Since 1990, substantial progress has been made in reducing the number of deaths among children under five across the world. Globally, an estimated five million children died before reaching their fifth birthday in 2021, according to the World Health Organization. That is a tragically high number, but that’s down from 6.1 million in 2015, an impressive 17.1% drop.

Despite that, the child mortality rate remains persistently high in Asia and the Pacific. Of the top ten countries with the highest number of children under five dying, four of them are in the region, according to WHO data.

What’s devastating in the second decade of this century is that most of those babies and young children are dying of preventable and treatable conditions, most notably malaria, pneumonia, and diarrhea. Alongside interventions to reduce these three big killers, vaccination remains key to early childhood health.  Timely and comprehensive national vaccination programs significantly reduce measles, rubella, and polio, all highly infectious diseases that prey on the young.

The COVID-19 pandemic had a huge impact on health services in developing countries from mid-2020. Child and adolescent vaccination programs were particularly badly hit due to lack of vaccines and the workers to administer them. Even when immunization was offered, people were often unable to access them due to lockdowns, transport problems, economic hardship, or fear of being exposed to the virus. 

The WHO sounded the alarm in July 2020 that the avoidable suffering and death caused by children denied routine immunization could be far greater than from COVID-19 itself.

Two years later, UNICEF reported that the percentage of children receiving three doses of vaccine against diphtheria, tetanus, and pertussis (an indicator for immunization coverage within and across countries) fell five percentage points between 2019 and 2021 to 81%. That’s the largest global decline in childhood vaccinations in 30 years.

A July 2021 study published in the Lancet found a marked global disruption to routine immunization occurred in 2020, with coverage estimated to have fallen more than 7% compared to expected coverage in the absence of COVID-19. Across Asia and the Pacific, UNESCAP has estimated that in 2020, 8 million children across Asia and the Pacific missed routine vaccinations, an increase of approximately 2.5 million from 2019.

Eight countries in Asia and the Pacific had an under-5 mortality rate (deaths per 1,000 live births) in 2021 estimated at higher than the global estimate of 38.1, according to Basic Statistics 2023. The under-5 mortality rate remains worryingly high in Pakistan (63 per 1,000 live births), Timor-Leste (51 per 1,000 live births), and other countries in the region.

The death rates of newborns in a certain area within their first 28 days typically reflect the death rates of children under the age of five in the same area. These figures don’t tell us very much in isolation. Pakistan had the highest rate in Asia and the Pacific in 2021 at 39.4, but that’s a major improvement on 20 years ago when it was 54.3. Timor-Leste has significantly reduced its rate from 34.2 to 22.2 in the same period.

 The pandemic has reminded the world of the power of vaccines to fight disease, save lives, and create a healthier, safer, and more prosperous future. Now the pandemic is largely contained, it’s time for a post-COVID-19 health dividend. 

A gradual recovery of national vaccinations programs appears to be underway, but several factors—ongoing transmission, emergence of new variants, and a focus on the roll-out of COVID-19 vaccines, among others—could easily stall or reverse this tentative progress. 

To recover lost ground,  countries in Asia and the Pacific, particularly those with historically high infant and child mortality rates, need to intensify efforts to rapidly re-establish routine life-saving national vaccination programs. In tandem, routine immunisation data systems must be strengthened to enable data-driven decision-making at local levels and improved monitoring of routine immunization over time. 

Immunization reaches more people in Asia and the Pacific than any other health and social service, making it the foundation of primary health care and a key driver of universal health coverage. The WHO’s Immunization Agenda 2030 (IA2030) is designed to address these and other vaccination challenges over the next decade. 

Although the global death rate of children under five is on a downward trend, the pandemic has threatened this hard-won progress. A new commitment is needed in Asia and the Pacific to ensure the region stays on track.