Strengthening routine immunization systems to improve global vaccination coverage

Abstract

Background: Global coverage with the third dose of diphtheria-tetanus-pertussis vaccine among children under 1 year of age stagnated at ∼ 83-84% during 2008-13.

Sources of data: Annual World Health Organization and UNICEF-derived national vaccination coverage estimates.

Areas of agreement: Incomplete vaccination is associated with poor socioeconomic status, lower education, non-use of maternal-child health services, living in conflict-affected areas, missed immunization opportunities and cancelled vaccination sessions.

Areas of controversy: Vaccination platforms must expand to include older ages including the second year of life. Immunization programmes, including eradication and elimination initiatives such as those for polio and measles, must integrate within the broader health system.

Growing points: The Global Vaccine Action Plan (GVAP) 2011-20 is a framework for strengthening immunization systems, emphasizing country ownership, shared responsibility, equity, integration, sustainability and innovation.

Areas timely for developing research: Immunization programmes should identify, monitor and evaluate gaps and interventions within the GVAP framework.

Keywords: Expanded Programme on Immunization; global health; immunization; routine immunization; vaccination; vaccination coverage.

Fig. 1

Global DTP3 coverage, 1980–2013. Source: WHO/UNICEF coverage estimates 2013 revision. July 2014. Immunization Vaccines and Biologicals (IVB), World Health Organization. DTP3 = third dose of diphtheria–tetanus–pertussis containing vaccine.

Fig. 2

Mean and cumulative absolute annual rate of change in global vaccination coverage, by coverage category, 1980–2009. MCV, measles-containing vaccine; POL3, third dose of polio vaccine; DTP3, third dose of diphtheria–tetanus–pertussis containing vaccine. Source: Wallace AS, Ryman TK, Dietz V. Overview of global, regional and national routine vaccination coverage trends and growth patterns from 1980 to 2009: implications for vaccine-preventable disease eradication and elimination initiatives. J Infect Dis 2014;210(Suppl. 1):S514–22. 180 × 127 mm (300 × 300 DPI).