New Zealand children face ‘perfect storm’ of dangerous diseases as vaccination rates plummet


Routine childhood immunization has dropped so dramatically around the world during the COVID-19 pandemic that the World Health Organization and UNICEF are sounding the alarm.

Globally, in 2021 alone, 25 million children did not receive life-saving vaccines. This is the largest sustained decline in childhood immunization in a generation.

In Aotearoa, New Zealand, we are seeing an equally worrying trend. The drop in childhood vaccination leading to low overall coverage now puts our tamariki (children) at real risk of preventable disease, especially with the reopening of national borders.

The country is not alone in experiencing collateral damage to normal childhood immunization programs due to the COVID-19 pandemic. But if the decline can be worrying, all is not lost.

Risk of epidemics

Immunization coverage at six months of age has dropped in New Zealand, from a peak of around 80% in early 2020 to 67% in June 2022, and as low as 45% for Maori.

This is important because vaccination coverage at six months is used as a marker for the timely receipt of life-saving government-funded vaccines, including pertussis (whooping cough), diphtheria, poliomyelitis, pneumococcal disease and rotavirus.

For example, whooping cough (whooping cough), a particularly serious disease for babies, is a very real concern. Aotearoa has seen a resurgence of whooping cough every three to four years, which means we are due for an increase in cases at a time when we also have low vaccination coverage.

Additionally, these declines in vaccination coverage and the resulting risk of infection are particularly important to consider now, as international travel resumes.

New Zealand Ministry of HealthCC BY-ND

The return of “old” diseases

Poliomyelitis, a viral disease that can cause paralysis, has been wiped out of Aotearoa through vaccination, with the Western Pacific region declared polio-free in 2000. However, as some parts of the world have yet to eradicate it , we continue to vaccinate children against poliomyelitis.

A recent case in an unvaccinated young man in New York shows how the virus can travel and reappear – even in polio-free developed countries.

Read more: Diphtheria is back in Australia, here’s why – and how vaccines can prevent its spread

Similarly, diphtheria is a rare but serious disease that causes breathing problems and can also lead to nerve palsy and heart failure, 5-10% of sufferers die.

Until widespread vaccination after the 1940s, diphtheria was a common cause of death in children, and we haven’t seen it in Aotearoa for decades. But diphtheria was recently detected in Australia in two unvaccinated children.

With the New Zealand borders fully open since July 31, we run the risk of these two ‘old’ diseases being imported and causing problems for our under-immunized tamariki and their whānau.

A perfect measles storm

The large measles outbreak of 2019 serves as a warning. More than 2,000 people have been infected and 700 hospitalized, with the highest number of cases in Auckland.

Fiji, Tonga and Samoa have also seen outbreaks, with Samoa particularly devastated by more than 5,000 cases and more than 80 deaths, mostly among young children.

The severity of this epidemic could have been avoided because the combined vaccine against measles, mumps and rubella (MMR) is very effective.

Read more: The toughest phase of the Omicron outbreak is yet to come, but New Zealand may be better prepared than other countries

But infant MMR coverage was not high enough then (and historically has not been), leaving known immune deficiency in susceptible adolescents and young adults.

Significant efforts have since been made to close this gap in MMR coverage, although they have been overshadowed by the COVID-19 vaccination campaign.

The result is a potential perfect storm for another measles outbreak, with low MMR coverage globally and locally. Measles could ‘cross’ New Zealand airports and encounter under-immunized tamariki and rangatahi (young people).

Prevention as a cure

There is, however, good news. This year we have seen the introduction of new initiatives to help manage winter disease outbreaks, including government funding of flu shots for children aged 3-12.

This is welcome, as the flu crosses our border every year (with the exception of 2020 when COVID-19 public health measures, including quarantine and mask-wearing, were in effect). Because children are often considered super-spreaders, vaccinating children can reduce flu-like illnesses and associated costs in both the tamariki and their whānau.

But the message from World Health Organization Director-General Tedros Adhanom Ghebreyesus remains urgent:

Planning for and responding to COVID-19 must also go hand in hand with vaccination against deadly diseases like measles, pneumonia and diarrhoea.

In Aotearoa, New Zealand, the COVID-19 vaccination experience has also shown how Maori and Pacific community health providers can help achieve lofty vaccination targets – especially when combined with good outreach services, increasing immunization providers beyond GP clinics and strengthening the immunization workforce.

But right now, the statistics paint a worrying picture. The low vaccination coverage of children exposes tamariki to the risk of many preventable and serious diseases and significantly burdens the already strained health system.

Prevention must be our top priority. It’s better than the best medicine and will protect the healthcare system from being overloaded so that it is available for those who need urgent care.


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