Overview
While immunization is one of the most successful public health interventions, coverage has plateaued over the last decade. The COVID-19 pandemic and associated disruptions have strained health systems, with 23 million children missing out on vaccination in 2020, 3.7 million more than in 2019 and the highest number since 2009.
During 2020, about 83% of infants worldwide (113 million infants) received 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine, protecting them against infectious diseases that can cause serious illness and disability or be fatal.
Only 19 vaccine introductions were reported in 2020 (not including COVID-19 vaccine introductions), less than half of any year in the past two decades. This slowdown is likely to continue as countries focus on ongoing efforts to control the Covid-19 pandemic, and on the introduction of Covid-19 vaccines.
Global immunization coverage 2020
A summary of global vaccination coverage in 2020 follows.
Haemophilus influenzae type b (Hib) causes meningitis and pneumonia. Hib vaccine had been introduced in 192 Member States by the end of 2020. Global coverage with 3 doses of Hib vaccine is estimated at 70%. There is great variation between regions. The WHO Region of South-East Asia is estimated to have 83% coverage, while it is only 25% in the WHO Western Pacific Region.
Hepatitis B is a viral infection that attacks the liver. Hepatitis B vaccine for infants had been introduced nationwide in 190 Member States by the end of 2020. Global coverage with 3 doses of hepatitis B vaccine is estimated at 83%. In addition, 113 Member States introduced one dose of hepatitis B vaccine to newborns within the first 24 hours of life. Global coverage is 42% and is as high as 84% in the WHO Western Pacific Region, while it is only estimated to be at 6% in the WHO African region
Human papillomavirus (HPV) is the most common viral infection of the reproductive tract and can cause cervical cancer in women, other types of cancer, and genital warts in both men and women. The HPV vaccine was introduced in 111 Member States by the end of 2020. Since many large countries have not yet introduced the vaccine and vaccine coverage decreased in 2020 in many countries - global coverage with the final dose of HPV is now estimated at 13%. This is a proportionally large reduction from 15% in 2019.
Meningitis A is an infection that is often deadly and leaves one in five affected individuals with long-term devastating sequelae. Before the introduction of MenAfriVac in 2010 – a revolutionary vaccine– meningitis serogroup A accounted for 80–85% of meningitis epidemics in the African meningitis belt. By the end of 2020 almost 350 million people in 24 out of the 26 countries in the meningitis belt had been vaccinated with MenAfriVac through campaigns. 11 countries had included MenAfriVac in their routine immunization schedule by 2020.
Measles is a highly contagious disease caused by a virus, which usually results in a high fever and rash, and can lead to blindness, encephalitis or death. By the end of 2020, 84% of children had received one dose of measles-containing vaccine by their second birthday, and 179 Member States had included a second dose as part of routine immunization and 70% of children received two doses of measles vaccine according to national immunization schedules.
Mumps is a highly contagious virus that causes painful swelling at the side of the face under the ears (the parotid glands), fever, headache and muscle aches. It can lead to viral meningitis. Mumps vaccine had been introduced nationwide in 123 Member States by the end of 2020.
Pneumococcal diseases include pneumonia, meningitis and febrile bacteraemia, as well as otitis media, sinusitis and bronchitis. Pneumococcal vaccine had been introduced in 151 Member States by the end of 2020, including three in some parts of the country, and global third dose coverage was estimated at 49%.
Polio is a highly infectious viral disease that can cause irreversible paralysis. In 2020, 83% of infants around the world received three doses of polio vaccine. In 2020, the coverage of infants receiving their first dose of inactivated polio vaccine (IPV) in countries that are still using oral polio vaccine (OPV) is estimated at 80%. Targeted for global eradication, polio has been stopped in all countries except for Afghanistan and Pakistan. Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries.
Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. Rotavirus vaccine was introduced in 114 countries by the end of 2020, including three in some parts of the country. Global coverage was estimated at 46%.
Rubella is a viral disease which is usually mild in children, but infection during early pregnancy may cause fetal death or congenital rubella syndrome, which can lead to defects of the brain, heart, eyes, and ears. Rubella vaccine was introduced nationwide in 173 Member States by the end of 2020, and global coverage was estimated at 70%.
Tetanus is caused by a bacterium which grows in the absence of oxygen, for example in dirty wounds or the umbilical cord if it is not kept clean. The spores of C. tetani are present in the environment irrespective of geographical location. It produces a toxin which can cause serious complications or death. Maternal and neonatal tetanus persist as public health problems in 12 countries, mainly in Africa and Asia.
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. As of 2019, yellow fever vaccine had been introduced in routine infant immunization programmes in 36 of the 40 countries and territories at risk for yellow fever in Africa and the Americas. In these 40 countries and territories, coverage is estimated at 45%.Key challenges
In 2020 17.1 million infants did not receive an initial dose of DTP vaccine pointing to lack of access to an immunization and other health services and an additional 5.6 million are partially vaccinated. Of the 23 million more than 60% of these children live in 10 countries: Angola, Brazil, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan and the Philippines.
Monitoring data at subnational levels is critical to helping countries prioritize and tailor vaccination strategies and operational plans to address immunization gaps and reach every person with life-saving vaccines.
WHO response
WHO is working with countries and partners to improve global vaccination coverage, including through these initiatives adopted by the World Health Assembly in May 2012.
Immunization Agenda 2030
IA2030 sets an ambitious, overarching global vision and strategy for vaccines and immunization for the decade 2021–2030. It was co-created with thousands of contributions from countries and organizations around the world, and came into effect after World Health Assembly endorsement. It draws on lessons from the past decade and acknowledges continuing and new challenges posed by infectious diseases (e.g. Ebola, COVID-19).
The strategy intends to inspire and align the activities of community, national, regional and global stakeholders, towards achieving a world where everyone, everywhere fully benefits from vaccines for good health and wellbeing. IA2030 will become operational during 2020-21 through regional and national strategies, a mechanism under development to ensure ownership and accountability and a monitoring and evaluation framework to guide country implementation.
The global strategy towards eliminating cervical cancer as a public health problem
In 2020 the WHA adopted the global strategy towards eliminating cervical cancer. In this strategy, the first of the three pillars requires the introduction of the HPV vaccine in all countries and has set a target of reaching 90% coverage. With introduction currently in 57% of Member states, in the next 10 years, large investments towards introduction in low and middle-income countries will be required as well as programme improvements to reach the 90% coverage targets in low and high-income settings alike will be required to reach the 2030 targets.