Peer-reviewed article
Routine Immunisation Coverage Shows Signs of Recovery at Global Level Postpandemic, but Important Declines Persist in About 20% of Countries
Beth Evans, Laurent Kaiser, Olivia Keiser, Thibaut Jombart ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines whether routine immunisation coverage recovered to pre-pandemic levels after the COVID-19 emergency ended in May 2023. Using data from 190 countries, researchers found that global diphtheria-tetanus-pertussis coverage remained 2.7% below expected levels in 2023, though the absolute number of immunised children nearly recovered due to lower birth rates. However, about 20% of countries still showed persistent disruptions to immunisation services, and the study could not identify clear factors explaining why some countries recovered better than others.
Key points
- Global mean DTP third-dose coverage was 2.7% lower than expected in 2023, two years after the end of the COVID-19 Public Health Emergency
- About 17.6% of countries remained below expected immunisation coverage levels, while 81.6% were within expected ranges and 1.7% exceeded expectations
- When accounting for demographic changes (decreasing fertility), the total number of immunised children almost returned to expected levels globally
- Predictive analysis using 28 health system, workforce, economic, and demographic indicators failed to identify clear drivers of coverage disruptions
- The study was unable to determine which factors help countries recover routine immunisation services after pandemic disruptions
Limitations
The study analyzes only DTP third-dose coverage as a marker for routine immunisation and does not explain which specific mechanisms or country characteristics determine recovery success. The analysis cannot identify actionable factors to guide policy interventions for the 20% of countries still below expectations.
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.