Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1.

BACKGROUND

Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time.

METHODS

For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development.

FINDINGS

By 2019, global coverage of third-dose DTP (DTP3; 81·6% [95% uncertainty interval 80·4-82·7]) more than doubled from levels estimated in 1980 (39·9% [37·5-42·1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38·5% [35·4-41·3] in 1980 to 83·6% [82·3-84·8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42·6% (41·4-44·1) in 1980 to 79·8% (78·4-81·1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56·8 million (52·6-60·9) to 14·5 million (13·4-15·9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019.

INTERPRETATION

After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines.

FUNDING

Bill & Melinda Gates Foundation.

Informations de copyright

Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests Quique Bassat reports participation on a data safety monitoring board (DSMB) or advisory board as a member of the Independent Data Monitoring Committee for Respiratory Syncytial Virus vaccine development for the protection of infants (since October, 2015) (GlaxoSmithKline [GSK]) and as DSMB chair for the research project “Phase IV study to evaluate the effectiveness of the inactivated adsorbed vaccine against COVID-19 CoronaVac, among public safety and education workers with risk factors for severity, in Manaus (Amazonas)” outside the submitted work. Sonu Bhaskar reports a leadership or fiduciary role in other board, society, committee or advocacy groups, unpaid with the Rotary Club of Sydney Board of Directors, outside the submitted work. Irina Filip reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Avicenna Medical and Clinical Research Institute, outside the submitted work. Bradford D Gessner reports participation on a DSMB or advisory board at Sanofi Pasteur with participation on a dengue vaccine and general immunisation advisory board that included honoraria; stock or stock options in Pfizer; and other financial or non-financial interests as an employee of Pfizer, all outside the submitted work. Sheikh Mohammed Shariful Islam reports grants or contracts from the National Health and Medical Research Council (NHMRC) and National Heart Foundation of Australia, outside the submitted work. Nicholas J Kassebaum reports grant support for the present manuscript from the Bill & Melinda Gates Foundation; support for attending meetings or travel support, or both, to the Gates Grand Challenges and Group B Strep Vaccine meeting from the Bill & Melinda Gates Foundation; and travel support to the Group B Strep Vaccine meeting from WHO, outside the submitted work. Philippa C Matthews reports grants or contracts from the Wellcome Intermediate Fellowship (Ref 110110Z/15/Z) and the BRC Fellowship NIHR British Research Council (Oxford) senior fellowship, outside the submitted work. Jonathan F Mosser reports support for the present manuscript from the Bill & Melinda Gates Foundation; and support for attending meetings or travel support, or both, from the Bill & Melinda Gates Foundation, outside the submitted work. Maarten J Postma reports grants and personal fees from MSD, GSK, Pfizer, Boehringer Ingelheim, Novavax, BMS, Astra Zeneca, Sanofi, IQVIA, and Seqirus; personal fees from Quintiles, Novartis, and Pharmerit; grants from Bayer, DIKTI, LPDP, Budi, WHO, Antilope, FIND, EU, and BioMerieux; stock ownership in Health-Ecore, and PAG; and is an adviser to Asc Academics, outside the submitted work. Amir Radfar reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from the Avicenna Medical and Clinical Research Institute, outside the submitted work. Alyssa N Sbarra reports support for the present manuscript from the Bill & Melinda Gates Foundation; direct consultancy fees from the Pan American Health Organization for a short-term consulting project from January to December, 2018; and support for attending meetings or travel support, or both, from the Bill & Melinda Gates Foundation for costs of travel (September, 2019, and April, 2018) and reimbursements (August, 2019). Jasvinder A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, Two Labs, Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, FocusForward, Navigant Consulting, Spherix, MedIQ, UBM, Trio Health, Medscape, WebMD, and Practice Point communications; and the National Institutes of Health and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Simply Speaking; support for attending meetings or travel support, or both, from OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, when travelling bi-annually to OMERACT meetings; participation on a DSMB or advisory board as a US Food and Drug Administration (FDA) Arthritis Advisory Committee member; a leadership or fiduciary role in other board, society, committee, or advocacy groups, paid or unpaid, with OMERACT as a member of the steering committee, with the Veterans Affairs Rheumatology Field Advisory Committee as a member, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as a director and editor; and stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, and Charlotte's Web Holdings, and previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals, all outside the submitted work. Andrea Sylvia Winkler reports grants or contracts from the German Federal Ministry of Education and Research for various global health projects where payments were made to her institution, the Technical University of Munich. All other authors declare no competing interests.