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In the 20th century, smallpox killed an estimated 300 million people, a population the size of the contemporary United States minus Texas. Edward Jenner, the English physician who developed the smallpox vaccine, described the excruciatingly painful disease as "the severest scourge of the human race."
UNICEF's flagship The State of the World's Children report, released last week, warns that perceptions of the importance of vaccinating children could be declining. According to data provided by the Vaccine Confidence Project, the number of survey respondents who agreed that vaccines are important for children fell after the onset of the pandemic in 52 out of 55 countries studied.
This decline was observed in rich and poor countries alike, including by as much as 44 percentage points in the Republic of Korea and Papua New Guinea, and by more than a third in Ghana, Japan, and Senegal. In the US, the perception of the importance of vaccines for children declined by 13.6 percentage points. Worryingly, people under 35 were most likely to report less confidence about the importance of vaccines for children after the start of the pandemic.
People's reasons for believing in the importance of vaccines tend to vary according to their lived experience. But a few common factors seem to be denting confidence across multiple countries, including uncertainty about the response to the COVID-19 pandemic, growing access to misleading information, declining trust in expertise, and political polarization.
Even before the pandemic, progress in reaching every child with life-saving vaccines was precarious. For almost a decade, progress toward vaccinating 100 percent of children had stalled as the world struggled to reach the most marginalized 20 percent. Likewise, before the pandemic, confidence in childhood immunizations was already under threat. In January 2019, WHO named vaccine hesitancy as one of the top 10 threats to global health.
We could ill afford to lose ground—yet the pandemic era saw the largest sustained drop in immunization in a generation. Between 2019 and 2021, a total of 67 million children missed out on one or more vaccinations and coverage levels decreased in 112 countries.
Of course, these declines are not simply a consequence of parents' hesitancy. Disruptions to health services during the pandemic, lockdowns, and the pre-existing challenge of reaching marginalized groups played a part. Trying to determine the extent to which one of these factors is more responsible than the other is like trying to untangle spaghetti. But what is clear is that routine childhood vaccinations appear to have been perceived as less important in people's minds—even as COVID-19 vaccinations saved the lives of millions.
We are now witnessing the consequences of the backslide. Thirty-three countries reported significant measles outbreaks last year, up from 22 countries in 2021. Polio is reappearing in places that had previously been declared polio-free, including London and New York. Cholera and other vaccine-preventable diseases are rising sharply.
This is a genuine cause for alarm. We must redouble our work with governments to ensure vaccines reach every child and help leaders understand the social and behavioral drivers of vaccination. We need community-specific strategies to promote vaccine uptake: through conversations with informed healthcare workers, via research-backed social media posts, and by just plain improved word-of-mouth.
Parents want the best for their children, but for that to happen, they need access to vaccines and, now more than ever, they need access to facts.
That will take a global effort. We must do more to provide verified information, debunk myths around vaccines, and tackle the real-life consequences of misinformation online, in print and in our communities. Proactive strategies are needed to counter the relatively limited number of highly prominent anti-vaccine voices online. And we must work with social media platforms and regulators to tackle the causes and consequences of fast-spreading, pernicious falsehoods, generated by a small number of individuals with questionable motivations.
And we need to better engage the public and parents on the long history of safe and effective childhood vaccines. Two centuries ago, Edward Jenner encountered similar challenges in winning the confidence of parents in his discovery. But Jenner was making the case for what was then a new form of treatment. Today, our biggest strength is 200 years of countless lives saved and entire diseases wiped from the planet. We just have to spread the word.
Catherine Russell serves as UNICEF's 8th executive director, overseeing the organization's work for children in over 190 countries and territories.
The views expressed in this article are the writer's own.
