Peer-reviewed article
Monitoring the SDG immunization indicator: Approaches and challenges.
Bianca O Cata-Preta, Luisa Arroyave, Francine S Costa, Tewodaj Mengistu, Taylor A Holroyd et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined whether national survey data can be used to monitor a key SDG indicator on immunization coverage. Researchers calculated co-coverage (the proportion of children receiving all three key vaccines: DPT3, PCV3, and MCV2) using data from 33 national surveys. Co-coverage ranged from 6.1% in Ethiopia to 90.2% in Rwanda, and was significantly lower than average coverage rates, revealing substantial gaps when children need to receive multiple vaccines. The research found important inequalities in coverage between wealthy and poor families, and between urban and rural areas.
Key points
- Only 33 out of 88 national surveys conducted since 2015 had sufficient data to calculate co-coverage
- Co-coverage ranged from 6.1% in Ethiopia to 90.2% in Rwanda
- Median co-coverage was 60.2%, which was 16 percentage points lower than median average coverage for the same vaccines
- Socioeconomic and urban-rural inequalities in co-coverage were observed in most countries
- More frequent and comprehensive national surveys are needed, particularly for adolescent HPV vaccination data
Limitations
This is a methodological study assessing data feasibility rather than evaluating an intervention's effectiveness. It cannot tell us how to improve immunization coverage or what approaches would work best to increase vaccination rates in countries with low co-coverage.
Abstract
The operational definition of the Sustainable Development Goal (SDG) immunization indicator encompasses coverage with full courses of diphtheria-tetanus-pertussis (DPT3), pneumococcal (PCV3), measles (MCV2), and human papillomavirus (HPV) vaccines. We assessed the feasibility of using publicly available national survey data to measure this using a summary co-coverage indicator. Due to lack of data on adolescent HPV vaccine coverage, HPV was excluded from the indicator. While 88 national surveys provided data on child immunizations since 2015, only 33 were suitable for calculating co-coverage-the receipt of all three child vaccines (DPT3, PCV3, and MCV2) by 36 months of age. Co-coverage ranged widely from 6.1 % in Ethiopia to 90.2 % in Rwanda. Because co-coverage requires that children receive all three vaccines, its median level of 60.2 % was 16 percentage points lower than the median for the country-specific average of the same vaccines. Socioeconomic and urban-rural inequalities in co-coverage were observed in most countries, with wider inequalities associated with co-coverage than average coverage. Ecological analyses revealed a strong correlation between co-coverage and existing summary measures based on WHO and UNICEF estimates. These findings show a critical need for more frequent and comprehensive national surveys, particularly for adolescent populations, to enable accurate monitoring of immunization along the life-course as intended by the SDG framework. Given current funding constraints for population-based surveys, reliance on administrative data for coverage monitoring is likely to continue.