps in immunization and hitting the most vulnerable first,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This is a solvable problem. Measles vaccine is cheap and can be delivered even in the most difficult places. WHO is committed to working with all our partners to support countries to close these gaps and protect the most at-risk children as quickly as possible.”

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Global HPV vaccine coverage among girls increased substantially

The new data also highlight some brighter spots in immunization coverage. The steady introduction of new and under-utilized vaccines, including for human papillomavirus (HPV), meningitis, pneumococcal, polio and rotavirus disease, continue to expand the breadth of protection, particularly in the 57 countries supported by Gavi, the Vaccine Alliance. 

For example, the share of adolescent girls globally who received at least 1 dose of the HPV vaccine, which provides protection against cervical cancer, increased from 20 per cent in 2022 to 27 per cent in 2023. This was largely driven by strong introductions in Gavi-supported countries, such as Bangladesh, Indonesia, and Nigeria. The use of the single-dose HPV vaccine schedule also helped boost vaccine coverage.

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“The HPV vaccine is one of the most impactful vaccines in Gavi’s portfolio, and it is incredibly heartening that it is now reaching more girls than ever before,” said Dr Sania Nishtar, CEO of Gavi, the Vaccine Alliance. “With vaccines now available to over 50 per cent of eligible girls in African countries, we have much work to be done, but today we can see we have a clear pathway to eliminating this terrible disease.” 

However, HPV vaccine coverage is well below the 90 per cent target to eliminate cervical cancer as a public health problem, reaching only 56 per cent of adolescent girls in high-income countries and 23 per cent in low- and middle-income countries.

A recent poll of over 400,000 users of UNICEF’s digital platform for young people, U-Report, revealed that over 75 per cent are unaware or unsure of what HPV is, underscoring the need for better vaccine accessibility and public awareness. When informed about the virus, its link to cancers, and the existence of a vaccine, 52 per cent of respondents indicated they want to receive the HPV vaccine but are hindered by financial constraints (41 per cent) and lack of availability (34 per cent).

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Robust local action needed to reach everyone, everywhere with vaccines

While there’s been modest progress in some regions, including the African region and low-income countries, the latest estimates highlight the need to accelerate efforts to meet the Immunization Agenda 2030 (IA2030) targets of 90 per cent coverage, and no more than 6.5 million ‘zero-dose’ children globally by 2030.

The IA2030 Partnership Council calls for increased investment in innovation and ongoing collaboration. The council also recommends partners step up their support for country leadership to improve routine immunization as part of their integrated primary health care programmes, backed by robust political support, community leadership, and sustainable funding.

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Leaders commit to creating pathways for transformative education, skills development for children

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BY SIRAK GEBREHIWOT

Victoria Falls – A historic gathering of seven Southern African leaders, international representatives, over 7000 children and youth took place at Baobab Primary School in the resort town of Victoria Falls to commemorate regional World Children’s Day.

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The event, attended by dignitaries from across the southern Africa region, emphasized universal dedication to the rights and welfare of children, guided by the UN Convention on the Rights of the Child.

His Excellency President Emmerson Mnangagwa of Zimbabwe extending warm welcome to delegates, underlined the unity and shared goals of the Southern African Development Community (SADC). “Today is a powerful reminder of our collective duty to protect the rights of all children,” he affirmed.

President Mnangagwa’s speech underscored the importance of providing children with quality education and resilience against climate change, all while fostering their sense of identity and pride in their African heritage.

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The President expressed gratitude to regional counterparts, particularly President Duma Boko of Botswana, for participating in Zimbabwe’s festivities. In a gesture of regional solidarity, he acknowledged, “Though we hail from different nations, we share a common vision for a vibrant, educated, and united Africa.”

Mr. Edward Kallon, the UN Resident and Humanitarian Coordinator for Zimbabwe, echoed the President’s sentiments. He stressed the significance of this event as a platform to emphasize children’s rights, aligning with the Sustainable Development Goals.

“The UN2.0 and its quintet of change—embracing innovation, technology, and inclusivity—guides the United Nations renewed mission towards a brighter future for all children,” Mr. Kallon stated.

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He underscored the UN’s reinvigorated strategy, UN 2.0, aiming for transformational change with children at its core. Kallon called on all stakeholders to remain accountable to the children’s Call to Action, reinforcing the imperative to incorporate young voices in policymaking processes and national development programmes.

Education: A Pillar for Progress

UNICEF Regional Director, Ms. Etleva Kadilli, focused on the transformative power of education. She recognized strides made in various SADC countries that have prioritized digital learning, inclusive education, and curriculum reform. “These advancements illustrate that when governments and educators listen to children and act, significant progress can be achieved,” Ms. Kadilli underlined.
Kadilli acknowledged the persistent challenges facing sub-Saharan Africa, where educational disparities remain stark. She encouraged children present, stating, “Your voices are vital. When you speak, you not only shape your future but ours as well.”

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Collective Regional Pledge

His Excellency President Duma Boko of Botswana accepted the honor of hosting the next World Children’s Day commemoration. He pledged his administration’s dedication to addressing the needs and aspirations voiced by the children and youth. “We stand ready to work with you, empowering our children to lead with wisdom and courage,” President Boko assured.

Senior officials from Zambia, Namibia, Mozambique, Malawi, and South Africa echoed these commitments. They affirmed their governments’ resolve to enhance children’s access to quality education, healthcare, and social protection, reinforcing their rights as a priority.

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Empowering Through Culture and Heritage

The celebration also spotlighted the role of arts, culture, and heritage in building inclusive societies. President Mnangagwa stressed the importance of embracing cultural identity and utilizing natural resources to foster development and unity. “Let us, together, promote our unique cultural products and enhance our children’s understanding of their heritage,” President ED Mnangagwa encouraged.

Combating Emerging Threats

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Addressing contemporary challenges such as climate change and drugs and substance abuse, President Mnangagwa reaffirmed Zimbabwe’s commitment to combating these issues through strategic initiatives like the Presidential Borehole Drilling Scheme and the establishment of Child-Friendly Courts. “Our measures ensure that all children, particularly the vulnerable, have their rights upheld and their futures secured,” he stressed.

A Call to Action and Hope

Ms. Etona Ekole, UNICEF Representative for Zimbabwe said, “This World Children Day, I am incredibly proud to see children from Botswana, Namibia, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe raising their voices for change. Their Call-for-Action is a testament to the power of listening to children and investing in their future.

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The event underscored a unified call to invest in children as Southern Africa’s future leaders. With collaborative resolve, the leaders and stakeholders committed to translating discussions into concrete actions, guided by the insights and demands of the children and youth.

Facilitating a call to action from children and youth representatives across seven countries, Ms. Sithabile Mtigo, Speaker of the Junior Parliament of Zimbabwe, highlighted the critical role of young advocates throughout Africa. She declared, “We are the leaders of both the present and the future for Africa.”

The Regional World Children’s Day served as a reminder of the shared journey towards a future where every child’s rights and potential are realized, and every opportunity leveraged.

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The commitment made in Victoria Falls to “Educate and Skill the African Child for Posterity” is not only a theme but a driving mission as the African continent marches towards a brighter, more inclusive tomorrow.

SOURCE: Sirak Gebrehiwot is UN Partnerships and Development Finance Advisor at the UN Resident Coordinator’s Office in Zimbabwe

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Botswana’s president concedes defeat in election, ending ruling party’s 58 years in power

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BY STAFF REPORTER

Botswana’s President Mokgweetsi Masisi conceded defeat in the general election Friday, in a seismic moment of change for the county that ended the ruling party’s 58 years in power.

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Masisi’s concession came before final results were announced, with his Botswana Democratic Party trailing in fourth place in the parliamentary elections.

The main opposition Umbrella for Democratic Change held a strong lead in the partial results, making its candidate, Duma Boko, the favorite to become president of a southern African country that is one of the world’s biggest producers of mined diamonds.

Masisi said he had called Boko to inform him he was conceding defeat.

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“I concede the election,” Masisi said in an early-morning press conference two days after the election. “I am proud of our democratic processes. Although I wanted a second term, I will respectfully step aside and participate in a smooth transition process.”

“I look forward to attending the coming inauguration and cheering on my successor. He will enjoy my support.”

Masisi’s BDP dominated politics in Botswana for nearly six decades, since independence from Britain in 1966. The nation of just 2.5 million people will now be governed by another party for the first time in its democratic history.

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SOURCE:AP

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Zambia offers health care to Zimbabweans — but for how long?

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Illustration Credit: Wynona Mutisi for Global Press Journal

BY GAMUCHIRAI MASIYIWA

Summary: Zambia is as generous with patients from neighboring Zimbabwe as it is with its own citizens. That could mean problems for both countries.

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This story was originally published by Global Press Journal.

MASHONALAND WEST, ZIMBABWE — When Dube was diagnosed with gallstones in 2013, the public hospital in Zimbabwe recommended surgery costing close to 4,000 United States dollars. She couldn’t afford that.

 

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A friend suggested she go to Zambia, about 150 kilometers (94 miles) to the north. There, the friend said, treatment would be cheaper.

 

Over the past decade, Dube has gone to Zambia multiple times for medical treatment. Her most recent trip was in June. Treatment is cheaper there, she says, but the level of care is also far better than what she would get at home. Dube asked that Global Press Journal use her totem name, a symbolic representation of ancestral lineage, out of concern about Zimbabwe’s Patriotic Bill, which discourages criticism of the government.

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In the 1980s, Zimbabwe had one of the best health care systems in sub-Saharan Africa. But over the years, this glory has faded. An ongoing economic crisis spanning over two decades has left the health care system scrambling to meet the needs of its population. Skilled health care workers have left in droves, drawn to opportunities abroad. More than 4,000 health care workers left Zimbabwe in 2021 and 2022 alone, according to government statistics. By late 2022, Zimbabwe had about 1,700 doctors and about 17,200 nurses to serve a population of 15 million people.

 

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Just as health care workers are leaving the country, so are patients.

 

Over the past decade, Zimbabweans have spent more than 4 billion US dollars on cross-border medical migration. Annually, more than 200,000 Zimbabweans spend around 400 million US dollars on specialized medical treatment abroad. India, China, Singapore and South Africa are the main destinations.

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But an increasingly popular choice is neighboring Zambia. In April alone, the International Organization for Migration surveyed over 260 people migrating from Zimbabwe to Zambia. When asked why they were traveling, 42% stated that it was to access better services — health being the top priority.

 

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Precise data is hard to come by, but anecdotal evidence from sources who spoke to Global Press Journal, including border officials, points to a growing trend, raising questions about Zambia’s ability to manage the influx, and the future of health care in Zimbabwe.

 

The choice of Zambia

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Zambia and Zimbabwe allocated nearly the same amount of money to their health sectors in 2024, even though Zambia is home to 4 million more people. With that budget, it’s an unlikely alternative to the Zimbabwean healthcare system. And in Africa, it’s South Africa and Kenya that are top destinations for medical tourism.

 

But the border with Zambia isn’t far for many Zimbabweans, making the cost of travel low and the process of crossing the border usually straightforward. A person needs either a passport or a pass issued at the border for just 1 US dollar, says Morgen Moyo, assistant regional immigration officer at the Chirunduborder post.

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Even without documentation, immigration officials will at times let those seeking health care pass through. “Zambians prioritize life,” Moyo says.

 

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It’s not only about convenience. Zambia offers free primary health services, including basic treatment, preventative care, vaccinations and maternal health care services, according to the 2022-2026 Zambia National Health Strategic Plan.

 

While these free services are not available to foreigners long-term, they can access them in emergencies within the first 24 to 48 hours in the country, says Dr. Kennedy Lishimpi, permanent secretary of administration for the Zambian Ministry of Health. Foreigners are expected to pay for Zambian health care after that timeframe.

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In practice, though, Zambian health workers rarely charge foreigners, according to a 2019 study paid for by the US Agency for International Development, known as USAID.

 

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“You wouldn’t want to see somebody from Zimbabwe, for instance, getting to Zambia and not accessing a service and then they end up dying. That is not good. Similarly, we expect that our sister countries do the same to our citizens when they are there,” Lishimpi says.

 

Dr. Mwanza, a Zambian doctor who chose to use only his last name for fear of retribution, says availability of surgical and specialist services in Zambia drives medical migration. In Zimbabwe, these services are rarely available outside of the large provincial and central hospitals. In 2019, for example, about 10% of district hospitals could provide basic surgeries, compared to 83% of provincial and central hospitals, according to a Zimbabwe health ministry assessment.

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When Mary Chipfuvamiti’s son broke his arm in June, she says she chose a hospital in Zambia — about 93 kilometers (nearly 58 miles) from her home — over local options. She suspected the local hospital’s X-ray machine wouldn’t be working, and they would likely refer her to a private facility where an X-ray would cost her 40 US dollars.

 

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“I only had 30 dollars on me,” she says. In Zambia, the total cost came to about 12.50 US dollars.

 

A case for Zimbabwe

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Things haven’t always been like this in Zimbabwe. Before the country’s economy took a downturn, it offered free health services in the 1980s to low-income earners. About 90% of the population fell in that bracket.

 

In the early 1990s, the government introduced user fees in public health facilities as part of the austerity measures imposed on the government by the International Monetary Fund to reduce government expenditures. Currently, free health services are offered only to pregnant and lactating mothers, children under age 5 and adults over 60.

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The economic crisis continues to strain what remains of the health care system. Hospitals struggle with obsolete infrastructure. Shortages of medicines and supplies in public health facilities are the norm.

 

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And although Zimbabwe and Zambia have similar health budgets, Zimbabwe’s treasury sometimes delays funds disbursement, says Norman Matara, secretary general for the Zimbabwe Association of Doctors for Human Rights.

 

That was the case in 2021, when the health ministry by September had used just 46% of its budget allocation for the fiscal year due to late disbursement of funds, according to a 2024 situational report by the Zimbabwe Coalition on Debt and Development, a nongovernmental organization that advocates for socioeconomic justice.

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“There is a mismatch between the money that is put on the budget and what is being received by the health institutions,” Matara says. Reasons include hyperinflation and currency rate fluctuations, he adds.

 

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Comparing health services across countries is unfair, says Donald Mujiri, a Zimbabwe health ministry spokesperson. “Each country has its set standards and pricing.”

 

He doesn’t think this migration of patients reflects poorly on Zimbabwe’s health care system. “We have all the services in the country, and they are adequate to serve the people,” he says, adding that people are free to seek health care where they want.

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Mujiri did not address questions regarding the late disbursement of funds.

 

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The cost of the journey

These journeys to Zambia come with challenges.

 

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Dube recalled her trips along the bumpy Harare-ChirunduHighway that connects the two countries, when every bump caused piercing pain.

 

In 2019, six years after her initial treatment in Zambia, she began experiencing severe pain. She went to a hospital in Harare for treatment, but a few months later the pain resurfaced. By that time, there was a health care strike at home, forcing her back to Zambia for treatment. Then in 2023, Zambian doctors discovered metal clips from her earlier surgery in Zimbabwe were piercing her liver. She returned to Zambia in January this year for corrective surgery, and again in June.

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Health care experts warn that such journeys can be especially risky for patients who undergo surgery. If a surgery is performed in Zambia and there is no proper follow-up, there can be complications if doctors in Zimbabwe are unaware of previous procedures or tests, says Mukanya, a health expert working in a Zimbabwean hospital who chose to use his totem, fearing that speaking to the media would cost him his job.

 

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In the case of misdiagnosis or malpractice in a foreign country, it’s difficult to get recourse. “In most cases you are powerless because you don’t know the [reporting] process and approaching a lawyer may require money,” he says.

 

Medical migration also comes at a cost to Zambia. The influx of patients complicates health planning, leading to shortages of essential medications and making it difficult to allocate resources effectively, according to USAID. The agency’s report recommends the Zambian government create a fee-for-service system to discourage foreigners from seeking free health care, but doctors in Zambia don’t seem to agree.

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“Most health care providers interviewed stated that they would continue to provide services free of charge should a foreign patient be unable to pay,” according to the USAID report.

 

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Lishimpi, the Zambia health ministry official, had no comment on the report’s concerns.

 

Dube, who is recuperating at home, is uncertain about the solutions. But she thinks the Zimbabwean government needs to prioritize fixing her country’s health care system. “I don’t know how best we can help our hospitals, but if there was any other way, I think they should consider the health sector more than anything else because we are talking of human life,” she says.

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Gamuchirai Masiyiwa is a Global Press Journal reporter based in Harare, Zimbabwe.

 

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Global Press is an award-winning international news publication with more than 40 independent news bureaus across Africa, Asia and Latin America.

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