Routine Vaccination Coverage — Worldwide, 2021

Abstract

In 2020, the World Health Assembly endorsed the Immunization Agenda 2030, an ambitious global immunization strategy to reduce morbidity and mortality from vaccine-preventable diseases (1). This report updates a 2020 report (2) with global, regional,* and national vaccination coverage estimates and trends through 2021. Global estimates of coverage with 3 doses of diphtheria-tetanus-pertussis-containing vaccine (DTPcv3) decreased from an average of 86% during 2015-2019 to 83% in 2020 and 81% in 2021. Worldwide in 2021, 25.0 million infants (19% of the target population) were not vaccinated with DTPcv3, 2.1 million more than in 2020 and 5.9 million more than in 2019. In 2021, the number of infants who did not receive any DTPcv dose by age 12 months (18.2 million) was 37% higher than in 2019 (13.3 million). Coverage with the first dose of measles-containing vaccine (MCV1) decreased from an average of 85% during 2015-2019 to 84% in 2020 and 81% in 2021. These are the lowest coverage levels for DTPcv3 and MCV1 since 2008. Global coverage estimates were also lower in 2021 than in 2020 and 2019 for bacillus Calmette-Guérin vaccine (BCG) as well as for the completed series of Haemophilus influenzae type b vaccine (Hib), hepatitis B vaccine (HepB), polio vaccine (Pol), and rubella-containing vaccine (RCV). The COVID-19 pandemic has resulted in disruptions to routine immunization services worldwide. Full recovery to immunization programs will require context-specific strategies to address immunization gaps by catching up missed children, prioritizing essential health services, and strengthening immunization programs to prevent outbreaks (3). The World Health Organization (WHO) established the Expanded Programme on Immunization in 1974 to protect infants against six diseases through vaccination (e.g., BCG, DTP, Pol, and MCV) (4). Since then, additional vaccines and vaccine doses have been introduced during the first year of life (e.g., HepB, Hib, pneumococcal conjugate vaccine [PCV], RCV, and rotavirus) and at older ages (e.g., human papillo-mavirus [HPV] vaccine in females) (4). WHO and UNICEF produce annual estimates of immunization coverage through review of available country-specific data, including administrative and survey-based coverage †, § (5). DTPcv3 coverage by age 12 months is an indicator of routine immunization program performance, and DTPcv3, MCV2, 3 doses of PCV * https://www.who.int/about/who-we-are/regional-offices (PCV3), and HPV vaccine are indicators for the Sustainable Development Goals. ¶ Children who have not received any doses of DTPcv by age 12 months (zero-dose children) represent those with poor access to immunization and other essential health services. Children who receive the first DTPcv dose (DTPcv1) but do not complete the full series are considered incompletely vaccinated. WHO and UNICEF global estimates of national immunization coverage for DTPcv1 decreased from 90% in 2019 to 87% in 2020 and 86% in 2021, the lowest level since 2005. In 2021, DTPcv1 coverage ranged from 80% in the WHO African Region to 97% in the European Region (Table 1). DTPcv3 coverage followed similar regional trends. The decline in first and third dose DTPcv coverage during 2019-2021 was largest in the SouthEast Asia Region (from 94% to 86% for DTPcv1 and from 91% to 82% for DTPcv3). In the Americas, DTPcv1 and DTPcv3 coverage decreased by 3 and 4 percentage points, respectively, during 2019-2021 (Figure). Among the 194 WHO member states, DTPcv1 coverage during 2019-2021 was stable or declined in 170 (88%); DTPcv3 coverage during this period was stable or declined in 167 member states (86%). In 2021, 25.0 million children worldwide had not completed the 3-dose DTPcv series, 2.1 million more than in 2020 (22.9 million) and 5.9 million more than in 2019 (19.1 million); 18.2 million (73%) had received no doses, and 6.8 million (27%) were incompletely vaccinated with DTPcv. The number of zero-dose children was unevenly † For a given vaccine, administrative coverage is the number of doses administered in a specified target group divided by the estimated target population. Doses administered during routine immunization visits are counted, but doses administered during supplemental immunization activities (mass campaigns) usually are not. Survey-based vaccination coverage is calculated as the proportion of persons in a target age group who had received a vaccine dose. During surveys, a representative sample of households is visited, and caregivers of children in a specified target age group (e.g., 12-23 months) are interviewed. Vaccination dates are transcribed from the child's home-based record or health facility records, and if documented evidence is unavailable, recorded based on caregiver recall. § For 18 countries that did not report 2021 immunization coverage data by July 7, 2021, estimated coverage for 2020 was used. https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/global-monitoring/ immunization-coverage/who-unicef-estimates-of-national-immunization-coverage ¶ The 2030 Agenda for Sustainable Development was adopted in 2015 by the 193 countries that make up the United Nations. The agenda lays out 17 Sustainable Development Goals (SDGs) and targets for dignity, peace, and prosperity for the planet and humankind, to be completed by 2030. SDG indicator SDG3.b.1 is the proportion of the target population covered by all vaccines included in their national program. https://sdgs.un.org/goals