Current Status + Progress
An estimated 1 in 7 children worldwide did not receive the required third dose of DTP in 2016

Immunization is one of the most cost-effective public health interventions to date, saving millions of lives1 and protecting countless children from illness and disability. As a direct result of immunization, polio is on the verge of eradication. Deaths from measles, a major child killer, declined by 79 percent worldwide and by 85 percent in sub-Saharan Africa between 2000 and 20152. And as of March 2017, 41 of 59 priority countries have eliminated maternal and neonatal tetanus. 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. The percentage of children receiving diphtheria, tetanus and pertussis (DTP) containing vaccine is often used as an indicator of how well countries are providing routine immunization services. Global coverage for three doses of DTP increased from 21 percent in 1980 to 72 percent in 2000 to an estimated 86 percent by the end of 2016. Nevertheless, global coverage of three doses of DTP has stalled during the current decade and immunization has not yet realized its full potential.

Globally, 131 countries achieved the target coverage of 90 percent with three doses of DTP during 2016. Still 64 countries are yet to reach the immunization target of the Global Vaccine Action Plan (GVAP) of achieving 90 percent or more for DTP3 coverage at the national level.

131 out of 195 countries achieved 90 per cent or greater coverage of DTP3 in 2016
Number of countries achieving 90 per cent DTP3 coverage since 2000

Source: WHO/UNICEF estimates of national immunization coverage, 2016

Conflicts along with under-investments in national immunization programmes, vaccine stock-outs, and disease outbreaks are some of the main factors preventing many countries in maintaining strong health systems that are needed to sustainably deliver vaccination services to reach and sustain high immunization coverage. Eight countries had less than 50 percent coverage for DTP3 in 2016, many of which are fragile states and affected by emergencies: Central African Republic, Chad, Equatorial Guinea, Nigeria, Somalia, South Sudan, Syrian Arab Republic and Ukraine.

Coverage challenges persist in fragile states and those affected by conflict
Countries will less than 50 per cent coverage of DTP3, 2016

Source: WHO/UNICEF estimates of national immunization coverage, 2016

As of 2016, 19.5 million children under 1 year of age worldwide had not received the three recommended doses of DTP, and 20.8 million children in the same age group had failed to receive a single dose of measles-containing vaccine. To achieve the GVAP goal of 90% DTP3 coverage in each of country in 2016, an estimated 10 million additional children would have to be vaccinated in 64 countries.

In 2016 nearly half of all unvaccinated infants for DTP3 were in Sub-Saharan Africa
Number of unvaccinated infants for DTP3 (millions), by year and UNICEF region (2000-2016)

Source: WHO/UNICEF estimates of national immunization coverage, 2016

In 2016, more than half of all children unvaccinated for DTP3 lived in just six countries: Nigeria, India, Pakistan, Indonesia, Ethiopia, and Democratic Republic of the Congo. With an estimated 3.4 million unvaccinated children for DTP3 in 2016, Nigeria surpassed India as the country with the most unvaccinated children. It is important to note that populous developing countries, because of their large age cohort, may contribute significantly to the number of unvaccinated children despite achieving relatively 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.

In 2016, 3.4 million Nigerian infants did not receive DTP3
Top 10 countries by number of unvaccinated infants for DTP3 in 2016

Source: WHO/UNICEF estimates for national immunization coverage, 2016

An increasing number of countries are now offering pneumococcal conjugate vaccine (134 countries as of July 2017) and rotavirus vaccine (91 countries as of July 2017) 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. Vaccine introduction is especially lagging in middle income countries. These countries are often not able to finance introduction with national resources, while they generally do not have access to external funding sources. Low income countries have largely been able to close the gap in coverage with high income countries with assistance from Gavi, the Vaccine Alliance.

PCV3 and Rotavirus coverage has expanded significantly since 2012, particularly in low income countries
Coverage of Pneumococcal Conjugate Vaccine (PCV3) and Rotavirus (ROTAC) vaccines, by year and income group, 20018-2016

Source: WHO/UNICEF estimates for national immunization coverage 2016

REFERENCES

  1. Levine, O.S., et al., ‘The Future of Immunisation Policy, Implementation, and Financing’, Lancet, vol. 378, 2011, pp. 439─448.
  2. Patel MK, Gacic-Dobo M, Strebel PM, et al., Progress Towards Regional Measles Elimination – Worldwide, 2000-2015, MMWR Morb Mortal Wkly Rep 2016; 65:1228-1233. DOI: http://dx.doi.org/10.15585/mmwr.mm6544a6

 

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Sample of the WHO/UNICEF Joint Reporting Form on Immunization in EnglishDownload Data
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Progress and ChallengesDownload Data
Immunization coverage by antigen (global and regional)Download Data
Recent Resources
Country Profiles

Immunization Country Profiles

Jul 4, 2017

Immunization is one of the most cost-effective public health interventions to date, saving millions of lives and protecting countless children from illness and disability. These statistical profiles based on WHO/UNICEF joint estimates of national immunization coverage (WUENIC), present summaries of the latest data at the country level.

Journal Article

Results from a survey of national immunization programmes on home-based vaccination record practices in 2013

Feb 10, 2015

During January 2014, WHO and the United Nations Children’s Fund sent a one-page questionnaire to 195 countries to obtain information on HBRs including type of record used, number of records printed, whether records were provided free-of-charge or required by schools, whether there was a stock-out and the duration of any stock-outs that occurred, as well as the total expenditure for printing HBRs during 2013.

Access article (PDF)
Publication

Immunization Summary: A statistical reference containing data through 2013

Nov 10, 2014

This immunization summary is a statistical reference containing data through 2013. It was jointly produced by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO). It presents detailed statistics on the performance of national and district-level immunization systems in 195 countries and territories.

Download Immunization Summary (PDF)
Web Application

Immunization Coverage Summary Application

Nov 1, 2014

The Immunization Summary is an app for visualizing (tables, graphs, maps) data on policies, activities and impact of national immunization systems. These data are reported by WHO & UNICEF member states annually for incidence, coverage and immunization indicators. The WHO UNICEF estimates of national immunization coverage constitute an independent technical assessment of coverage. The population data are provided by the United Nations’ Population Division’s “World Population Prospects – The 2012 Revision.” With the exception of the infant and child mortality figures which are provided by WHO’s “World Health Statistics 2014,” data for 2013. The GNI & GDP data are taken from the “2015 World Bank Development Indicators” online. Data are available from 1980 to 2014 (as of 14 July 2015) for a 195 countries or territories.

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Journal Article

A Summary of Global Immunization Coverage through 2013

Aug 14, 2014

This paper summarizes the 2013 revision (completed July 2014) of the WHO and UNICEF estimates of national immunization coverage (WUENIC).

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Country Specific Reports and Notes on the Data

Country-specific reports of the WHO and UNICEF estimates of national immunization coverage

The graphs and data tables displayed in the country-specific reports show the national coverage levels for each vaccine for the period from 2003 through 2014 (see guide). Owing to evolving methodology and revisions of the time series, the data in each revision supersede all historical data previously published.

To access country data please click on country name

Central and Eastern Europe and the Commonwealth of Independent States

Albania Georgia Serbia
Armenia Kazakhstan Tajikistan
Azerbaijan Kyrgyzstan The former Yugoslav Republic of Macedonia
Belarus Montenegro Turkey
Bosnia and Herzegovina Republic of Moldova Turkmenistan
Bulgaria Romania Ukraine
Croatia Russian Federation Uzbekistan

East Asia and the Pacific

Brunei Darussalam Lao People’s Democratic Republic Palau Timor-leste
Cambodia Malaysia Papua New Guinea Tonga
China Marshall Islands Philippines Tuvalu
Cook Islands Micronesia Federated States of Republic of Korea Vanuatu
Democratic People’s Republic of Korea Mongolia Samoa Viet Nam
Fiji Myanmar Singapore
Indonesia Nauru Solomon Islands
Kiribati Niue Thailand

Eastern and Southern Africa

Angola Kenya Namibia Swaziland
Botswana Lesotho Rwanda United Republic of Tanzania
Burundi Madagascar Seychelles Uganda
Comoros Malawi Somalia Zambia
Eritrea Mauritius South Africa Zimbabwe
Ethiopia Mozambique South Sudan

Industrialized countries

Andorra France Lithuania Slovakia
Australia Germany Luxembourg Slovenia
Austria Greece Malta Spain
Belgium Hungary Monaco Sweden
Canada Iceland Netherlands Switzerland
Cyprus Ireland New Zealand United Kingdom
Czech Republic Israel Norway United States
Denmark Italy Poland
Estonia Japan Portugal
Finland Latvia San Marino

Latin America and the Caribbean

Antigua and Barbuda Costa Rica Haiti Saint Lucia
Argentina Cuba Honduras Saint Vincent and the Grenadines
Bahamas Dominica Jamaica Suriname
Barbados Dominican Republic Mexico Trinidad and Tobago
Belize Ecuador Nicaragua Uruguay
Bolivia (Plurinational State of) El Salvador Panama Venezuela (Bolivarian Republic of)
Brazil Grenada Paraguay
Chile Guatemala Peru
Colombia Guyana Saint Kitts and Nevis

Middle East and North Africa

Algeria Jordan Qatar United Arab Emirates
Bahrain Kuwait Saudi Arabia Yemen
Djibouti Lebanon State of Palestine
Egypt Libya Sudan
Iran (Islamic Republic of) Morocco Syrian Arab Republic
Iraq Oman Tunisia

South Asia

Afghanistan Maldives
Bangladesh Nepal
Bhutan Pakistan
India Sri Lanka

West and Central Africa

Benin Democratic Republic of the Congo Mali
Burkina Faso Equatorial Guinea Mauritania
Cabo Verde Gabon Niger
Cameroon Gambia Nigeria
Central African Republic Ghana Sao Tome and Principe
Chad Guinea Senegal
Congo Guinea-Bissau Sierra Leone
C�te d’Ivoire Liberia Togo

Since June 2000, WHO and UNICEF have conducted annual reviews of national immunization coverage. Immunization coverage estimates are used for a variety of purposes: to monitor the performance of immunization services at local, national and international levels; to guide polio eradication, measles control and maternal and neonatal tetanus elimination; to identify areas of weak system performance that may require extra resources and focused attention; and as one indicator when deciding whether to introduce a new vaccine. Coverage levels with diphtheria-tetanus-pertussis-containing vaccine (DTP) are considered one indicator of health system performance.

A detailed explanation of the methods behind the WHO and UNICEF estimates of national immunization coverage is provided elsewhere.1,2,3,4 Estimates of immunization coverage are generally based on two sources of empirical data: reports of vaccinations performed by service providers (administrative data5) and household surveys containing items on children’s vaccination history (coverage surveys).  For estimates based on administrative data, the immunization coverage is derived by dividing the total number of vaccinations given by the number of children in the target population.  For most vaccines the target population is the national annual number of births or number of surviving infants (this may vary depending on countries’ policies and the specific vaccine). Immunization coverage surveys are frequently used in connection with administrative data. The Expanded Programme on Immunization (EPI) 30-cluster survey, the UNICEF-supported Multiple Indicator Cluster Surveys (MICS) and the Demographic Health Surveys (DHS) supported by the United States Agency for International Development are the principal surveys used as sources of information on immunization coverage.

This review relies on the following data:

  • Officially reported data by WHO and UNICEF Member States
  • A historical database maintained by UNICEF
  • Nationally representative, population-based household survey reports (published and unpublished).

It is important to distinguish whether data accurately reflect immunization system performance or whether they are compromised and thus present a misleading view of immunization coverage.  Officially reported data are therefore compared with independent surveys.  Based on the data available, the consideration of potential biases and the contributions of local experts, the most likely level of immunization coverage is determined for each country–year–antigen combination.  An essential part of this review is consultation and collaboration with national authorities, who are asked to review the draft estimates and provide comments.

  1. Burton, A., et al., ’A Formal Representation of the WHO and UNICEF Estimates of National Immunization Coverage: A computational logic approach’, PLOS ONE, vol. 7, no. 10:e47806, 2012.
  2. Kowalski R., A. Burton, ’WUENIC – A Case Study in Rule-based Knowledge Representation and Reasoning’, Lecture Notes in Computer Science, vol. 7258, 2012, pp. 112─125.
  3. Burton, A., et al., WHO and UNICEF Estimates of National Infant Immunization Coverage: Methods and processes, Bulletin of the World Health Organization, vol. 87, 2009, pp. 535─541.
  4. Brown DW, Burton AH, Gacic-Dobo M, Karimov RI. An Introduction to the Grade of Confidence Used to Characterize Uncertainty Around the WHO and UNICEF Estimates of National Immunization Coverage. Open Public Hlth J. 2013;6:73-76.
  5. Administrative data are collected through the WHO/UNICEF Joint Reporting Form on Vaccine-Preventable Diseases, completed annually by countries.

ImmunizationInfo: Expanding access to national immunization coverage estimates

The data above can also be viewed through ImmunizationInfo, an interactive online dissemination tool of national childhood immunization coverage statistics developed in 2010 by UNICEF and WHO in collaboration with Community Systems Foundation.  ImmunizationInfo is powered by DevInfo database technology and built using Adobe-Flex technology and allows users to view national immunization coverage estimates in graph, map and table formats based on a user-defined selection of country-year-vaccine combinations. Users can generate comparative graphs and also download the underlying data.