This tenth annual immunisation coverage report shows data for the calendar year 2016 derived from the Australian Immunisation Register (AIR) and the National Human Papillomavirus (HPV) Vaccination Program Register. After a decade of being largely stable at around 90%, ‘fully immunised’ coverage at the 12-month assessment age increased in 2016 to reach 93.7% for the age assessment quarterly data point in December 2016, similar to the 93.4% for the age assessment quarterly data point in December 2016 for 60 months of age. Implementation of the ‘No Jab No Pay’ policy may have contributed to these increases. While ‘fully immunised’ coverage at the 24-month age assessment milestone decreased marginally from 90.8%, in December 2015, to 89.6% for the age assessment quarterly data point in December 2016, this was likely due to the assessment algorithm being amended in December 2016 to include four doses of DTPa vaccine instead of three, following reintroduction of the 18-month booster dose. Among Indigenous children, the gap in coverage assessed at 12 months of age decreased fourfold, from 6.7 percentage points in March 2013 to only 1.7 percentage points lower than non-Indigenous children in December 2016. Since late 2012, ‘fully immunised’ coverage among Indigenous children at 60 months of age has been higher than for non-Indigenous children. Vaccine coverage for the nationally funded seasonal influenza vaccine program for Indigenous children aged 6 months to <5 years, which commenced in 2015, remained suboptimal nationally in 2016 at 11.6%. Changes in MMR coverage in adolescents were evaluated for the first time. Of the 411,157 ten- to nineteen-year-olds who were not recorded as receiving a second dose of MMR vaccine by 31 December 2015, 43,103 (10.5%) of them had received it by the end of 2016. Many of these catch-up doses are likely to have been administered as a result of the introduction on 1 January 2016 of the Australian Government’s ‘No Jab No Pay’ policy. In 2016, 78.6% of girls aged 15 years had three documented doses of HPV vaccine (jurisdictional range 67.8–82.9%), whereas 72.9% of boys (up from 67.1 % in 2015) had received three doses.
Australian Immunisation Register data have been analysed for children aged < 5 years, focusing on changes in vaccination coverage at standard age milestones (12, 24 and 60 months) between 2018 and 2019. ‘Fully vaccinated’ coverage in 2019 increased by 0.1–0.4% at the three age milestones to 94.3% at 12 months, 90.2% at 24 months (in the context of additional antigens required at 24 months) and 94.2% at 60 months. Rotavirus vaccine coverage (2 doses) increased from 90.9% in 2018 to 91.9% in 2019. ‘Fully vaccinated’ coverage in Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) children increased by 0.5–1.1% in 2019, reaching 92.9% at 12 months, 88.9% at 24 months and 96.9% at the 60 months (2.7 percentage points higher than in children overall). Recorded influenza vaccination coverage in children aged 6 months to < 5 years increased by 11.4 percentage points to 42.7% in Indigenous children in 2019, and by 15.6 percentage points to 41.8% in children overall. Longstanding issues with timeliness of vaccination in Indigenous children persisted, although the disparity between Indigenous and non-Indigenous children in on-time coverage (within 30 days of due date), for vaccines due at 4 months of age, decreased from 10.4–10.7 to 9.6–9.8 percentage points between 2018 and 2019. The timeliness of ‘fully vaccinated’ coverage was also examined at earlier age milestones (3 months after due date of last scheduled vaccine) of 9, 15, 21 and 51 months, by Indigenous status, socioeconomic status and remoteness of area of residence. Coverage in children living in the least-advantaged residential area quintile was 2.6–2.7% lower than that for those living in the most-advantaged quintile at the 9-, 15- and 21-month milestones, although these disparities were 0.5–1.5 percentage points lower than in 2018. Coverage at the earlier milestones in Indigenous children in remote areas was 1.5–6.7% percentage points lower than that for Indigenous children in major cities and regional areas, although there were some improvements since 2018. Importantly, although Indigenous children had lower coverage for the second dose of measles-mumps-rubella vaccine at 24 months (92.7% versus 93.3% overall), coverage increased to 98.8% at 60 months; coverage was also high overall at 96.4%, above the 95% target critical to measles control. In conclusion, this report demonstrates continuing improvements across a range of immunisation indicators in Australia in 2019. However, some issues with timeliness persist, particularly in Indigenous and socioeconomically disadvantaged children. New coverage targets for earlier protection in the first 2 years of life may be indicated, along with a review of current ‘fully vaccinated’ assessment algorithms, particularly at the 60-month age milestone.
Abstract Background Cameroon adopted a single-dose gender-neutral human papillomavirus (HPV) vaccination schedule in January 2023. Girls’ first-dose coverage rose sharply to 68% in 2023 before declining to 36% in 2024 and further to 30% in 2025, representing a net two-year decline of 38 percentage points from the 2023 peak. The central analytical question was what operational, policy, and system factors plausibly account for this trajectory. Methods We conducted a health policy analysis informed by Walt and Gilson’s health policy triangle and a root-cause-to-intervention logic model to address this question and propose an evidence-informed girls-first recovery framework. Primary data were WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2025 revision estimates for Cameroon, including HPV first dose and completed series among girls from 2020 to 2025, and coverage for 11 comparator antigens with stable indicator definitions across the 2024 and 2025 revisions. WUENIC Estimate Descriptions and WHO/UNICEF 2025 revision notes were reviewed for documented stockout events and reporting-method context. Results Under the former two-dose schedule, dose-completion attrition was marked: estimated dropout was 76% in 2021 and 70% in 2022. An apparent 2023 supply paradox suggests a plausible role for policy, delivery, and demand-side factors: despite a four-month national and subnational stockout affecting the first and third doses of diphtheria-tetanus-pertussis-containing vaccine, HPV coverage nearly tripled that year. By 2025, all 11 comparator antigens had improved from 2024 while remaining substantially higher than HPV coverage; the HPV-specific coverage gap widened for every comparator antigen assessed. This pattern is consistent with an HPV/adolescent-specific delivery and sustainability barrier rather than general immunisation-system weakness. Conclusions The analysis suggests that renewed recovery may depend on reliable supply, protected school-based delivery, strategic communication, outreach for underserved girls, multi-year faith-sector engagement, and time-limited girls-first prioritisation until enabling conditions for gender-neutral vaccination are restored.
We analysed Australian Immunisation Register (AIR) data, predominantly for National Immunisation Program (NIP) funded vaccines, as at 4 February 2024 for children, adolescents and adults, focusing on the calendar year 2023 and trends from previous years. This report aims to provide comprehensive analysis and interpretation of vaccination coverage data to inform immunisation policy and programs. ChildrenFully vaccinated coverage in Australian children in 2023 was lower than in 2022 at the 12-month (92.8%, down from 93.3%), 24-month (90.8%, down from 91.0%) and 60-month (93.3%, down from 93.4%) age assessment milestones. This follows the 1.1–1.5 percentage point decrease at these three milestones between the 2020 and 2022 reports, which came after eight years of generally increasing coverage. Fully vaccinated coverage in Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) children was also slightly lower in 2023 than in 2022 at the 12-month (89.7%, down from 90.0%), 24-month (87.8%, down from 87.9%) and 60-month (95.0%, down from 95.1%) milestones, following a 1.9–3.3 percentage point decrease between the 2020 and 2022 reports. Due to the lag time involved in assessment, fully vaccinated coverage figures for 2023 predominantly reflect vaccinations due in 2022, when COVID-19 pandemic-related restrictions had largely been removed. Factors contributing to this ongoing decline in coverage in children include a combination of acceptance and access issues. AdolescentsAmong adolescents turning 15 years in 2023, 84.2% of girls and 81.8% of boys (80.9% and 75.0% of Indigenous girls and boys) had received at least one dose of human papillomavirus (HPV) vaccine by their fifteenth birthday, 1.1 and 1.3 percentage points lower than in 2022, respectively (2.1–3.1 percentage points lower for Indigenous adolescents). Coverage of an adolescent dose of meningococcal ACWY vaccine in adolescents turning 17 years in 2023 was 72.8% overall and 62.3% in Indigenous adolescents, 3.1 and 3.3 percentage points lower than in 2022, respectively. These decreases reflect impacts of the pandemic on school-based programs in 2020–2021. To provide an early insight into any immediate impacts on coverage of moving to the NIP single-dose HPV vaccine schedule in 2023 (offered in Year 7 in all jurisdictions), we calculated coverage of at least one dose of HPV vaccine by 31 December in adolescents turning 13 years, with South Australia excluded due to change of delivery from Year 8 in 2022, and found it to be around 3 percentage points lower in 2023 than 2022, and 6 percentage points lower in Indigenous girls, with patterns of diphtheria-tetanus-pertussis vaccination (also single-dose at this age) and HPV vaccination coverage broadly similar. This decrease in vaccinations due in school programs after pandemic restrictions had been removed could be due to impacts of the single-dose HPV transition (i.e. if fewer opportunities for vaccination are provided due to fewer school visits) or may be due to other factors that have changed or disrupted previous school immunisation program operations or reduced parental confidence in vaccination. It is important to promote catch-up vaccination and to monitor renewed efforts to ensure equitable coverage is achieved, particularly given HPV vaccine coverage by 15 years of age in 2023 was 4–8 percentage points lower in adolescents residing in socio-economically disadvantaged and remote areas. AdultsZoster vaccination coverage in adults turning 71 years was 41.0% overall in 2023, down from 41.3% in 2022, and 36.1% in Indigenous adults, down from 36.5%. However, the availability of the new (non-live) protein-based herpes zoster vaccine (Shingrix) from 1 November 2023 has resulted in increased uptake for the larger eligible cohort. Coverage of 13-valent pneumococcal conjugate vaccine (13vPCV) in adults turning 71 years was 37.6% in 2023, up from 33.8% in 2022, and 43.0% in Indigenous adults, up from 37.7%. Coverage of 13vPCV was lower among Indigenous adults turning 50–59 years (17.5%) and 60–69 years (23.4%) in 2023, despite this vaccine being funded under the NIP. Influenza vaccination coverage decreased across all adult age groups in 2023, both overall and in Indigenous adults, with decreases ranging from 5–11 percentage points. ConclusionsThere have continued to be modest but concerning declines in vaccination coverage in children and adolescents relative to pre-pandemic peaks, with decreases greater in Indigenous children and adolescents. Evidence suggests that the factors contributing to these ongoing declines are complex and variable but include both vaccine acceptance and access issues. The picture for adult coverage is more mixed, with coverage increasing for 13vPCV, stable for zoster and decreasing for influenza vaccination, though consistently suboptimal across all vaccines. Ongoing monitoring of vaccination coverage, and further exploration of the reasons underpinning these decreases and suboptimal coverage, are needed to inform approaches to address barriers effectively and to increase vaccine uptake and equity of coverage.
Brynley Hull, Alexandra Hendry, Kristine Macartney et al.
Introduction: Immunisation coverage is a vital strategy adopted by most programs on child survival globally. A robust immunisation coverage program goes a long way in controlling the Vaccine Preventable Disease (VPDs). It is very important to analyse the factors which are detrimental in achieving 100% immunisation among children. Aim: To find the extent of immunisation coverage and to identify the factors for failure of immunisation among children in the rural field practice area of Mysore Medical College & Research Institute, Mysuru. Materials and Methods: A cross-sectional was carried out from November 2019 to January 2020 on children between 0-2 years of age using the World Health Organisation (WHO) thirty clusters sampling method. The sample size was estimated to be 210. Identification of clusters was done as per the WHO manual on 30×7 cluster survey. Interview was conducted using a structured interview format in selected households with study subjects. Data was entered in Microsoft Excel sheet and analysed using chi-square test. Statistical Package for Social Sciences(SPSS) software version 23.0 was used for analysis of data. Results: Among the study participants, 131 (86%) were fully immunised and 29 (14%) were partially immunised (those who did not receive all the due vaccines till two years of age). Religion, educational status of parents and the presence or absence of immunisation card had significant (p-values=0.01, <0.05, <0.05 respectively) association with the immunisation status. The main reasons for partial immunisation were: parents being unaware of the need for returning for subsequent doses 13 (44.8%), fear of side-effects 12 (41.3%), and vaccine not being available 7 (24.1%). Coverage of all individual vaccines among the children (0-2 years) were mostly above 199 (95%). Conclusion: This study observed higher immunisation coverage as compared to that of the national immunisation coverage of 62%. In spite of efforts to increase the immunisation coverage in the country there are regional differences in the extent of this coverage which points to the need for better strategies to tackle this problem.
We analysed Australian Immunisation Register (AIR) data for children, adolescents and adults as at 2 February 2025, concentrating primarily on National Immunisation Program (NIP)–funded vaccines. Our focus was on the calendar year 2024 and trends from previous years. This report provides comprehensive analyses and interpretation of vaccination coverage data to inform immunisation policy and programs in Australia. Along with the results outlined below, the report also includes a range of other data for vaccines given across the lifespan, including data on timeliness and vaccination provider settings. Population overall Children Fully vaccinated coverage decreased between 2023 and 2024 at all three standard age milestones: 12 months (from 92.8% to 91.6%); 24 months (from 90.8% to 89.4%); and 60 months (from 93.3% to 92.7%). This follows the 1.2–2.0 percentage point decrease in vaccination coverage uptake at these three milestones between the 2020 and 2023 reports. A combination of acceptance and access factors have contributed to this ongoing decline. Adolescents Coverage of a dose of HPV vaccine by the fifteenth birthday decreased in 2024 to 81.1% in girls and 77.9% boys; these values were 3.1 and 3.9 percentage points lower, respectively, than in 2023 and 5.5 and 7.0 percentage points lower than in 2020. In girls and boys turning 15 years of age in 2024, respectively 83.4% and 80.9% had received an adolescent dose of diphtheria-tetanus-pertussis vaccine by 31 December 2024. Overall, 68.5% of girls and 64.4% of boys turning 16 years of age in 2024 had received an adolescent dose of meningococcal ACWY vaccine by 31 December 2024. Adults Zoster vaccination coverage (one dose of Zostavax or two doses of Shingrix given at least 4 weeks apart) was 45.9% for adults aged ≥ 65 years in 2024. Coverage of an adult dose of 13vPCV was 38.6% for adults turning 71 years of age in 2024, which was 1.0 percentage point higher than in 2023; and 41.5% for adults aged ≥ 70 years, which was 6.9 percentage points higher than in 2023. Influenza vaccination coverage decreased in 2024 across all adult age groups. Aboriginal and Torres Strait Islander peoples Children Fully vaccinated coverage for Aboriginal and Torres Strait Islander children decreased between 2023 and 2024 at all three age milestones: 12 months (from 89.7% to 89.2%), 24 months (from 87.8% to 86.7%) and 60 months (from 95.0% to 94.4%), following a 2.0–3.4 percentage point decrease between the 2020 and 2023 reports. However, coverage of meningococcal B vaccine, which was introduced onto the NIP for all Aboriginal and Torres Strait Islander children in July 2020, was higher in 2024 than 2023: namely, 83.0% versus 81.0% for the first dose; 80.9% versus 80.0% for the second dose; and 75.0% versus 71.7% for the third dose. Adolescents Coverage of a dose of HPV vaccine by the fifteenth birthday decreased in 2024 in Aboriginal and Torres Strait Islander adolescents to 76.7% for girls and 69.2% for boys; these values were 4.2 and 5.8 percentage points lower, respectively, than in 2023 and 11.1 and 13.8 percentage points lower than in 2020. In Aboriginal and Torres Strait Islander girls and boys turning 15 years of age in 2024, respectively 79.3% and 73.0% had received an adolescent dose of diphtheria-tetanus-pertussis vaccine by 31 December 2024. Coverage of an adolescent dose of meningococcal ACWY vaccine received by 31 December 2024 in Aboriginal and Torres Strait Islander adolescents turning 16 years of age in 2024 was 52.7% for girls and 47.1% for boys. Adults Zoster vaccination coverage (one dose of Zostavax or two doses of Shingrix given at least 4 weeks apart) was 42.2% for Aboriginal and Torres Strait Islander adults aged ≥ 65 years in 2024. Coverage of an adult dose of 13vPCV was 48.7% for Aboriginal and Torres Strait Islander adults turning 71 years of age in 2024, which was 5.7 percentage points higher than in 2023, and 47.8% for those aged ≥ 70 years, which was 8.1 percentage points higher than in 2023. However, it was only 23.2% for those aged 50–69 years. Influenza vaccination coverage decreased in 2024 across all Aboriginal and Torres Strait Islander adult age groups. Conclusions There have been concerning and persistent downward trends in childhood and adolescent vaccination coverage in Australia since 2020, with further declines in 2024. The picture for adult coverage is more mixed, but consistently suboptimal across all vaccines. National surveys of parents of young children and adults have identified a range of access and acceptance barriers that may be contributing to observed declines in coverage. More research is needed to delineate contributory factors, particularly among adolescents and Aboriginal and Torres Strait Islander peoples. This can then be used to inform evidence-based and culturally appropriate strategies to increase vaccine uptake and coverage equity. The National Immunisation Strategy for Australia 2025–2030 provides a comprehensive framework to guide such measures and improve coverage – and hence the protection provided by vaccine programs – against disease.
Brynley Hull, Alexandra Hendry, Kristine Macartney et al.
Background: Vaccination is the most cost-effective intervention to improve health and reduce morbidity and mortality due to vaccine-preventable diseases in the child population. The South Asian region was home to 1.8 of the 6 million babies who died within twenty-eight days of birth in 2015. Objective: To describe the status and its determinants of immunisation coverage in three South Asian countries, India, Bangladesh and Nepal.Method: The study utilized data from the Demographic Health Surveys of India, Bangladesh and Nepal. We used the principal component analysis (PCA) to compute the wealth index. Descriptive statistics, bivariate analysis and multivariate logistic regression model were utilised to access the status and factors associated with immunisation coverage.Results:The study found increasing trends in immunisation coverage in India, Bangladesh and Nepal. More than 85% of children from Nepal and Bangladesh were fully immunised in contrast to 43.6% from India. There was a wide variation in child immunisation coverage in terms of socioeconomic and demographic factors. Multivariate logistic regression revealed that factors like mother’s age, residence, birth order and religion had minimal impact on complete immunisation coverage. However, mother’s education and wealth index appeared as the significant confounding factors of full immunization coverage. Children belonging to the higher educated and rich families were more likely to be fully immunised. Maximum impact of education (AOR=9.833; p<0.01) and wealth index (AOR=8.105; p<0.01) were observed in 2006 and 2011 respectively in Nepal.Conclusions: More than 85% of children from Nepal and Bangladesh were fully immunised in contrast to 43.6% from India. Mother’s education and wealth index appeared to have a significant impact on full immunization coverage.Sri Lanka Journal of Child Health, 2018; 47(1): 56-63
Abstract In a bid to address the high burden of vaccine-preventable disease and low immunisation coverage in Africa, Ministers of health and finance from several African countries conveyed at the maiden Ministerial Conference on Immunisation at Addis Ababa, Ethiopia on the 25th of February 2016 to pledge political commitments to reduce the prevalence and deaths from vaccine-preventable diseases to the barest minimum. The fulfilment of this pledge across Africa would require the design of contextually tailored sustainable plans to finance the procurement of vaccines and the running of apt immunisation programs. A robust understanding of the trend of immunisation financing in Africa will support the development of suitable national immunization financing plans, guide policy makers to develop immunisation financing strategies focused on domestic resources but factor in donor support; and provide insights for the rejuvenation and expansion of immunisation programs. Our study’s objective is to estimate the minimum fraction of a country’s health budget that should be invested in the national immunisation programme to achieve a national immunisation coverage of 80% or greater depending on the context with and without donors’ support. The study results did not find any evidence to indicate that health expenditure on immunisation (as a proportion of total health expenditure) could be a strong predictor of immunisation coverage. However, we observed an association between total health expenditure (as a % of the GDP) and immunisation coverage, for BCG (p=0.047) and DPT3 (p=0.013) vaccines. Therefore, health expenditure as a percentage of GDP can be considered as an important predictor of immunisation coverage. We demonstrate in selected countries that to achieve the GAVI target of 80% in the countries with low DPT3 coverage, health expenditure as a percentage of GDP would need to be increased by more than 45%. We are optimistic that our study results and recommendations will facilitate the development of strategies that support African countries to increase domestic financing for national immunization programmes towards achieving 2030 targets for immunization coverage. Evidence before this study We conducted a desk review to identify official government records and reports on immunisation financing in African countries in Google scholar, WHO Library, GAVI and World bank databases using keywords such as “immunisation financing”, “health budget”, “health financing policies”, “immunisation financing policies” and “health expenditure”. We identified data for all countries in Africa but were only able to retrieve complete data from 24 countries. We considered the retrieved data for each country to be complete for our study if we found data on immunisation expenditure, health expenditure as a percentage of Gross Domestic Product, Gross Domestic Product, BCG coverage, DPT3 coverage, PCV1 coverage, MCV1 coverage, fertility rates, under-five mortality rates, under-five population and the total population. Added value of this study We sought for any association between immunisation expenditure and health expenditure (as a % of the GDP) and immunisation coverage over a five-year period (2013 to 2017) in twenty-four African countries. To our knowledge, this is the first study that has shown a correlation between immunisation financing, health expenditure and immunisation coverage and how this association varies across countries. Prediction modelling of vaccine coverage time series for countries with less than desired level of coverage (below 80%) enabled us to construct a predictive index that visualised the effect of increasing health expenditure (as a % of the GDP) would have on immunisation coverage with all other variables unchanged. Implications of the available evidence We posit that immunisation expenditure is not a statistically significant predictor for immunisation coverage for DPT3 and BCG vaccines; rather, with strong statistical evidence, health expenditure (as a % of the GDP) can be used to predict immunization coverage. Our prediction model estimated the percentage increase in health expenditure (as a % of the GDP) that would be required for countries with low immunization coverage to attain the target for immunization coverage recommended by the IA2030 Framework for Action.
Israel Oluwaseyidayo Idris, Janet Tapkigen, Luke Ouma et al.
Sub–Saharan Africa (SSA) alone accounts for 40% of all global deaths, a phenomenon attributed to lack of access to available lifesaving vaccines (Wiysonge, Uthman, Ndumbe, & Hussey, 2012). WHO estimates that in 2019 the African region accounted for approximately 43% of unimmunised and incomplete immunised infants in the world (i.e.: 8.5 million of the global 19.4 million). Relatedly, the region scores the lowest immunisation coverage, at 76% versus the global coverage of 86% (WHO, 2020a). This is despite several documented efforts by different stakeholders to improve coverage in the region (Mihigo, Okeibunor, Anya, Mkanda, & Zawaira, 2017). Many studies have been conducted on coverage and drivers for and bottlenecks against immunisation in SSA. (Wiysonge, Uthman, Ndumbe, & Hussey, 2012), (Wiysonge, Young, Kredo, McCaul, & Volmik, 2015), (Mihigo, Okeibunor, Anya, Mkanda, & Zawaira, 2017), (Madhi & Rees, 2018),(Bangura, et al., 2020), all of which have observed that there is varied performance among the constituent countries, and also within countries over time, denoting some implicitly common underlying correlates threading through areas of higher performance; and the same is seen with the poorer performing areas. This consensus study therefore seeks to categorise and make explicit these “root causes” and based on documented successes, to make recommendations to address the bottlenecks and harness the opportunities for reaching every child with all the recommended vaccines. The theory of change presentation style used in this report, categorising the root causes under four broad interlinked themes, can provide a common basis to rally like-minded partners around a thematic cause and thus develop multi-component, comprehensive strategies to bring about impactful change. This is in line with the call made by the World Health Organisation Strategic Advisory Group of Experts on Immunisation, which recommended that countries, regions and global immunisation partners commit to a comprehensive review of progress, impact, and implementation of the WHO Global Vaccine Action Plan to inform a post-2020 strategy taking into account lessons learned. This strategy will assist with attaining the relevant United Nations Sustainable Development Goals by 2030.
Introduction Child immunisation is a cost-effective strategy to reduce vaccine-preventable diseases. While effective coverage is key to ensuring quality immunisation, little is known about its geographical distribution in Ethiopia. This study aims to assess the spatial distribution of effective coverage of child immunisation and identify areas with low coverage to inform targeted interventions. Methods We used the 2019 Ethiopia Mini Demographic and Health Survey and Ethiopia Service Provision Assessment datasets. After calculating the effective coverage of immunisation, Bayesian model-based geostatistics were employed to assess the spatial distribution of effective immunisation coverage in Ethiopia, using relevant covariates to estimate coverage rates across regions. Results The national effective coverage of immunisation was 34% (95% CI: 31.9% to 36.5%), with significant regional variation. Addis Ababa, western Benishangul-Gumuz, Dire Dawa city administrative, the northern part of South West Ethiopia and the northwest part of Amhara had hotspots for high level of effective coverage of child immunisation. On the other hand, central Amhara, northern Gambela, central Oromia, Sidama, northern Southern Nations, Nationalities and Peoples regions (SNNPR) and Somali had low effective coverage of child immunisation. Travel time to the nearest city (−0.292: 95% CI:−0.533 to −0.052) was found to be negative predictor of spatial distribution. Conclusion There were significant geographical variations in the effective coverage of immunisation services in Ethiopia. Travel time to nearest city was a significant predictor of spatial distribution. Policymakers are advised to prioritise underserved areas and improve spatial predictors to have a safe, effective and life-saving vaccination program in Ethiopia.
Samrawit Birhanu Alemu, Daniel Gashaneh Belay, Aynalem Belay et al.
