Abstract
The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)1–4. Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)5–8. Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.
Highlights
Low vaccination rates and increasing vaccine hesitancy[10,11,12] contribute to the persistence of measles as a major cause of childhood morbidity and mortality
Since 2016, the WHO and UNICEF have collected subnational coverage data through their annual Joint Reporting process, poor data quality and biases currently limit the use of administrative data to track progress towards Global Vaccine Action Plan (GVAP) targets[18,19,20]
Building from our previous work mapping diphtheria–tetanus– pertussis vaccine coverage in Africa[14], here we present mapped high-spatial-resolution estimates of routine MCV1 coverage across 101 low- and middle-income countries (LMICs) from 2000 to 2019, aggregated to policy-relevant second-level administrative units
Summary
Low vaccination rates and increasing vaccine hesitancy[10,11,12] contribute to the persistence of measles as a major cause of childhood morbidity and mortality. Even in countries with high national coverage, these estimates mask important subnational heterogeneities that may sustain ongoing disease transmission and increase the risk of outbreaks[14,15,16,17], especially in light of the current service disruptions associated with the COVID-19 pandemic[7,8]. Global vaccination initiatives, such as the GVAP and Immunization Agenda 2030, recognize the importance of eliminating subnational coverage disparities, aiming for at least 90% of the target population in every country and 80% in every district to be covered[5,6]. We assessed trends in geographical inequality, progress towards global targets and differential vaccination status by geographical remoteness
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