Immunization is an affordable means of protecting whole communities from disease and reducing poverty. Immunization coverage for the six major vaccine-preventable diseases – pertussis, childhood tuberculosis, tetanus, polio, measles and diphtheria – has risen significantly since the Expanded Programme on Immunization began in 1974. 

An increasing number of countries are now offering pneumococcal conjugate vaccine and rotavirus vaccine in their immunization programmes, thus offering protection against pneumonia and diarrhoea. Use of underutilized vaccines, such as those against yellow fever and Japanese encephalitis, has also been expanded. UNICEF and the World Health Organization (WHO) have broadened their monitoring process accordingly to include coverage of all of these vaccines.

Global coverage of three doses of DTP-containing vaccine has more than quadrupled since 1980, and now stands at 84 per cent

Global coverage (percentage) of three doses of DTP-containing vaccine, 1980─2013

WHO and UNICEF estimates of national immunization coverage, 2013 revision (completed July 2014).

Global coverage of three doses of DTP-containing vaccine has more than quadrupled since 1980, and now stands at 84 per cent

Global coverage (percentage) of three doses of DTP-containing vaccine, 1980─2013

WHO and UNICEF estimates of national immunization coverage, 2013 revision (completed July 2014).

ROUTINE IMMUNIZATION COVERAGE    

The percentage of children receiving DTP₃ is often used as an indicator of how well countries are providing routine immunization services. Global coverage for three doses of DTP-containing vaccine increased from 20 per cent in 1980 to 73 per cent in 2000 to an estimated 84 per cent by the end of 2013. 

120 countries achieved and sustained coverage of at least 90 per cent with three doses of DTP-containing vaccine during 2011–2013

Sustained coverage with three doses of DTP-containing vaccine of at least 90 per cent, 2011–2013

WHO and UNICEF estimates of national immunization coverage, 2013 revision (completed July 2014).

Map disclaimer

120 countries achieved and sustained coverage of at least 90 per cent with three doses of DTP-containing vaccine during 2011–2013

Sustained coverage with three doses of DTP-containing vaccine of at least 90 per cent, 2011–2013

WHO and UNICEF estimates of national immunization coverage, 2013 revision (completed July 2014).

Despite these advances, many more children could be receiving the benefits of immunization. Of the 21.8 million children worldwide who have not received three doses of DTP-containing vaccine, 75 per cent live in just 15 countries. 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 levels will require 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.

Nearly three quarters of the children who have not received three doses of DTP-containing vaccine during 2013 live in 15 countries

Global distribution of the number of children who did not receive three doses of DTP-containing vaccine during 2013 (millions)

Source: WHO and UNICEF estimates of national immunization coverage, 2013 revision (completed July 2014). Population data for children surviving to 1 year of age obtained from: United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects: The 2012 revision, United Nations, New York, 2013.

Nearly three quarters of the children who have not received three doses of DTP-containing vaccine during 2013 live in 15 countries

Global distribution of the number of children who did not receive three doses of DTP-containing vaccine during 2013 (millions)

Source: WHO and UNICEF estimates of national immunization coverage, 2013 revision (completed July 2014). Population data for children surviving to 1 year of age obtained from: United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects: The 2012 revision, United Nations, New York, 2013.

THE GOAL: UNIVERSAL ACCESS

The Global Vaccine Action Plan was endorsed by 194 Member States of the World Health Assembly in May 2012 to achieve the vision of universal access to immunization outlined in the Decade of Vaccines. The action plan is a framework to prevent millions of deaths by 2020 and beyond by:

• Strengthening routine immunization to meet vaccination coverage targets
• Accelerating control of vaccine-preventable diseases with polio eradication as the first milestone
• Introducing new and improved vaccines
• Spurring research and development for the next generation of vaccines and technologies.

Progress on the Global Vaccine Action Plan is reported annually to the World Health Assembly and began in 2014.

The Global Vaccine Action Plan builds on the Global Immunization Vision and Strategy 2006─2015, developed by UNICEF, WHO and partners to assist countries in expanding the reach of immunization to every eligible person, including those in age groups beyond infancy. One of its goals is to increase national immunization coverage to at least 90 per cent by 2010 and to sustain such levels through 2015.During 2013, seven of 195 countries had an estimated DTP3 coverage less than 50 per cent, while 130 countries achieved at least 90 per cent coverage with three doses of DTP containing vaccine. Of these 130 countries, 120 had sustained DTP₃ coverage of at least 90 per cent during 2011–2013.

130 countries achieved coverage of at least 90 per cent with three doses of DTP-containing vaccine during 2013

Coverage with three doses of DTP-containing vaccine of at least 90 per cent, 2013

WHO and UNICEF estimates of national immunization coverage, 2013 revision (completed July 2014).

Map disclaimer

130 countries achieved coverage of at least 90 per cent with three doses of DTP-containing vaccine during 2013

Coverage with three doses of DTP-containing vaccine of at least 90 per cent, 2013

WHO and UNICEF estimates of national immunization coverage, 2013 revision (completed July 2014).

For further details on the Global Vaccine Action Plan and current progress, visit the GVAP Secretariat.

FUTURE DIRECTIONS

Gavi, the Vaccine Alliance (formerly known as the GAVI Alliance and the Global Alliance for Vaccines and Immunization) has developed financial sustainability plans for countries eligible for support. But mobilizing and securing adequate funding will also require stronger political will, better management and greater advocacy.

Increases in routine coverage and improved availability of new vaccines can succeed in reducing child deaths, even in the poorest countries and under difficult circumstances. Strategies to reach every district include re-establishing outreach services, building 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 GAVI for the introduction of new vaccines, including training, demand-creation and cold-chain expansion, are helping boost immunization activities.

Greater attention is also being focused on improving the availability, retention and utilization of home-based vaccination records. Home-based vaccination records play an important role in documenting immunization services received by individuals (1). A home-based vaccination record is a document (more often physical than electronic) — issued to an individual person by an official authority such as a national, provincial or district health department and retained by the individual or their caregiver — on which an individual’s history of vaccinations received from all health care providers, through routine immunization and supplementary immunization activities, is recorded. Home-based records foster coordination and continuity of immunization service delivery between service providers, facilitate communication between health workers and caregivers and support public health monitoring. When properly used, home-based records provide a relatively inexpensive and effective instrument for promoting childhood immunization, educating caregivers about their child’s immunization status and stimulating demand for services. Unfortunately, the child immunization card is often underutilized or misused by parents and health workers and does not always fulfil its intended purpose. UNICEF and WHO in collaboration with partners are working with national immunization programmes to improve the availability, utilization and retention of vaccination cards ultimately will lead to improvements in immunization data quality. An online library, www.immunizationcards.org, 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 through household surveys.

REFERENCES

1. Levine, O.S., et al., ‘The Future of Immunisation Policy, Implementation, and Financing’, Lancet, vol. 378, 2011, pp. 439─448.  
2. Updated measles mortality estimates data through 2011 were obtained from Dr. Robert Perry, WHO, Geneva, Switzerland, based on a model reported in: Simons, E., et al., ‘Assessment of the 2010 Global Measles Mortality Reduction Goal: Results from a model of surveillance data’, Lancet , vol. 379, 2012, pp. 2173–2178.