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Routine Immunisation Coverage Shows Signs of Recovery at Global-Level Post Pandemic, But Important and Declines Persist in 20% of Countries
Beth Evans, Laurent Kaiser, Olivia Keiser, Thibaut Jombart ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5The study asks whether routine childhood immunisation has returned to pre-pandemic trends after COVID-19. It uses time-series forecasting of DTP coverage in 190 countries and compares 2023 coverage with what was expected. Global DTP third-dose coverage was still about 2.7% lower than expected in 2023. However, the total number of children immunised was almost back to expected levels, because falling fertility means fewer children are due for vaccination. In about 20% of countries coverage stayed below expectations, and the study could not identify clear reasons why.
Key points
- Mean global DTP third-dose coverage in 2023 was 2.7% lower than expected (95% CI: 1.1% to 4.3%).
- After accounting for demographic change, the total number of immunised children almost returned to expected levels, because decreasing fertility shrinks the target population.
- Notable disruption remained in over 30 countries: 17.6% of countries were below expectations, 81.6% within expected ranges and 1.7% above.
- Neither Discriminant Analysis of Principal Components nor Random Forests identified factors that predicted coverage disruption well, although 28 indicators were tested.
- The authors conclude that more research is needed to guide recovery and to protect routine services in future epidemics and pandemics.
Limitations
The abstract does not name the affected countries or give country-level detail, and the study found no clear drivers of the continued declines. It covers only DTP coverage in 2023 and compares it with forecasts, not with observed outcomes. The reported percentages sum to slightly more than 100%.
Abstract
Background/Objectives: Routine immunisation (RI) coverage declines during the COVID-19 pandemic, from 2020 to 2022, are well-reported. With the declared end to the Public Health Emergency of International Concern in May 2023, and the end of most non-pharmaceutical interventions that were introduced to prevent or minimise COVID-19 spread, we (I) assess whether routine immunisation coverage has rebounded to pre-pandemic trends, and (II) seek to identify factors that help predict whether country performance has exceeded, maintained, or declined compared to expectations (based on time-series forecasting). Methods: We quantify global and country-level routine immunisation diphtheria-tetanus-pertussis (DTP) coverage trends post-pandemic (2023) compared to pre-pandemic trends using time-series forecasting across 190 countries. We used Discriminant Analysis of Principal Components and Random Forests to identify relevant predictors of country-level coverage performance, including 28 indicators of health system strength, health workforce, country income, pandemic containment, economic, and health policies, and demographic aspects. Results: We show that mean global DTP third-dose coverage levels remained on average 2.7% [95% confidence intervals: 1.1% - 4.3%] lower than expected in 2023. However, once accounting for temporal demographic changes, we find that this translates to the total number of immunised children almost reverting to expected levels, owing to decreasing fertility reducing global-level immunisation target populations. At a country-level, notable disruption remaining in over 30 countries (17.6% of countries below expectations, 81.6 within expected ranges, and 1.7% above expectations). Neither predictive method performed well at identifying factors associated with coverage disruptions. Conclusions: Despite the end of COVID-19 pandemic measures, RI remains below expectations in 20% of countries. No clear drivers of this continued disruption were identified. Further research is required to inform recovery efforts and prevent future epidemic and pandemic disruptions to routine health services.