Routine Vaccination Coverage - Worldwide, 2022.

In 2020, the World Health Assembly endorsed the Immunization Agenda 2030 (IA2030), the 2021-2030 global strategy that envisions a world where everyone, everywhere, at every age, fully benefits from vaccines. This report reviews trends in World Health Organization and UNICEF immunization coverage estimates at global, regional, and national levels through 2022 and documents progress toward improving coverage with respect to the IA2030 strategy, which aims to reduce the number of children who have not received the first dose of a diphtheria-tetanus-pertussis-containing vaccine (DTPcv1) worldwide by 50% and to increase coverage with 3 diphtheria-tetanus-pertussis-containing vaccine doses (DTPcv3) to 90%. Worldwide, coverage ≥1 dose of DTPcv1 increased from 86% in 2021 to 89% in 2022 but remained below the 90% coverage achieved in 2019. Estimated DTPcv3 coverage increased from 81% in 2021 to 84% in 2022 but also remained below the 2019 coverage of 86%. Worldwide in 2022, 14.3 million children were not vaccinated with DTPcv1, a 21% decrease from 18.1 million in 2021, but an 11% increase from 12.9 million in 2019. Most children (84%) who did not receive DTPcv1 in 2022 lived in low- and lower-middle-income countries. COVID-19 pandemic-associated immunization recovery occurred in 2022 at the global level, but progress was unevenly distributed, especially among low-income countries. Urgent action is needed to provide incompletely vaccinated children with catch-up vaccinations that were missed during the pandemic, restore national vaccination coverage to prepandemic levels, strengthen immunization programs to build resiliency to withstand future unforeseen public health events, and further improve coverage to protect children from vaccine-preventable diseases.

Immunization programs to support primary health care and achieve universal health coverage.

Gains in immunization coverage and delivery of primary health care service have stagnated in recent years. Remaining gaps in service coverage reflect multiple underlying reasons that may be amenable to improved health system design. Immunization systems and other primary health care services can be mutually supportive, for improved service delivery and for strengthening of Universal Health Coverage. Improvements require that dynamic and multi-faceted barriers and risks be addressed. These include workforce availability, quality data systems and use, leadership and management that is innovative, flexible, data driven and responsive to local needs. Concurrently, improvements in procurement, supply chain, logistics and delivery systems, and integrated monitoring of vaccine coverage and epidemiological disease surveillance with laboratory systems, and vaccine safety will be needed to support community engagement and drive prioritized actions and communication. Finally, political will and sustained resource commitment with transparent accountability mechanisms are required. The experience of the impact of COVID-19 pandemic on essential PHC services and the challenges of vaccine roll-out affords an opportunity to apply lessons learned in order to enhance vaccine services integrated with strong primary health care services and universal health coverage across the life course.

Data quality of reported child immunization coverage in 194 countries between 2000 and 2019.

Analyzing immunization coverage data is crucial to guide decision-making in national immunization programs and monitor global initiatives such as the Immunization Agenda 2030. We aimed to assess the quality of reported child immunization coverage data for 194 countries over 20 years. We analyzed child immunization coverage as reported to the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) between 2000-2019 by all WHO Member States for Bacillus Calmette-Guérin (BCG) vaccine birth dose, first and third doses of diphtheria-tetanus-pertussis-containing vaccine (DTP1, DTP3), and first dose of measles-containing vaccine (MCV1). We assessed completeness, consistency, integrity, and congruence and assigned data quality flags in case anomalies were detected. Generalized linear mixed-effects models were used to estimate the probability of flags worldwide and for different country groups over time. The probability of data quality flags was 18.2% globally (95% confidence interval [CI] 14.8-22.3). The lowest probability was seen in South-East Asia (6.3%, 3.3-11.8, p = 0.002), the highest in the Americas (29.7%, 22.7-37.9, p < 0.001). The probability of data quality flags declined by 5.1% per year globally (3.2-7.0, p < 0.001). The steepest decline was seen in Africa (-9.6%, -13.0 to -5.8, p < 0.001), followed by Europe (-5.4%, -9.2 to -1.6, p = 0.0055), and the Americas (-4.9%, -9.2 to -0.6, p = 0.026). Most country groups showed a statistically significant decline, and none had a statistically significant increase. Over the past two decades, the quality of global immunization coverage data appears to have improved. However, progress has not been universal. The results highlight the need for joint efforts so that all countries collect, report, and use high-quality data for action in immunization.

Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya = 50%, Ghana = 53%) and poor data concordance between child registers and facility tally sheets (Kenya = 0%, Ghana = 3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.