Scorecard for global childhood immunizations: On track toward raising coverage and reducing mortality, but far from the finish line

Background: More than 2.5 million deaths are averted each year worldwide through immunization; however, an equal number of children still die yearly from vaccine-preventable diseases (VPD) despite improvements in immunization coverage.

Methods: We reviewed available data from the World Health Organization and national immunization program reports to assess immunization coverage, VPD mortality estimates, and the potential impact on mortality if pneumococcal and rotavirus vaccines were used more extensively.

Results: From 2000 to 2007, third dose of diphtheria-tetanus-pertussis vaccine coverage increased from 73% to 81% globally but left an estimated 24.1 million children under one unvaccinated. In 2002, an estimated 1.4 million deaths could have been averted by currently recommended vaccines (excluding measles) with 2 million more averted if pneumococcal and rotavirus vaccines were recommended and fully utilized. Additionally, measles mortality decreased from an estimated 750,000 deaths in 2000 to 197,000 deaths in 2007. However, multiple program reviews have raised questions about the status of immunization programs including poor quality of coverage data, increasing reliance on donor support, lack of sustainability, lack of training and supervision, outdated cold chain equipment, and stagnated coverage in many countries.

Conclusions: Improved immunization coverage and introduction of new vaccines has reduced VPD mortality in the last decade; nevertheless, national programs continue to face substantial problems. Unless efforts are made to secure financing and improve the management of routine immunization programs, countries risk failing to sustain the achievements made and may be unable to take advantage of further improvements in mortality reduction through new vaccine introduction.