In April 2023 UNICEF published its The State of the World’s Children report with a focus on the global vaccination situation for children. These reports have been released since 1980, with UNICEF hoping to “deepen knowledge and raise awareness of key issues affecting children”, advocating for “solutions that improve children’s lives”.  

Director Catherine Russell introduces the report with a comment on the power of vaccines, which have “radically altered the course of human survival and development”. In 1980, the first edition of the report stated that “in the poorest countries only one child in ten will ever see a trained health worker or be immunised in its first year against…the six most common preventable diseases of childhood”. Although this was a “troubling” report, Russell identifies “hope and progress in immunisation”.  

Fast forward to the end of the 1980s, and “about 7 in 10 of the world’s children were protected by vaccines”. This number inches higher every decade with the support of UNICEF and other organisations. However, in 2020 the COVID-19 pandemic became a persistent reality.  

In the shadow of the pandemic  

Russell acknowledges the “largest vaccine supply operation in history” in response to this. As we “slowly” recover from the pandemic, she recognises that “the approaches we have taken in the past may not always be suited for current or future circumstances”. Despite efforts to simultaneously vaccinate and educate on the safety of vaccines, “our collective efforts are falling short”.  

“Put simply, we are not meeting our goal to vaccinate every child.”  

Although vaccination development strides ahead, no new vaccines have “managed to reach more than 9 out of 10 children”, with several falling far short of this.  

“The pandemic has only darkened this picture.” 

With the “shadow” hanging over economies for “years to come”, there is another challenge to address: confidence. Russell states that, although it is “far from being the most important determinant of vaccine demand in most communities”, the rise in hesitancy cannot be ignored. Do you agree with her, or do you think it plays a more significant role in more places than she seems to suggest? 

The report at a glance 

In the report, UNICEF explores some positive achievements and some worrying data. Calling for “real commitment by governments”, the authors predict “difficult conversations” will take place.  

“Achieving the change needed to vaccinate every child will not be easy…our journey has been long but, in many ways, it is only just beginning.”  

The report begins with 7 “key messages”: 

  1. Vaccines save lives 
  2. When we don’t vaccinate children, we risk their lives and health – as well as our societies’ growth and development 
  3. The COVID-19 pandemic set back childhood immunisation around the world 
  4. But even before the pandemic, far too many children missed out on vaccination. Many live in the poorest and marginalised communities 
  5. To vaccinate every child, it is vital to strengthen primary health care and provide its mostly female front-line workers with the resources and support they need 
  6. Parents and communities need to believe in the value of vaccination; there are worrying signs that confidence in vaccines is slipping in some countries 
  7. Vaccinating every child means investing in new approaches to strengthen financing and make the most of scientific and technological innovations 

The report examines the needs we must meet to ensure that every child is protected against vaccine-preventable diseases. In the context of the COVID-19 pandemic, it focuses on the “role of poverty, marginalisation, and gender in determining whether or not children are vaccinated”.  

Four key recommendations 

The report offers four recommendations for “global, national, and local stakeholders”: 

  • Vaccinate every child, everywhere by, first catching up on children who were not vaccinated during the pandemic and helping disrupted services to recover fully. Longer term, an even more determined effort is needed to tackle the bottlenecks in health and other systems that have persistently prevented children in marginalised and underserved communities from being vaccinated. 
  • Strengthen demand for – and confidence in – vaccination by engaging with communities, to ensure their evolving needs help to shape programmes, and by focusing on interventions that target the role of women. 
  • Spend more and spend better in immunisation and health.  
  • Build resilient systems and shockproof them for the future by expanding the health workforce, especially community health workers, and by offering them training, support, and predictable payments.  

To download the report in full, head to the UNICEF website and select a language.