Immunization maintains strong performance made in last quarter century

October 4, 2005 by PATH

Millions more could be saved with new vaccines, stronger health systems

Laura Cooley of PATH at, +
Ariane Manset of the Vaccine Fund at, +
or Melinda Henry of the World Health Organization at, +

Lyon, France, October 4, 2005—Immunization at the global level has progressed very well during the past 25 years, but further increases in coverage would save the lives of millions more who do not yet benefit from this protection, said a group of immunization partners at the World Vaccine Congress in Lyon, France.

This conclusion was drawn after an analysis of the latest immunization global data, published today. The World Health Organization (WHO) and United Nation’s Children’s Fund (UNICEF), with financial support from the US Centers for Disease Control and Prevention, conduct world-wide monitoring and work closely with ministries of health to produce estimates of immunization coverage each year. The major findings are summarized as follows:

  • Global immunization coverage with three doses of diphtheria-tetanus-pertussis (DTP3) vaccine has been sustained at 78 percent for the year 2004.1
  • One hundred and two countries have reached DTP3 coverage of 90 percent or more, and 80 countries are within the 50 to 89 percent range. Ten countries—in Africa, Asia, and Central America—have coverage levels below 50 percent.2
  • There has been dramatic expansion in the use of hepatitis B and Haemophilus influenzae type b (Hib) vaccines. One hundred fifty-three countries now routinely vaccinate children with hepatitis B vaccine, up from 12 countries in 1990. Ninety-two countries include Hib vaccine in their routine immunization systems, up from four countries in 1991.
  • Twenty-seven million infants were not immunized with DTP3 in 2004, putting them at risk for life-threatening illnesses.3
  • Five countries—China, India, Indonesia, Nigeria, and Pakistan—each have more than 1 million unvaccinated children, accounting for 16.3 million (more than 60 percent) of the world's 27 million unvaccinated children.4

"The spectacular gains made in immunization in the '80s have been sustained. This is the result of strong commitment of countries and partners, effective strategies, and substantial financing. But, we can and must do better. Vaccines must be brought to the millions who are currently unreached and all people must benefit from new, life-saving vaccines. Our mission is to protect all people at risk from vaccine-preventable diseases," said Dr Jean-Marie Okwo-Bele, Director of the WHO Department of Immunization, Vaccines, and Biologicals.

The estimated number of deaths in all age groups from diseases preventable by vaccines currently recommended by WHO, such as measles, hepatitis B, Hib, pertussis, tetanus, and others, was 2.1 million in 2002, including 1.4 million children under age five.

Yet, in 2003 alone, immunization averted more than two million deaths from vaccine-preventable diseases. An additional 600,000 hepatitis B-related deaths that would have otherwise have occurred in adulthood were also prevented. Historically, immunization is one of the greatest public health success stories ever: smallpox was eradicated in 1980; the global incidence of polio has been reduced by 99 percent; and in just five years, (1999 through 2003) global measles deaths have decreased by 39 percent, with a 46 percent reduction in Africa.

Immunization is at an exciting turning point. Unprecedented new resources for immunization are being made available through the International Finance Facility for Immunization (IFFIm) towards which a group of European countries committed nearly US$4 billion last month.

"IFFIm funding will enable us to scale up immunization and introduce new vaccines to millions of the world’s poorest children. Substantial funding to support health systems is needed if countries are going to expand access to the traditional vaccines and manage and deliver the new vaccines," said Dr. Julian Lob-Levyt, Executive Secretary of the Global Alliance for Vaccines and Immunization (GAVI).

A revolution is expected in the next decade in the ways that vaccines are designed, manufactured, financed, delivered, and administered. Major breakthroughs are occurring in vaccine development. About 20 new or improved vaccines are anticipated within the next ten years.

"Dramatic progress has been made in the development of several new vaccines for diseases that afflict children in developing countries—new vaccines that are capable of protecting the lives of even more children," said Dr. John Wecker, Director, Immunization Solutions at PATH, an international nonprofit organization. "The challenge we face is to ensure that all children who could benefit from these vaccines will have access to them."

WHO and UNICEF have produced a new Global Immunization Vision and Strategy for 2006 to 2015 which aims to protect more people, of all age groups, against more diseases and sets a number of immunization goals.

WHO is the United Nations specialized agency for health. Its objective is the attainment by all people's of the highest possible level of health. WHO has 192 Member States. More information is available at; for information on immunization, please see:

The IFFIm and GAVI: The International Finance Facility for Immunization (IFFIm) will be implemented through GAVI, an historic alliance of all the major stakeholders in immunization. Alliance members include a wide range of development partners: developing country and donor governments; WHO; UNICEF; the World Bank; the vaccine industry (from industrialized and developing countries); research and technical agencies; non-governmental agencies; the Bill & Melinda Gates Foundation; and The Vaccine Fund, the resource and financing arm of GAVI.

PATH is an international, nonprofit organization that creates sustainable, culturally relevant solutions that enable communities worldwide to break longstanding cycles of poor health. By collaborating with diverse public- and private-sector partners, PATH helps provide appropriate health technologies and vital strategies that change the way people think and act. PATH’s work improves global health and well-being.

1 WHO and UNICEF routinely monitor national infant immunization coverage for protection against tuberculosis, diphtheria, tetanus, pertussis, polio, measles, hepatitis, and Haemophilus influenzaetype b. DTP coverage is commonly used as the indicator vaccine for immunization system performance. In 1980, global immunization coverage with DTP3 was low at 20 percent and only about 30 percent of countries had a formal infant immunization system, but dramatic gains were made during the 1980s and these have been sustained until present, despite an increasing world population. Of the 124.6 million infants born in 2004 and surviving to their first year of life, more than 108 million received at least one vaccine and 95 million received bacille Calmette-Guérin vaccine against tuberculosis, DTP3, oral polio, and measles vaccines. One hundred ninety-two countries now have an infant immunization system.

The ten countries are Central African Republic (40 percent), Equatorial Guinea (33 percent), Gabon (38 percent), Haiti (43 percent), the Lao People's Democratic Republic (45 percent), Liberia (31 percent), Nigeria (25 percent), Papua New Guinea (46 percent), Somalia (30 percent), and Vanuatu (49 percent). In these ten countries, 4.3 million children were unvaccinated in 2004.

3 The 27 million includes 11 million in South Asia, 9 million in sub-Saharan Africa, and 3.9 million in East Asia and the Pacific.

4 India had 8.5 million, Nigeria 3.3 million, Pakistan 1.8 million, China 1.6 million, and Indonesia 1.3 million unvaccinated children in 2004.