New data from WHO and UNICEF reveals that 20 million children worldwide – more than 1 in 10 – missed out on life-saving vaccines such as measles, diphtheria and tetanus in 2018. Most of these children, over 40 per cent, live in 16 countries that are fragile or affected by conflict. These latest estimates of national immunization coverage show that global progress has stalled and that stark disparities across countries have resulted in devastating outbreaks of measles. Alarmingly, a number of previously well performing countries such as Brazil, Ecuador, Bosnia & Herzegovina and Vietnam have reported declining vaccination coverage rates.
- Immunization prevents illness, disability and death from vaccine-preventable diseases including cervical cancer, diphtheria, hepatitis B, measles, mumps, pertussis (whooping cough), pneumonia, polio, rotavirus diarrhoea, rubella and tetanus.
- Global vaccination coverage remains at 86%, with no significant changes during the past few years.
- Uptake of new and underused vaccines is increasing.
- An additional 1.5 million deaths could be avoided, however if global immunization coverage improves.
- An estimated 19.4 million children under the age of one did not receive DTP3 vaccine.
Global vaccination coverage – the proportion of the world’s children who receive recommended vaccines – has remained the same over the past few years.
During 2018, about 86% of infants worldwide (116.3 million infants) received 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine, protecting them against infectious diseases that can cause serious illness and disability or be fatal. By 2018, 129 countries had reached at least 90% coverage of DTP3 vaccine.
Global immunization coverage 2018
A summary of global vaccination coverage in 2018 follows.
Haemophilus influenzae type b (Hib) causes meningitis and pneumonia. Hib vaccine had been introduced in 191 countries by the end of 2018. Global coverage with 3 doses of Hib vaccine is estimated at 72%. There is great variation between regions. The WHO Regions of the Americas and South East Asia are estimated to have 87% coverage, while it is only 23% in the WHO Western Pacific Region.
Hepatitis B is a viral infection that attacks the liver. Hepatitis B vaccine for infants had been introduced nationwide in 189 countries by the end of 2018. Global coverage with 3 doses of hepatitis B vaccine is estimated at 84% and is as high as 90% in the Western Pacific. In addition, 109 countries introduced one dose of hepatitis B vaccine to newborns within the first 24 hours of life, and the global coverage is 42%.
Human papillomavirus (HPV) is the most common viral infection of the reproductive tract, and can cause cervical cancer, other types of cancer, and genital warts in both men and women. HPV vaccine was introduced in 90 countries by the end of 2018, excluding four countries with introduction in some parts of the country.
Measles is a highly contagious disease caused by a virus, which usually results in a high fever and rash, and can lead to blindness, encephalitis or death. By the end of 2018, 86% of children had received one dose of measles vaccine by their second birthday, and 171 countries had included a second dose as part of routine immunization and 69% of children received two doses of measles vaccine according to national immunization schedules.
Meningitis A is an infection that can cause severe brain damage and is often deadly. By the end of 2018 – eight years after its introduction – more than 300 million people in African countries affected by the disease had been vaccinated with MenAfriVac, a revolutionary vaccine developed in collaboration with Serum Institute of India through the WHO and PATH Meningitis Vaccine Project. In 2012, MenAfriVac became the first vaccine to gain approval for use outside the cold chain – for as long as four days without refrigeration and at temperatures of up to 40°C. Ghana and Sudan were the first two countries to include the MenAfriVac in their routine immunization schedule in 2016, followed by Burkina Faso, Central African Republic, Chad, Mali and Niger in 2017, and Côte d’Ivoire in 2018.
Mumps is a highly contagious virus that causes painful swelling at the side of the face under the ears (the parotid glands), fever, headache and muscle aches. It can lead to viral meningitis. Mumps vaccine had been introduced nationwide in 122 countries by the end of 2018.
Pneumococcal diseases include pneumonia, meningitis and febrile bacteraemia, as well as otitis media, sinusitis and bronchitis. Pneumococcal vaccine had been introduced in 145 countries by the end of 2018, including five in some parts of the country, and global third dose coverage was estimated at 47%.
Polio is a highly infectious viral disease that can cause irreversible paralysis. In 2018, 85% of infants around the world received three doses of polio vaccine. Targeted for global eradication, polio has been stopped in all countries except for Afghanistan, Pakistan and Nigeria. Polio-free countries have been infected by imported virus, and all countries – especially those experiencing conflict and instability – remain at risk until polio is fully eradicated.
Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. Rotavirus vaccine was introduced in 101 countries by the end of 2018, including four in some parts of the country. Global coverage was estimated at 35%.
Rubella is a viral disease which is usually mild in children, but infection during early pregnancy may cause fetal death or congenital rubella syndrome, which can lead to defects of the brain, heart, eyes, and ears. Rubella vaccine was introduced nationwide in 168 countries by the end of 2018, and global coverage was estimated at 69%.
Tetanus is caused by a bacterium which grows in the absence of oxygen, for example in dirty wounds or in the umbilical cord if it is not kept clean. The spores of C. tetani are present in the environment irrespective of geographical location. It produces a toxin which can cause serious complications or death. Maternal and neonatal tetanus persist as public health problems in 13 countries, mainly in Africa and Asia.
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. As of 2018, yellow fever vaccine had been introduced in routine infant immunization programmes in 36 of the 40 countries and territories at risk for yellow fever in Africa and the Americas. In these 40 countries and territories, coverage is estimated at 49%.
In 2018, an estimated 19.4 million infants worldwide were not reached with routine immunization services such as 3 doses of DTP vaccine. Around 60% of these children live in 10 countries: Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines and Viet Nam.
Monitoring data at subnational levels is critical to helping countries prioritize and tailor vaccination strategies and operational plans to address immunization gaps and reach every person with lifesaving vaccines.
WHO is working with countries and partners to improve global vaccination coverage, including through these initiatives adopted by the World Health Assembly in May 2012.
The Global Vaccine Action Plan
The Global Vaccine Action Plan (GVAP) is a roadmap to prevent millions of deaths through more equitable access to vaccines by 2020. To date, progress towards the GVAP targets is off track.
In May 2017, Ministers of Health from 194 countries endorsed a new resolution on strengthening immunization to achieve the goals of the GVAP. The resolution urges countries to strengthen the governance and leadership of national immunization programmes, and improve monitoring and surveillance systems to ensure up-to-date data guides policy and programmatic decisions to optimize performance and impact. It also calls on countries to expand immunization services beyond infancy, mobilize domestic financing, and strengthen international cooperation to achieve GVAP goals.
It requests the WHO Secretariat to continue supporting countries to achieve regional and global vaccination goals. It recommends scaling up advocacy efforts to improve understanding of the value of vaccines and urgency of meeting the GVAP goals.