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

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

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 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

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

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