12 Things You Didn’t Know About Immunization Around The Globe

Vaccines keep children alive and healthy by protecting them against disease. Yet in 2016, an estimated 1.4 million children under five years of age died from vaccine-preventable diseases. Approximately one fourth of deaths among children under five years old were from pneumonia, diarrhoea and measles, and could have been mostly prevented by vaccines.

Globally one in seven children- over 19 million - missed out on routine vaccines, including 13 million who have never been vaccinated,putting them and their communities at risk of disease and death. Low immunization coverage compromises gains in all other areas of health for mothers and children. The poorest,most vulnerable children who need immunization the most continue to be the least likely to get it.

UNICEF and its partners are working to ensure that the lives of all children are protected. But,if vaccination is not prioritized, some of the most marginalized children will miss out on their right to benefit from immunization,which could mean the difference between life and death.

Despite these challenges,vaccines are protecting more children than ever before.Behind their phenomenal success lies the hard work of health workers who go from village-to village to vaccinate children, eventhough they encounter fear and suspicion.

A health worker vaccinates 5-year-old Yousef in Hulluk neighbourhood in Aleppo city,Syria as part of the nationwide immunization campaign.

A brave child looks at the midwife while receiving measles injection in Tone LeVillage, Nyaung Shwe Township, Shan State in Myanmar.

“Last year, it is estimated that vaccines saved the lives of as many as three million children.That’s three million future doctors, teachers,artists, community leaders, mothers and fathers alive today thanks to millions of frontline health workers who walk for hundreds of miles to remote locations, through jungles and across seas to reach every child,”said Robin Nandy, UNICEF’s Chief of Immunization.

A ‘cadre’ (volunteer community health worker) uses an illustrated flipbook to explain about immunization in Pandas Village,Klaten District, Central Java.

“We continue to work with governments on the ground,including in places affected by conflict, in support of these unsung heroes who take on this extremely dangerous work to save lives.” Nandy added.


Two-thirds of unvaccinated children live in fragile countries or those affected by conflict.Between 2010 and 2016, Syria saw the sharpest decline in vaccinated children, with coverage* falling by 38 percentage points over this period. Second is Ukraine where coverage decreased by 33 percentage points.

A mural encourages parents to vaccinate their children at the UNICEF-supported Redemption Public Hospital in Monrovia, Liberia.

A number of countries have seen a significant increase in the number of vaccinated children since 2010, driving most of the gains inimmunization coverage this decade,including India, Ethiopia, Democratic Republic of the Congo, Bangladesh,Philippines, Mexico, United Republic of Tanzania, Vietnam, Turkey and Sudan. In India, the number of unvaccinated children** reduced by 45 percent, from 5.3 million in 2010 to 2.9 million in 2016.

As of 2016, six countries accounted for half of the world’sunimmunized children*: Nigeria (18%);India (15%); Pakistan (7%); Indonesia(5%); Ethiopia (4%); and Democratic Republic of the Congo (3%).The top 10 countries where vaccination coverage*, in percentagepoints, has increased between2010 and 2016 are Palau (29%),Malta (21%), Democratic Republicof the Congo (19%), Comoros (17%),Azerbaijan (16%), Ethiopia (16%),Timor-Leste (13%), Barbados (11%),Costa Rica (9%) and India (9%).

In 2017, Yemen witnessed one of the worst cholera epidemics on record with over a million suspected cases, almost 29 percent of them among are children under five years old. Around 5.2 million people received two doses of the oral choleravaccine in South Sudan, Somalia,Mozambique, Malawi, Sierra Leone,Philippines, Nigeria, Chad, Haiti,Cameroon, Zambia and Bangladesh during cholera outbreaks or as part of preventive campaigns.

Diphtheria, a disease that is only rarely seen thanks to immunization,is making a come-back. Inresponse to an out break among Rohingya refugees- in which three out offour people affected were children - UNICEF supported several large vaccination campaigns insouthern Bangladesh, reaching close to half a million children.

In 1988, there were 350,000 cases of polio a year. Since then, over 2.5 billion children have been vaccinated against the disease. Today, the world is closer than ever to eradicating polio, with only 22 cases in two countries last year. More than 400 million children will be vaccinated this year.

The lives of an estimated 20 million children have been saved through measles immunization between 2000 and 2016.

The pentavalent, a single vaccine that protects against 5 major diseases - hepatitis B,Haemophilus influenzae typeb, diphtheria, tetanus and pertussis.

10-day polio vaccination campaign in 13 provinces in Lao PDR was undertaken in March 2018 to vaccinate about 460,000 at-risk children aged 0 months to 5.

A billion people will be vaccinated against Yellow fever in Africa by 2026 - almost half of them children under 15 years of age. Since 2001,the production of the yellow fever vaccine has quadrupled from 20 million to 80 million doses annually,and is expected to increase in the coming years.As of 2016, an estimated 86 percent of children less than one year of age were fully vaccinated against diphtheria, tetanus and pertussis,compared to 52 percent some 30 years ago.In 2017, UNICEF procured 2.4 billion vaccine doses worth USD1.3 billion, reaching 45 percent of the world’s children.Thanks to vaccines, maternal and neonatal tetanus, which is extremely deadly amongst newborns, has been eliminated in all but 15 countries.Ethiopia, Haiti and Philippinese liminated the disease in 2017.


Immunization is one of the most cost-effective public health interventions to date, averting an estimated two to three million deaths every year. As a direct result of immunization, the world is closer than ever to eradicating polio,reaching a record low of just 22 cases in 2017. Deaths from measles,a major child killer, declined by 79 percent worldwide and by 85 percent in sub-Saharan Africa between 2000 and 2015. And as of March 2017, all but 15 countries have eliminated maternal and neonatal tetanus, a disease with a fatality rate of 70 to 100 percent among newborns.

Still, an estimated 1.5 million children under 5 years of age die every year from vaccine-preventable diseases.

The percentage of children receiving the diphtheria, tetanus and pertussis vaccine (DTP) is often used as an indicator of howwell countries are providing routine immunization services. In 2016, global coverage rates for the third dose of the diphtheria, tetanus and pertussisvaccine (DTP3) reached 86 percent,up from 72 percent in 2000 and 21percent in 1980.

Still, progress has stalled over the last decade, and 64 countries have yet to achieve the Global Vaccine Action Plan (GVAP) target of 90 percent or greater coverage of DTP3.19.5 million children under one year of age worldwide did not receive the three recommended doses of DTP in2016, and 20.8 million children in the same age group had failed to receive a single dose of measles-containing vaccine.

Male Health worker in Primary Health Center carry vaccines through trolley in a hard to reach districtat Balichowki,Himachal Pradesh, India.


No child should die from apreventable cause, and all children should be able to reach their full potential in health and well-being.The cost of a vaccine, often less than USD1, is much lower than the cost of treating a sick child or fighting a disease outbreak. Each USD1 invested in childhood vaccination produces a return on investment of USD44 in low and middle income countries.

To achieve 90 percent DTP3 coverage, vaccinations in 64 countries must be accelerated.

Conflict is one of the main factors- along with under-investments in national immunization programmes,vaccine stock-outs and disease outbreaks - disrupting health systems and preventing sustainable delivery of vaccination services.Two thirds of the world’s unimmunized children live in fragile countries or in areas affected by conflict. These children are the most vulnerable to disease outbreaks.

In Yemen, for example, children accounted for over 58 percent of the more than one million people affected by a cholera outbreak or watery diarrhoea in 2017 alone.

In 2016, eight countries had less than 50 percent coverage for DTP3 in 2016, many of which are fragile states and affected by emergencies:Central African Republic, Chad,Equatorial Guinea, Nigeria, Somalia,South Sudan, Syrian Arab Republicand Ukraine. But more than half of all children unvaccinated for DTP3 lived in just six countries: Nigeria,India, Pakistan, Indonesia, Ethiopia,and Democratic Republic of the Congo. Nigeria surpassed India as the country with the most children unvaccinated for DTP3, with an estimated 3.4 million unvaccinated children.

* Coverage is measured by the percentage of infants receiving all three required doses of diphtheria-tetanus pertussis-containing (DTP3) vaccine.

** Number of children not receiving all three required doses of diphtheriatetanus-pertussis-containing (DTP3)vaccine.