The United Nations Children's Fund (UNICEF)

This 30 page UNICEF report provides a broad assessment of the status of childhood immunisation
throughout the world, including both regional analyses and an overview of global trends. The authors use as their framework for measurement a variety of
international goals including:

• The Millennium Development
  Goal (MDG) 4 which aims to reduce child
  mortality by two thirds between 1990 and 2015
• The 2002 United Nations General
  Assembly Special Session on Children target of ensuring by 2010 the full immunisation of children under
  one year of age at 90% nationally
• The 'World Fit for Children' agenda whose targets include:
  
  • Reduce measles deaths by half by 2005
  • Certify the global eradication of polio by 2005
  • Eliminate maternal and neonatal tetanus by 2005
  • Extend the benefits of new and improved vaccines and

  other preventive initiatives to children in all countries.

The report credits immunisation programmes with preventing over "2 million deaths a year and preventing countless episodes of illness and disability."
In addition, they see broader health benefits which can be achieved when an
immunisation programme is in place.

Immunization also provides a network and a mechanism by which health services
can make contact with the children and women whom they need to reach with other
interventions, such as vitamin A supplementation, the delivery of
insecticide-treated bednets to combat malaria, and deworming medicine.



Such an integrated approach is not only the most effective way to protect the
health of all children, including the most marginalized. It is also a
cost-effective way of building up health systems through which the overall
impact of immunization on child survival becomes far greater than the sum of its
parts.

The report begins with a look at the challenges faced in reaching each of the
'World Fit for Children' agenda items, and presents the Global Immunization Vision and Strategy (GIVS) approach for
responding to these challenges:

1. Immunize more people against more diseases, through
   an appropriate mix of routine and campaign strategies,
   with unprecedented attention to targeting the unreached.
2. Introduce a range of newly available vaccines and technologies,
   focusing on promoting their development and
   supporting countries in evaluating need, planning and
   establishing priorities, and obtaining the necessary financing.
3. Provide a number of critical health interventions along
   with immunization, with emphasis on the role of immunization
   in strengthening health systems by building
   human resource capacity, improving logistics and
   securing financial resources.
4. Achieve a secure, equitable supply of resources for
   immunization through collaboration among governments,
   international organizations, donors and vaccine manufacturers
   in both industrialized and developing countries.

The remainder of the report contains regional analyses for eight world regions, focusing on
routine coverage of the measles-containing vaccine (MCV)
as the primary indicator of progress
towards the goal of 90% immunisation coverage
nationally. The authors note that when looked at in a broad view, three of these regions, Latin America/Caribbean, CEE/CIS
and the Industrialised Countries, have reached this goal. Closer regional examination, however,
finds "both success stories within
underperforming regions and pockets of failure within
high-achieving areas." An abbreviated version of the regional findings is listed below:

• Eastern/Southern Africa - This region achieved 71%
  immunization of children
  against measles through routine services. Coverage has increased
  at an average annual rate of 0.7%
  between 1990 and 2003. In order to meet the 90% coverage goal, the average rate of increase
  will need to rise by 2.6 percentage points each year
  until 2010. Significant variation within the region is noted, with Somalia at only 40%
  coverage while the Seychelles have achieved a 99% rate. Of note is
  the progress made by Eritrea, which reached only 18% of children in 1992, yet
  has achieved a 6% growth rate per year, and is now expected to meet the 90% target
  by 2010.
• West/Central Africa - This region is described as having by far the
  lowest coverage in the world, with just 52% of children in 2003
  receiving measles vaccine through routine immunization
  services. Further, the region failed to show any improvement
  at all between 1990 and 2003. In the Central African Republic and Nigeria only
  35% of children are vaccinated, making them the
  two countries in the world with the lowest coverage against
  measles. Only three of the region’s countries are likely to achieve the
  goal of 90% immunization against measles: Gambia (which has already attained the
  target) plus Ghana and Sao
  Tome and Principe, which are considered on course to
  achieve it by 2010.
• South Asia - South Asia increased routine immunization coverage faster
  between 1990 and 2003 than any other region except Latin
  America/Caribbean, with an average annual rise of 0.9 percentage
  points in coverage against measles. Measles immunization coverage in the region,
  however, was still at just 67% in 2003. The Maldives and Sri Lanka
  are noted as having achieved the 90% target, while Afghanistan had the
  lowest measles immunization coverage, about 50%
  in 2003. The authors note, however, that this represented huge progress on the mere 20 per
  cent achieved in 1990 and included a 6-percentage-point rise
  between 2002 and 2003 alone
• Middle East/North Africa - With routine coverage against measles at 88% in
  2003, the Middle East/North Africa region is noted as well on course
  to achieve the goal of 90% coverage. Of the 20 countries and territories in the region, 16 have
  already achieved the 90% coverage goal for measles
  immunization. The Sudan, however, has never reached immunization coverage
  above two thirds.
• CEE/CIS [Central and Eastern Europe and the Commonwealth of
  Independent States] - Of the 20 countries in the CEE/CIS region, 15 have already achieved
  the 90% goal for measles immunization and 3 others - Bosnia and Herzegovina, Serbia and Montenegro, and
  Tajikistan - are likely to reach it. The generally high immunization coverage in the region has
  enabled a focus on children who have previously been hard to
  reach. Turkey and Georgia are noted as the two countries that will need work in
  order to reach the goals.
• Latin America/Caribbean - Not only has the Latin America/Caribbean region
  as a whole reached
  the 90% goal (with measles immunization coverage of 93%
  in 2003) but its coverage is also better than that of any other
  region, surpassing that of industrialized countries. There are, however, still seven countries in which
  substantial improvements will be required in measles immunization
  coverage levels if the goal is to be met by 2010:
  Bolivia, Dominican Republic, Guatemala, Haiti, Jamaica,
  Panama and Suriname. Also of concern are injection safety policies and practices
  which are outdated in much
  of Latin America/Caribbean. The authors note an urgent need
  to upgrade injection safety standards and practices in the
  region’s immunization programmes.
• East Asia/Pacific - This was the only region in the world that, in
  terms of overall coverage, took a small step backwards
  between 1990 and 2003, with routine coverage against measles
  declining from 84% to 82%. This figure was largely influenced by
  changes in China, where the rate fell from 90% to 84%. In 2004,
  however, the Chinese government issued
  a new infectious disease law requiring basic immunization
  to be provided free for all citizens.
• Industrialised Countries - Taken as a whole, the industrialized world has already
  achieved the immunization goal of 90%coverage
  against measles and is likely to sustain the coverage until and
  beyond 2010. Four industrialized countries are noted as in need of improvement: Austria,
  Belgium, Ireland and the United Kingdom. In Austria,
  there has been a waning in immunization coverage for all the major vaccines since 1997, with measles at 79%.
  In Belgium and the United Kingdom, protection against
  measles has also fallen below 90%. Ireland, in contrast, has never
  yet managed to achieve coverage of 90% of any of
  the basic vaccines, except BCG, with measles standing
  lowest (in 2003), at 78%.

The authors cite this data as showing that "substantial progress is
being made in many countries towards the goal of 90 per
cent coverage against measles, the primary immunizationrelated
indicator in MDG 4." The authors note, however, that much remains to be
done. Areas needing attention include mobilising new funds and extending the
reach of new vaccines; building up the infrastructure and capacity of health
systems; and making these systems accessible to every child.



This publication can be downloaded for free from the UNICEF website in French, Spanish or English.