Abstract:
Vaccine preventable diseases (VPD) pose significant morbidity and
mortality globally. Two years after the endorsement of
Immunization Agenda 2030 (IA2030), the number of children not
fully vaccinated increased from 19 million pre-COVID-19 to 25
million post-COVID, with 72% (18.2 million) of these labelled as
zero-dose, i. e those who did not receive DPT 1 vaccine. While
children who do not initiate vaccination early (zero-dose) may be
at a greater risk of missing subsequent vaccinations, we most
respectfully suggest that this term zero-dose may be problematic,
lending itself to misconceptions among policy makers and health
professionals. Firstly, zero-dose is currently set at six weeks DPT1
vaccination point and not at birth for children 12-23 months of age.
Secondly, assessing zero-dose in children 12 to 23 months of age,
delays corrective or remedial action because by month 12, the
children have missed key vaccines before they are flagged as zero
dosers. Thirdly, in poor settings, many children who initiate
vaccination do not complete the schedule, with DPT1 coverage
always higher than measles vaccine coverage. Additionally, the
children in poor countries who miss the first DPT dose face similar
challenges and deprivations and barriers as those who fail to
complete their immunization schedule. The problems of poverty,
inability to fully access immunization services, hesitant caregivers
and poorly equipped immunization programs affect all children
across sub–Saharan Africa and other poor countries. This review
seeks to discuss the importance of looking at the entire
recommended immunization schedule over and above highlighting
those who miss DPT1 alone and proposes that “under-immunized”
children as an entity be equally emphasized as “zero dose”
children in low- and middle-income countries to ensure that
adequate attention is given to both vulnerable groups.