East African Health Publications & Thesis Hub

Welcome to Universal Health Thesis & Publications Hub: open and free access to quality thesis, peer reviewed articles and policy documents.

State of inequality: childhood immunization


World Health Organisation


Immunization programmes are guided by data. Dating back to as early as the 1970s, immunization programmes have been setting an example for data-driven programme implementation. In the 1980s, population-based coverage surveys – the so-called EPI 30 Cluster Sample Surveys – were introduced to collect immunization data from households. At the same time, immunization programmes standardized the collection of data from health facilities, including routine reporting of vaccinations and regular facility assessments to check on the availability and quality of service delivery. In the 1990s, immunization programmes were one of the first health programmes to focus on subnational data and coverage estimates
based on routine reports as part of the Reaching Every District strategy.
Socioeconomic and demographic differences in child immunization coverage have generally received less attention than geographic monitoring within immunization programmes. This report addresses this gap. Through analysis of survey data, the state of inequality in childhood immunization is presented for 69 low- and middle-income countries.
The results show major successes in many countries. For instance, immunization coverage rates do not differ between girls and boys. Overall trends in coverage gaps are encouraging, as inequalities narrowed during the last decade. And a substantial number of countries have achieved high levels of coverage in
even the poorest populations.
The report also demonstrates a need to pay more attention to persistent inequalities within countries. While national immunization coverage rates are high in many countries, there are still major gaps in coverage between the richest and the poorest and between children whose mothers have different levels of education. Gaps are largest for the full immunization coverage indicator and for vaccines delivered in three doses. Alarmingly, as many as one in three countries in this report has DTP3 coverage gaps between poor and rich children that are greater than 20 percentage points.
No country can reach high levels of coverage and global targets without effectively addressing the needs of disadvantaged children, including those from families that are the poorest and least educated. Success stories from several countries have demonstrated that no matter the situation of the child – whether living in the slums of cities, remote rural areas or amidst conflict – they are reachable by immunization programmes. This report presents detailed analyses (and data visualizations) of countries with the lowest immunization coverage rates to show where big gains can be made. These data, in combination with detailed routine data for small geographic areas, will help to ensure that immunization programmes reach every child, everywhere.

Document details

Document Type:Policy Documents
Health Topic:Child Health, Health Services & Policy, Maternal Health
Downloaded30 times
KeywordsCoverage, low income countries, Middle income countries, Brazil,Immunization, WHO, Child Health, Inequity,
Access this Publication who_State_of_inequality_-immunisation.pdf