Global Vaccination Coverage Remains Unchanged at 86% Since 2010

Global vaccination coverage has remained steady at 85% to 86% since 2010, according to the US Centers for Disease Control and Prevention (CDC).

About two-thirds (129 of 194) of World Health Organization member countries have surpassed the Global Vaccine Action Plan national vaccination coverage goal of 90% by 2020, according to the CDC’s report, Global Vaccination Coverage, 2018. That is up from 123 in countries that had surpassed the goal last year.

In 2018, 19.4 million children worldwide were not fully vaccinated, including 13.5 million who hadn’t received any doses of the diphtheria and tetanus toxoids and pertussis-containing vaccine (DTP).

“There is room for improvement with 13.5 million children globally still not receiving any DTP doses. Many of these children live in the poorest countries and have limited access to routine immunization and quality health care,” Megan Peck, PhD, MPH, EIS Officer, Global Immunization Division, CDC Center for Global Health, told Contagion^®. “Vaccine-preventable diseases have no borders, and many of the vaccine-preventable disease outbreaks we are currently experiencing globally, such as the measles outbreak in the United States, are related to low immunization coverage globally. Improvement in childhood vaccination coverage requires clinicians, health care providers and other stakeholders to ensure children have access to vaccination services.”

About 90% of children worldwide received the first dose of DTP and 86% received the third dose in 2018. Those rates are relatively unchanged from 2010, when they were 89% and 84%, respectively.

Measles vaccination (MCV1) coverage also remained steady at between 84% and 86% for the first dose. Countries offering a second dose of the vaccine saw increases from 19% in 2007 to 54% in 2018 among those offered in the second year of life and from 36% in 2007 to 69% in 2018 among those offered for ages 3-14 years.

“Strong immunization systems are the foundation for successful routine immunization. In many low-resource settings, these systems do not function,” Peck told Contagion^®. “Among the almost 20 million children who did not receive the third DTP dose (DTP3) in 2018, 60% live in 10 countries. Many of these countries are affected by instability, emergencies, and conflict and are unable to meet global vaccination goals. To improve global coverage of DTP3, countries should strengthen routine immunization services focusing on equitable access.”

Countries with the most children who were left out of or dropped out of the immunization program in the first year of life were Nigeria, India, Pakistan, Indonesia, Ethiopia, Philippines, the Democratic Republic of the Congo, Brazil, Angola and Vietnam.

“Although global coverage for routine immunizations such as measles-containing vaccine (MCV) and diphtheria-tetanus-pertussis (DTP) remains relatively stagnant, coverage is increasing among new and underused vaccines,” Peck told Contagion^®.

Those include the completed rotavirus series, which quadrupled from 8% in 2010 to 35% in 2018; pneumococcal conjugate vaccine (PCV), which saw an increase from 11% to 47% for the completed series; rubella vaccine, which rose from 35% to 69%; Haemophilus influenzae type b vaccine (Hib), which climbed from 40% to 72%; hepatitis B vaccine (HepB), which went from 28% to 42% for the birth dose and 73% to 84% for the 3-dose series.

“This finding suggests that access to these vaccines is expanding and adequate support has been provided for successful integration of these vaccines into national immunization programs, particularly in low-income countries,” Peck said.

She said targeting hard-to-reach and hard-to-vaccinate populations with “innovative and context-specific strategies” is necessary to improving global immunization coverage.

“To reach the global immunization coverage target of 90%, important gaps, particularly among countries that introduced MCV2 into vaccination visits beyond the first year of life, need to be addressed,” Peck said. “As described in the MMWR article, establishing vaccination contact points during the second year of life and among targeted age groups, such as adolescents and pregnant women, is a core component of the Global Vaccine Action Plan (GVAP) life-course approach. Strategies such as reducing missed opportunities for vaccination and overcoming mechanisms that lead to hard-to-reach and hard-to-vaccinate populations are critical to increasing global immunization coverage.”

Attitudes about vaccines continue to be a challenge for health care practitioners, with anti-vaccine messaging continuing to spread online amid outbreaks of measles. In the United States, insurance remains another challenge, with gaps in immunization linked to uninsured status, according to a recent CDC report.