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Last update: Oct 2013

Current status   

 

A summary of global immunization coverage through 2012 can be found here.

 

Coverage with three doses of DTP containing vaccine, 2012

                

DTP comprises a series of immunizations to prevent diphtheria, tetanus and pertussis. To be fully immunized, children must receive three doses of the vaccine before their first birthday. Complete coverage with three doses of DTP containing vaccine (DTP3) is a valuable indicator of countries' performance of routine immunization and is often considered a useful indicator of access to basic health services.

 

Basic Immunization schedule recommended for all children by the WHO Expanded Programme on Immunization

Source: World Health Organization, Summary of WHO Position Papers – Recommended Routine Immunizations for Children added July 2013.

 

Of the estimated more than 22 million children worldwide who did not receive three doses of DTP containing vaccine, 16.3 million (or 72 per cent) live in 10 countries.

                 

Numbers of unvaccinated children reported in millions.

Source: WHO and UNICEF estimates of national immunization coverage, 2012 revision (completed July 2013); Population data for children surviving to age one year obtained from United Nations, Department of Economic and Social Affairs, Population Division (2013). World Population Prospects: The 2012 Revision.

 

Absolute numbers of unvaccinated infants are highest in the most populous developing countries, some of which enjoy fairly high rates of immunization coverage. Efforts to raise global immunization will need a strong focus on the countries where the highest numbers of unvaccinated children live – while also ensuring that the countries where children are most likely to miss out on immunization are not neglected in the search for greater global impact.

GIVS Progress

One of the goals set forth by the Global Immunization Vision and Strategy (GIVS) (2006-2015) is to increase national immunization coverage to at least 90% by 2010 and to sustain such levels through 2015. Of the 195 countries and territories for which estimates are made, more than three quarters either achieved coverage of at least 90% by DTP3 or MCV in 2010 or were on track to do so by 2015 (as estimated by UNICEF and WHO; see http://www.biomedcentral.com/1471-2458/11/806 for details). Based on the 2012 revision of the WHO and UNICEF estimates of national immunization coverage, 132 of 195 countries or territories attained at least 90 per cent coverage with DTP3 by the end of 2012. Of these 132 countries, 117 countries maintained DTP3 coverage of at least 90 per cent during the three year period 2010-2012.


Based on the analysis by Brown et al of the mid-term GIVS progress, a total of 45 countries made either insufficient or no progress towards the GIVS goal as measured by DTP3 coverage. These 45 countries are home to nearly two thirds of the world’s surviving infants not vaccinated with DTP3. Most of them are classified as developing or least developed by the World Bank (41 countries); about half are located in Africa (22 countries) and more than half (28 countries) are among the 75 priority countries where more than 95% of all maternal and child deaths occur. Similar patterns were seen for MCV coverage.


These results suggest that the failure to achieve the GIVS goals is at least in part linked to larger systemic shortcomings. They also highlight the importance of a renewed focus on issues of equity in the global efforts to raise vaccination coverage levels.

Future directions

With renewed commitment, increases in routine coverage and the improved availability of new vaccines, great progress can be achieved in reducing child deaths, even in the poorest countries and under difficult circumstances. Strategies to reach every district include re-establishing outreach services, district level micro-planning, providing supportive supervision and linking communities with services.

 

Campaigns such as those for polio eradication and measles mortality reduction have helped strengthen the cold chain and injection safety. Support from the GAVI Alliance for the introduction of new vaccines, including training, demand creation and cold-chain expansion, help boost immunization activities.

 

In addition, there is a renewed focus on improving the availability, utilization and retention of home-based vaccination records (i.e., vaccination cards or child health cards). The child immunization card is an inexpensive yet effective instrument for systematically recording the vaccines received by a child. Moreover, the card can enhance health professionals’ ability to make clinical decisions, empower parents/caregivers in the health care of their children, and support public health monitoring. Unfortunately, the child immunization card is too often underutilized or inappropriately used by parents and health care workers and therefore does not always fulfil its intended purpose. Improving the prevalence of vaccination cards ultimately will lead to improvements in immunization data quality.

 

An online library has been established to facilitate review and exchange of information on existing vaccination and child health cards, and a website has been developed to monitor the prevalence of vaccination cards.