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
Authors: Natalie C Galles, Patrick Y Liu, Rachel L Updike, Nancy Fullman, Jason Nguyen, Sam Rolfe, Alyssa N Sbarra, Megan F Schipp, Ashley Marks, Gdiom Gebreheat Abady, Kaja M Abbas, Sumra Wajid Abbasi, Hedayat Abbastabar, Foad Abd-Allah, Amir Abdoli, Hassan Abolhassani, Akine Eshete Abosetugn, Maryam Adabi, Abdu A Adamu, Olatunji O Adetokunboh, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Saira Afzal, Seyed Mohammad Kazem Aghamir, Bright Opoku Ahinkorah, Sohail Ahmad, Tauseef Ahmad, Sepideh Ahmadi, Haroon Ahmed, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Yusra Ahmed Salih, Yonas Akalu, Addis Aklilu, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Fares Alahdab, Luciana Albano, Yosef Alemayehu, Kefyalew Addis Alene, Ayman Al-Eyadhy, Robert Kaba Alhassan, Liaqat Ali, Syed Mohamed Aljunid, Sami Almustanyir, Khalid A Altirkawi, Nelson Alvis-Guzman, Hubert Amu, Catalina Liliana Andrei, Tudorel Andrei, Adnan Ansar, Alireza Ansari-Moghaddam, Ippazio Cosimo Antonazzo, Benny Antony, Jalal Arabloo, Morteza Arab-Zozani, Kurnia Dwi Artanti, Judie Arulappan, Asma Tahir Awan, Mamaru Ayenew Awoke, Muluken Altaye Ayza, Ghasem Azarian, Ahmed Y Azzam, Darshan B B, Zaheer-Ud-Din Babar, Senthilkumar Balakrishnan, Maciej Banach, Simachew Animen Bante, Till Winfried Bärnighausen, Hiba Jawdat Barqawi, Amadou Barrow, Quique Bassat, Narantuya Bayarmagnai, Diana Fernanda Bejarano Ramirez, Tariku Tesfaye Bekuma, Habtamu Gebrehana Belay, Uzma Iqbal Belgaumi, Akshaya Srikanth Bhagavathula, Dinesh Bhandari, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Krittika Bhattacharyya, Sadia Bibi, Ali Bijani, Antonio Biondi, Archith Boloor, Dejana Braithwaite, Danilo Buonsenso, Zahid A Butt, Paulo Camargos, Giulia Carreras, Felix Carvalho, Carlos A Castañeda-Orjuela, Raja Chandra Chakinala, Jaykaran Charan, Souranshu Chatterjee, Soosanna Kumary Chattu, Vijay Kumar Chattu, Fazle Rabbi Chowdhury, Devasahayam J Christopher, Dinh-Toi Chu, Sheng-Chia Chung, Paolo Angelo Cortesi, Vera Marisa Costa, Rosa A S Couto, Omid Dadras, Amare Belachew Dagnew, Baye Dagnew, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Jan-Walter De Neve, Meseret Derbew Molla, Behailu Tariku Derseh, Rupak Desai, Abebaw Alemayehu Desta, Deepak Dhamnetiya, Mandira Lamichhane Dhimal, Meghnath Dhimal, Mostafa Dianatinasab, Daniel Diaz, Shirin Djalalinia, Fariba Dorostkar, Bassey Edem, Hisham Atan Edinur, Sahar Eftekharzadeh, Iman El Sayed, Maysaa El Sayed Zaki, Muhammed Elhadi, Shaimaa I El-Jaafary, Aisha Elsharkawy, Shymaa Enany, Ryenchindorj Erkhembayar, Christopher Imokhuede Esezobor, Sharareh Eskandarieh, Ifeanyi Jude Ezeonwumelu, Sayeh Ezzikouri, Jawad Fares, Pawan Sirwan Faris, Berhanu Elfu Feleke, Tomas Y Ferede, Eduarda Fernandes, João C Fernandes, Pietro Ferrara, Irina Filip, Florian Fischer, Mark Rohit Francis, Takeshi Fukumoto, Mohamed M Gad, Shilpa Gaidhane, Silvano Gallus, Tushar Garg, Biniyam Sahiledengle Geberemariyam, Teshome Gebre, Birhan Gebresillassie Gebregiorgis, Ketema Bizuwork Gebremedhin, Berhe Gebremichael, Bradford D Gessner, Keyghobad Ghadiri, Mansour Ghafourifard, Ahmad Ghashghaee, Syed Amir Gilani, Ionela-Roxana Glăvan, Ekaterina Vladimirovna Glushkova, Mahaveer Golechha, Kebebe Bekele Gonfa, Sameer Vali Gopalani, Houman Goudarzi, Mohammed Ibrahim Mohialdeen Gubari, Yuming Guo, Veer Bala Gupta, Vivek Kumar Gupta, Reyna Alma Gutiérrez, Emily Haeuser, Rabih Halwani, Samer Hamidi, Asif Hanif, Shafiul Haque, Harapan Harapan, Arief Hargono, Abdiwahab Hashi, Shoaib Hassan, Mohamed H Hassanein, Soheil Hassanipour, Hadi Hassankhani, Simon I Hay, Khezar Hayat, Mohamed I Hegazy, Golnaz Heidari, Kamal Hezam, Ramesh Holla, Mohammad Enamul Hoque, Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Mowafa Househ, Vivian Chia-rong Hsieh, Junjie Huang, Ayesha Humayun, Rabia Hussain, Nawfal R Hussein, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Sumant Inamdar, Usman Iqbal, Lalu Muhammad Irham, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Nahlah Elkudssiah Ismail, Ramaiah Itumalla, Ravi Prakash Jha, Farahnaz Joukar, Ali Kabir, Zubair Kabir, Rohollah Kalhor, Zul Kamal, Stanley M Kamande, Himal Kandel, André Karch, Getinet Kassahun, Nicholas J Kassebaum, Patrick DMC Katoto, Bayew Kelkay, Andre Pascal Kengne, Yousef Saleh Khader, Himanshu Khajuria, Ibrahim A Khalil, Ejaz Ahmad Khan, Gulfaraz Khan, Junaid Khan, Maseer Khan, Moien AB Khan, Young-Ho Khang, Abdullah T Khoja, Jagdish Khubchandani, Gyu Ri Kim, Min Seo Kim, Yun Jin Kim, Ruth W Kimokoti, Adnan Kisa, Sezer Kisa, Vladimir Andreevich Korshunov, Soewarta Kosen, Barthelemy Kuate Defo, Vaman Kulkarni, Avinash Kumar, G Anil Kumar, Nithin Kumar, Alexander Kwarteng, Carlo La Vecchia, Faris Hasan Lami, Iván Landires, Savita Lasrado, Zohra S Lassi, Hankil Lee, Yeong Yeh Lee, Miriam Levi, Sonia Lewycka, Shanshan Li, Xuefeng Liu, Stany W Lobo, Platon D Lopukhov, Rafael Lozano, Ricardo Lutzky Saute, Muhammed Magdy Abd El Razek, Alaa Makki, Ahmad Azam Malik, Fariborz Mansour-Ghanaei, Mohammad Ali Mansournia, Lorenzo Giovanni Mantovani, Francisco Rogerlândio Martins-Melo, Philippa C Matthews, John Robert Carabeo Medina, Walter Mendoza, Ritesh G Menezes, Endalkachew Worku Mengesha, Tuomo J Meretoja, Amanual Getnet Mersha, Mohamed Kamal Mesregah, Tomislav Mestrovic, Bartosz Miazgowski, George J Milne, Andreea Mirica, Erkin M Mirrakhimov, Hamid Reza Mirzaei, Sanjeev Misra, Prasanna Mithra, Masoud Moghadaszadeh, Teroj Abdulrahman Mohamed, Karzan Abdulmuhsin Mohammad, Yousef Mohammad, Mokhtar Mohammadi, Abdollah Mohammadian-Hafshejani, Arif Mohammed, Shafiu Mohammed, Archisman Mohapatra, Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Mohammad Ali Moni, Ahmed Al Montasir, Catrin E Moore, Ghobad Moradi, Rahmatollah Moradzadeh, Paula Moraga, Ulrich Otto Mueller, Sandra B Munro, Mohsen Naghavi, Mukhammad David Naimzada, Muhammad Naveed, Biswa Prakash Nayak, Ionut Negoi, Sandhya Neupane Kandel, Trang Huyen Nguyen, Rajan Nikbakhsh, Dina Nur Anggraini Ningrum, Molly R Nixon, Chukwudi A Nnaji, Jean Jacques Noubiap, Virginia Nuñez-Samudio, Vincent Ebuka Nwatah, Bogdan Oancea, Chimedsuren Ochir, Felix Akpojene Ogbo, Andrew T Olagunju, Babayemi Oluwaseun Olakunde, Obinna E Onwujekwe, Nikita Otstavnov, Stanislav S Otstavnov, Mayowa O Owolabi, Jagadish Rao Padubidri, Keyvan Pakshir, Eun-Cheol Park, Fatemeh Pashazadeh Kan, Mona Pathak, Rajan Paudel, Shrikant Pawar, Jeevan Pereira, Mario F P Peres, Arokiasamy Perianayagam, Marina Pinheiro, Majid Pirestani, Vivek Podder, Roman V Polibin, Richard Charles G Pollok, Maarten J Postma, Faheem Hyder Pottoo, Mohammad Rabiee, Navid Rabiee, Amir Radfar, Alireza Rafiei, Vafa Rahimi-Movaghar, Mosiur Rahman, Amir Masoud Rahmani, Setyaningrum Rahmawaty, Aashish Rajesh, Rebecca E Ramshaw, Priyanga Ranasinghe, Chythra R Rao, Sowmya J Rao, Priya Rathi, David Laith Rawaf, Salman Rawaf, Andre M N Renzaho, Negar Rezaei, Mohammad Sadegh Rezai, Maria Rios-Blancas, Emma L B Rogowski, Luca Ronfani, Godfrey M Rwegerera, Anas M Saad, Siamak Sabour, Basema Saddik, Mohammad Reza Saeb, Umar Saeed, Amirhossein Sahebkar, Mohammad Ali Sahraian, Nasir Salam, Hamideh Salimzadeh, Mehrnoosh Samaei, Abdallah M Samy, Juan Sanabria, Francesco Sanmarchi, Milena M Santric-Milicevic, Benn Sartorius, Arash Sarveazad, Brijesh Sathian, Monika Sawhney, Deepak Saxena, Sonia Saxena, Abdul-Aziz Seidu, Allen Seylani, Masood Ali Shaikh, Morteza Shamsizadeh, Pavanchand H Shetty, Mika Shigematsu, Jae Il Shin, Negussie Boti Sidemo, Ambrish Singh, Jasvinder A Singh, Smriti Sinha, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Amin Soheili, Eyayou Girma Tadesse, Animut Tagele Tamiru, Ker-Kan Tan, Yohannes Tekalegn, Mohamad-Hani Temsah, Bhaskar Thakur, Rekha Thapar, Aravind Thavamani, Ruoyan Tobe-Gai, Hamid Reza Tohidinik, Marcos Roberto Tovani-Palone, Eugenio Traini, Bach Xuan Tran, Manjari Tripathi, Berhan Tsegaye, Gebiyaw Wudie Tsegaye, Anayat Ullah, Saif Ullah, Sana Ullah, Brigid Unim, Marco Vacante, Diana Zuleika Velazquez, Bay Vo, Sebastian Vollmer, Giang Thu Vu, Linh Gia Vu, Yasir Waheed, Andrea Sylvia Winkler, Charles Shey Wiysonge, Vahit Yiğit, Birhanu Wubale Yirdaw, Dong Keon Yon, Naohiro Yonemoto, Chuanhua Yu, Deniz Yuce, Ismaeel Yunusa, Mohammad Zamani, Maryam Zamanian, Dejene Tesfaye Zewdie, Zhi-Jiang Zhang, Chenwen Zhong, Alimuddin Zumla, Christopher J L Murray, Stephen S Lim, Jonathan F Mosser
Journal: The Lancet (2021)

<h2>Summary</h2><h3>Background</h3> 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. <h3>Methods</h3> 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. <h3>Findings</h3> 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. <h3>Interpretation</h3> 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. <h3>Funding</h3> Bill & Melinda Gates Foundation.