New Vaccine Introductions Worldwide Slowed Sharply During COVID-19, 2016–2021

The Immunization Agenda 2021–2030 (IA2030), endorsed by the World Health Assembly, envisions a world where everyone benefits from vaccines. One target: 500 introductions of new and underutilized vaccines in low- and middle-income countries' schedules by 2030. CDC and WHO researchers tracked progress for eight WHO-recommended vaccines (10 antigens) across 194 countries.

Where things stood in 2021

• Only 33 countries (17%) offered all eight, and just one low-income country had introduced them all; 56 (29%) offered all five infant vaccines.

New introductions of WHO-recommended vaccines each year, 2016–2021, by vaccine (bars) and in total (line); the arrow marks the start of the COVID-19 pandemic. CDC.

The COVID-19 slowdown

• From 2016 to 2021, countries averaged 31 new introductions a year, versus 47 a year in 2010–2015 — a decline of about one third.
• Introductions plunged from 48 in 2019 to 15 in 2020, then rose to 26 in 2021 (7 HPV, 6 PCV, 5 RV, 4 MCV2, 3 DTPCV4, 1 HepB-BD).
• RV grew most among infant vaccines (84 countries to 116). HPV had the most new introductions overall, up 65% (69 countries to 114); MCV2 rose 12% and DTPCV4 4%.

Gaps by income and region

Percentage of high-, middle- and low-income countries that had introduced DTPCV4, the hepatitis B birth dose and HPV vaccine, 2016–2021. CDC.

• HPV was still missing in 71% of low-income, 50% of middle-income and 12% of high-income countries.
• RV was missing in 25% of low-, 39% of middle- and 49% of high-income countries — the most underused vaccine in wealthy countries.
• DTPCV4 and HepB-BD made little progress at any income level.
• Of 152 introductions in 2016–2021, 38% were in the African Region, 18% in the Americas, 15% Western Pacific, 14% Europe, 11% South-East Asia and 3% Eastern Mediterranean.
• Africa had the largest shares of countries lacking HepB-BD, DTPCV4, MCV2 and RCV; 90% of Eastern Mediterranean countries had yet to introduce HPV.

Why, and what could help

• Supply: RV and HPV vaccines faced shortages, worsened by the pandemic. Gavi, the Vaccine Alliance, and partners are working on supply and affordability.
• Gavi support: from 2016, Gavi helped scale up HPV introductions, after 2011–2015 demonstration projects showed feasibility. Its support reached 57 low- and lower-middle-income countries, but no upper-middle-income countries; during COVID-19 it paused investment in DTPCV4 and HepB-BD.
• Middle-income countries cite cost, weak procurement and slow regulatory processes. In December 2020, Gavi approved a new approach for middle-income countries, including former and never-eligible ones, to introduce vaccines like HPV and RV.
• Single-dose HPV: in 2022, WHO said HPV vaccine may be given as one dose, likely easing delivery and cutting cost.
• Rotavirus lags in rich countries for reasons beyond cost — low awareness and lingering safety concerns — even though benefits far exceed risks; high-level advocacy is needed.
• DTPCV4 and HepB-BD need targeted funding, awareness and logistics such as trained staff and cold chains.

As of 2021, 167 cumulative introductions in low- and middle-income countries counted toward IA2030's goal of 500. Many countries kept introducing vaccines despite the pandemic, but urgent recovery is needed — including for vaccines given beyond infancy.

Limitations: reported schedules may not reflect actual availability; some DTPCV4 data were missing; and income classifications weren't available for every country.

Sources

Based on Kaur G, Casey RM, Patel JC, Bloem P, Walldorf JA, Hyde TB, "Status of New Vaccine Introduction — Worldwide, 2016–2021," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.