More than four years after the COVID-19 pandemic started, childhood vaccination rates worldwide haven’t recovered, according to a report issued by the WHO and UNICEF.

More than four years after the pandemic started, childhood vaccination rates worldwide have yet to recover, according to a report issued by the WHO and UNICEF.

The report, which reflects 2023 vaccination rates, is the world’s largest dataset on immunization trends for 14 diseases. It analyzed estimates from 185 countries and used a third dose of the diphtheria, tetanus and pertussis (DTP3) vaccine as the global marker for immunization coverage.

Worldwide, DTP3 coverage was 84% in 2023, the same as in 2022 but below the 86% recorded in 2019.

“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,” the WHO said in the news release.

Many African countries showed the greatest progress in vaccination coverage, the WHO noted. However, HPV vaccine coverage remains well below the 90% target to eliminate cervical cancer as a public health problem, reaching only 56% of adolescent girls in high-income countries and 23% in low- and middle-income countries.

Measles coverage in countries with large or disruptive outbreaks following the pandemic was too low to control further outbreaks. Nearly 35 million children were left with no or only partial protection against measles. Low vaccination rates fueled outbreaks in 103 countries in the past 5 years, the report found.

In 2023, the 92% of American children that had been vaccinated against measles, mumps, and rubella by the age of 2 fell below the federal target of 95%, CNN reported.

“Measles outbreaks are the canary in the coal mine, exposing and exploiting gaps in immunization and hitting the most vulnerable first,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said in the release.

Over half of unvaccinated children in 2023 live in countries experiencing conflict and vulnerability.

“The latest trends demonstrate that many countries continue to miss far too many children,” UNICEF Executive Director Catherine Russell said in a news release announcing the data. “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.”