Mapping routine measles vaccination inlow- and middle-income countries

Abstract

The safe, highly efective 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 frst-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, quantifed 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. ; This work was primarily supported by grants from the Bill & Melinda Gates Foundation (OPP1182474, OPP11093011 and OPP1132415). S.I.H. is funded by additional grants from the Bill & Melinda Gates Foundation (OPP1119467 and OPP1106023). The opinions expressed in this paper are those of the authors and not necessarily those of the World Health Organization. J.-W.D.N. was supported by the Alexander von Humboldt Foundation. C.H. is partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084, and a grant co-funded by the European Fund for Regional Development through Operational Program for Competitiveness, Project ID P_40_382. Y.J.K. acknowledges support by the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). K. Krishan is supported by a DST PURSE Grant and UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. B.L. acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. M.A.M. acknowledges NIGEB and NIMAD grants. A. Sheikh acknowledges support by Health Data Research UK. S.B.Z. acknowledges support from the Australian Government research training program (RTP) for his academic career. ; publishedVersion