Strengthening routine immunization systems to improve global vaccination coverage

Br Med Bull. 2015 Mar;113(1):5-14. doi: 10.1093/bmb/ldv001. Epub 2015 Feb 3.


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.

Publication types

  • Review

MeSH terms

  • Developing Countries
  • Diphtheria-Tetanus-Pertussis Vaccine* / administration & dosage
  • Diphtheria-Tetanus-Pertussis Vaccine* / supply & distribution
  • Educational Status
  • Health Services Accessibility / organization & administration*
  • Humans
  • Immunization Programs / organization & administration*
  • Infant
  • Maternal-Child Health Services* / organization & administration
  • Program Development
  • Program Evaluation
  • Socioeconomic Factors
  • Vaccination* / statistics & numerical data


  • Diphtheria-Tetanus-Pertussis Vaccine