The Critical Role of Childhood Immunization and the Challenges of Vaccine Hesitancy

Over the past two decades, childhood immunization has become a cornerstone of global health, preventing a vast number of deaths, hospitalizations, and cases of disease worldwide. These include virtually 100% reductions in diseases such as diphtheria, Haemophilus influenza Type B, measles, mumps, rubella, and polio. In the US, childhood vaccination has led to exponential reductions in pediatric morbidity and mortality. Pneumococcal conjugate and rotavirus vaccines have also played a critical role in preventing severe infections, hospitalizations, and deaths.

The Impact of New Vaccines

Recent advancements in vaccines continue to support the fight against deadly diseases. The newly approved malaria vaccine R21/Matrix-M is one such example. It has the potential to prevent hundreds of deaths and hundreds of thousands of cases of malaria. For every 100,000 children vaccinated in areas with seasonal malaria, the vaccine could prevent 200,000 cases and 650 deaths. The cost to prevent one case is estimated to be as low as $7 in regions where malaria is seasonal, and $6 where transmission occurs throughout the year. Recommended for use by the World Health Organization, this vaccine could have a substantial public health impact, particularly in Sub-Saharan Africa.

Disruptions to Immunization Due to COVID-19

The COVID-19 pandemic has introduced significant challenges to routine immunization, especially in the WHO African Region. Coverage for routine immunization in the region has been disrupted, with only 28% of countries achieving the global target coverage of 90% or above for DTP3 in 2022. A staggering 28.7 million zero-dose children were recorded from 2019 to 2022. Only 13 out of 47 countries in the region achieved the global target coverage, underscoring the urgent need for governments to prioritize investments for restoring immunization services, catching up on the vaccination of zero-dose and under-vaccinated children, and improving data quality.

Vaccine Hesitancy: A Global Challenge

Despite considerable progress in increasing vaccine coverage, equitable access remains challenging, particularly in remote areas such as Indonesia. Here, childhood immunization has decreased during the COVID-19 pandemic, and vaccine hesitancy has slowed efforts to end the pandemic. Public health campaigns and community engagement efforts are much needed to promote vaccine acceptance and uptake. Vaccine hesitancy is influenced by various factors such as a lack of trust in vaccines, misinformation, cultural beliefs, and past negative vaccine experiences.

Collaboration with community or religious leaders, healthcare providers, and influencers could significantly increase people's awareness and gain trust, thereby reducing vaccine hesitancy. The COVID-19 vaccination program in Indonesia has also experienced hesitation, which could lead to low vaccination coverage and slow eradication of vaccine-preventable diseases. The vaccination hesitancy framework developed by SAGE includes the 3Cs model: complacency, convenience, and confidence.

It is vital that we continue to advocate for and promote the benefits of immunization while addressing the challenges of vaccine hesitancy. The health and well-being of future generations depend on it. By ensuring that every child has access to life-saving vaccines and reliable health information, we can continue to reduce the burden of preventable diseases and pave the way to a healthier future.