Are we making progress on immunisation equity?

18 Aug 2016

Last month, the WHO released the official vaccine coverage figures for 2015. Not quite ground breaking news, but for a geeky vaccines policy officer like me this is a day to look forward to. The data tells us how many children missed out on vaccines, providing a statistical update on global progress.

This years WHO press release led with the promising news in 2015 86% of children were vaccinated. Moreover, we have maintained global vaccine coverage rates above 85% every year since 2010. That’s great right?

It is when compared to the year 2000. At the dawn of the new millennium, only 29% children received the required three doses of the vaccine containing diphtheria, tetanus and pertussis (DTP3); this is the vaccine used as an indicator of immunisation coverage to compare progress. When you compare the leap from 29%-86% in fifteen years, that is definitely something to celebrate , particularly when  immunisation currently prevents an estimated 2 to 3 million deaths every year. By 2015, 126 of 194 WHO Member State countries had reached at least 90% coverage of DTP3 vaccine – a target all 194 Member States agreed to meet by 2015. Even though this goal was missed, it is an important improvement from 63 countries in 2000.


DTP3 global coverage rate between 1980 and 2015. Photo: Immunisation Vaccines and Biologicals, (IVB), World Health Organisation July 2016

Despite this significant progress, too many children are still missing out, an estimated 19.4 million. This represents an increase from 18.7 million in 2014. Further, there have been no improvements in the overall percentage of children being vaccinated since 2014 and in the last five years, we have only seen coverage rates rise by 1% to 86%. Progress is stalling.

Too many countries with worrying low vaccine rates

In 2015, six countries had less than 50% coverage with DTP3, many of which are fragile states and affected by emergencies: Central African Republic, Equatorial Guinea, Somalia, South Sudan, Syrian Arab Republic and Ukraine. This list highlights the worrying impact of instability on a countries immunisation services. For example, Ukraine’s DTP3 coverage rate was 96% in 2005 but has been reduced to 23% in 2015. Similar Syria has fallen from 80% to 41%.In situations where conflict persists; children are much more at risk of disease and infection, often moving around with little access to clean water, sanitation facilities and access to health facilities. This means children at put at even more risk from vaccine preventable diseases. 

Inequitable access

We know that it is far too often the children from the poorest and hardest to reach areas which are missing out on being immunised. Data disaggregated to district level coverage is essential to help countries understand where children are missing out so they can target them with improved routine immunisation systems or special immunisation campaigns.


DTP3 comparison of 13 countries highlighting how much immunisation rates can change in 10 years. Photo:Immunisation
Vaccines and Biologicals, (IVB), World Health Organisation July 2016

In 2015, 158 countries reported coverage estimates at the district level. 126 countries reported DTP3 coverage of 90% or more at the national level, but only 90 countries reported the same coverage at all subnational levels. Of these, only 53 countries had coverage of 80% or more in all districts. Worldwide, of the districts which reports, 25% had coverage below 80%.

Earlier this year we released an immunisation equity scorecard which highlighted how large inequities can be in the same country. For example, in Nigeria, children from the richest households are 11 times more likely to be immunised than children from poor households. In Pakistan, regional disparities are high, with coverage over 90% in Islamabad compared with 27% in Balochistan.

Next week, RESULTS UK is running a parliamentary delegation with three MPs to Uganda. The MPs will be finding out what the challenges are to achieving universal immunisation coverage, how we can tackle inequities and how we can ensure increased immunisation budgets to achieve this. Look out for more information on the delegation next week.

Blog categories: 

Archive

Subscribe to our newsletter to receive all the latest news and information.

RESULTS UK is a charity registered as RESULTS Education in England and Wales (1015286), a company limited by guarantee (2761858), and a charity registered in Scotland (SC041481).