Post on 24-Nov-2021
Document last revised: 16 July 2021
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WHO UNICEF Immunization Coverage Estimates
2020 revision (completed 15 July 2021)
The estimates are based on data and information available to WHO and UNICEF as of
6 July 2021.
The data are available from both WHO and UNICEF web sites:
https://immunizationdata.who.int/
and http://www.data.unicef.org/child-health/immunization.
An explanation how to interpret the country profiles is also available:
http://www.who.int/entity/immunization/monitoring_surveillance/routine/coverage/U
ser_Ref_Country_Reports.pdf.
Methodology:
Each year WHO and UNICEF jointly review reports submitted by Member States
regarding national immunization coverage, finalized survey reports as well as data
from the published and grey literature. Based on these data, with due consideration to
potential biases and the views of local experts, WHO and UNICEF attempt to
distinguish between situations where the available empirical data accurately reflect
immunization system performance and those where the data are likely to be
compromised and present a misleading view of immunization coverage while jointly
estimating the most likely coverage levels for each country.
WHO and UNICEF estimates are country-specific; that is to say, each country's data
are reviewed individually, and data are not borrowed from other countries in the
absence of data. Estimates are not based on ad hoc adjustments to reported data; in
some instances, empirical data are available from a single source, usually the
nationally reported coverage data. In cases where no data are available for a given
country/vaccine/year combination, data are considered from earlier and later years
and interpolated to estimate coverage for the missing year(s). In cases where data
sources are mixed and show large variation, an attempt is made to identify the most
likely estimate with consideration of the possible biases in available data.
Due to the COVID-19 pandemic, the data collection response rate is lower than in
recent years. For the 15 July 2021 release, no estimate for 2020 was made for
countries that did not report coverage date by 6 July 2021. WHO and UNICEF have
extended the data collection for the 2020 WUENIC revision to give countries extra
time to report, complement, or correct already submitted data. UNICEF and WHO
will release an update of the WUENIC 2020 revision in September/October2021
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A detailed explanation of the estimation methods is provided in following three
publications:
Burton A, Monasch R, Lautenbach B, Gacic-Dobo M, Neill M, Karimov R, Wolfson
L, Jones G, Birmingham M. WHO and UNICEF estimates of national infant
immunization coverage: methods and processes. Bull World Health Organ.
2009;87(7):535-41.
Burton A, Kowalski R, Gacic-Dobo M, Karimov R, Brown D. A Formal
Representation of the WHO and UNICEF Estimates of National Immunization
Coverage: A Computational Logic Approach. PLoS ONE 2012;7(10): e47806.
doi:10.1371/journal.pone.0047806
Brown D, Burton A, Gacic-Dobo M, Karimov R An Introduction to the Grade of
Confidence in the WHO and UNICEF Estimates of National Immunization Coverage
The Open Public Health Journal, 2013, 6, 73-76
Disclaimer
All reasonable precautions have been taken by the World Health Organization and
United Nations Children's Fund to verify the information contained in the WUENIC.
However, the WUENIC are distributed without warranty of any kind, either expressed
or implied. The responsibility for the interpretation and use of the material lies with
the reader. In no event shall the World Health Organization or United Nations
Children's Fund be liable for damages arising from its use.
Vaccines recently added to the estimation production cycle
Second dose of measles containing vaccine
Beginning with the 2013 revision (completed in July 2014), WHO and UNICEF
produce coverage estimates for the second dose of measles containing vaccine from
2000 onwards for countries where a second dose is recommended in the national
immunization schedule for universal use and where empirical data are available for at
least one year since introduction in the schedule.
Coverage estimates for the second dose of measles-containing vaccine (MCV2) are
produced for the age cohort according to the administration recommended in national
immunization schedule of each country. Global and regional coverage estimates are
produced for vaccinations by 2 years of age and by the nationally recommended age.
Currently, much of the information available is nationally reported coverage, as only
few countries have included the second dose of measles-containing vaccine in
nationally representative coverage surveys.
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Hepatitis B birth dose
Beginning with the 2013 revision (completed in July 2014), WHO and UNICEF
produce coverage estimates for the hepatitis B birth dose from 2000 onwards for
countries where the vaccine dose is recommended in the national immunization
schedule for universal use and where empirical data are available for at least one year
since introduction in the schedule.
Hepatitis B birth dose estimates are produced for doses given within 24 hours after
birth. Currently, survey results for Hepatitis B birth dose are scant and in many
instances the surveys either do not appropriately collect or report on the strict timing
for administration. WHO and UNICEF estimates for Hepatitis B birth dose may well
be overestimated, especially for countries with low rates of institutionalized births.
Inactivated polio vaccine
WHO and UNICEF began producing estimates of vaccination coverage for
inactivated polio vaccine (IPV) in 2015 following the Global Polio Eradication
Initiative (GPEI) strategic plan recommendation that at least one full dose, or two
fractional doses, of IPV be included in routine immunization schedules as a strategy
to mitigate the potential consequences should any re-emergence of type 2 poliovirus
occur following the withdrawal of Sabin type 2 strains from oral polio vaccine
(OPV). In April 2016 the switch from trivalent OPV (tOPV) to bivalent OPV (bOPV)
began, thereby removing the type 2 component from immunization programmes
worldwide in order to minimize the risk of continued type 2 circulating vaccine-
derived poliovirus (cVDPV) cases and vaccine associated paralytic polio (VAPP). In
2018-19, >2-doses of IPV, whether full or fractional, are recommended by the
Strategic Advisory Group of Experts on Immunization (SAGE) to induce long-lasting
protection against poliomyelitis1.
Beginning with the 2015 revision (completed in July 2016), IPV coverage estimates
were produced for countries using both IPV and OPV in their immunization
programme. Beginning with the 2016 revision, IPV estimates are produced for all
countries using IPV and reporting IPV coverage data regardless of OPV use.
Estimated global and regional average coverage levels are produced only for those
countries where both OPV and IPV are included in the national immunization
schedule.
The production of IPV coverage estimates results in no change on the estimated
coverage levels for the third dose of polio (Pol3). For countries recommending routine
immunization with a primary series of three doses of IPV alone, the WHO and
UNICEF estimates of coverage for Pol3 are equivalent to estimated coverage with
1 https://www.who.int/teams/immunization-vaccines-and-biologicals/policies/position-papers/polio
Document last revised: 16 July 2021
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three doses of IPV. For countries with a sequential schedule, estimated coverage for
Pol3 is based on that for the third dose of polio vaccine regardless of vaccine
presentation.
During 2015-17 revisions (i.e., estimates for 2015, 2016 and 2017), estimates for IPV
reflect coverage with at least one routine full dose, or two fractional doses, of IPV
(IPV1) among infants <1 year of age. With the new recommendation for >2-doses of
IPV, whether full or fractional, the interpretation of WHO and UNICEF estimates for
IPV have become more complex as of the 2018 revision with regards to what the
estimates reflect.
For IPV1, in the 2016 revision, WHO and UNICEF produced estimates for individual
countries, but not regional or global coverage estimates given that countries were still
introducing this vaccine and IPV supply was unreliable. Beginning with the 2017
revision, WHO and UNICEF produced regional and global average coverage
estimates for IPV1 for countries using OPV.
During 2016 and 2017 (mostly), with the occurrence of global IPV supply disruptions,
some countries began implementing fractional doses of IPV. The quality of reporting
first and second fractional doses is largely unknown; however, when countries did
report coverage for the first and second fractional dose, the WHO and UNICEF
estimate for IPV reflected coverage for the second fractional dose. This remained the
practice since the 2018 revision (completed during July 2019). However, with the new
SAGE recommendations, interpretation of what IPV1 reflects as of the 2018
WUENIC revision is not straightforward. See the table below.
IPV bOPV Protection
1 fractional dose >3 doses Primed for protection against strain 2; Protected against strain 1 and 3
>2 fractional doses >3 doses Protected against strains 1, 2 and 3
1 full dose >3 doses Primed for protection against strain 2; Protected against strain 1 and 3
>2 full doses >3 doses Protected against strains 1, 2 and 3
1 fractional dose <3 doses Primed for protection against strains 1, 2 and 3
>2 fractional doses <3 doses Primed for protection against strain 1 and 3; Protected against strain 2
>2 full doses <3 doses Primed for protection against strain 1 and 3; Protected against strain 2
1 full dose <3 doses Primed for protection against strains 1, 2 and 3
In some instances, estimated IPV1 coverage may reflect the percentage of infants in a
country who received two fractional IPV doses, in which case these children are
protected against strains 1, 2 and 3 if the child has received bOPV3. In other
instances, estimated IPV1 coverage may reflect the percentage of infants in a country
who received one full dose of IPV, likely through a combination penta- or hexa-valent
vaccine.
Further discussions are planned during 2021 to better disentangle the complexities
that have arisen. It may well be that in next revisions, the WHO and UNICEF
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estimates of IPV1 coverage will reflect the percentage of infants who are primed for
protection against strains 1, 2 and 3 if the child has not received three doses of bOPV;
or, if the child has received bOPV3, the estimates will reflect the percentage of infants
who are primed for protection against strain 2 and protected against strains 1 and 3. In
countries using IPV and no OPV, only children who receive at least two doses of IPV
are considered fully protected against strains 1, 2 and 3.
Cautious interpretation of IPV1 estimates is required at this time.
Rubella containing vaccine
Also beginning with the 2015 revision, WHO and UNICEF produce coverage
estimates for rubella containing vaccine for those countries where the vaccine is
included in the national immunization schedule. Estimates are made for the entire
time series from 1980. The approach taken to estimate coverage for rubella containing
vaccine is as follows:
• If rubella-containing vaccine is recommended in year Y and rubella containing
vaccine is administered with the first dose of measles-containing vaccine, then
the estimate for rubella containing vaccine for year Y is equal to the estimated
coverage for the first dose of measles-containing vaccine in year Y.
• If rubella-containing vaccine is recommended in year Y and rubella-
containing vaccine is administered with the second dose of measles-containing
vaccine, then the estimate for rubella containing vaccine for year Y is equal to
the estimated coverage for the second dose of measles-containing vaccine in
year Y.
Given that estimates for rubella containing vaccine are based on estimates for either
MCV1 or MCV2, reported country coverage are not included in the country reports in
order to avoid confusion by readers as to how such data are incorporated.
Global and regional average estimates have been produced for rubella-containing
vaccine since the 2015 revision.
Starting with the 2016 revision, the minor layout changes were made to the country
profile report:
• A detailed explanatory note was added to the front page.
• The order of the explanatory text was changed presenting the most recent year
on the top of the page, as opposed to the first year in the graph on the top.
Country response to the Joint Reporting Form on Immunization, 2021 (data for 2020)
During 2021 by 6 July, reported immunization service delivery performance data
were received through the Joint Reporting Form on Immunization from 160 of 195
WHO/UNICEF Member States.
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List WHO and UNICEF member states with no report submitted as of . 6 July2021 .
Country ISO-3 CountryCode
Albania alb
Armenia arm
Belgium bel
Bahamas bhs
Bosnia and Herzegovina bih
Cook Islands cok
Cyprus cyp
Czechia cze
Germany deu
Algeria dza
Fiji fji
France fra
Gambia gmb
Guinea-Bissau gnb
Croatia hrv
Hungary hun
Iceland isl
Republic of Korea kor
Kuwait kwt
Morocco mar
Monaco mco
Marshall Islands mhl
North Macedonia mkd
Namibia nam
Niue niu
Netherlands nld
Oman omn
Peru per
Poland pol
Portugal prt
Singapore sgp
Serbia srb
Sao Tome and Principe stp
Thailand tha
Trinidad and Tobago tto
For 2020 exceptionally estimates were only made for countries with reported data.
Therefore there are no estimates available for the above listed 35 countries for the
year of 2020. If reports become available exceptional update will be issued later in the
year.
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Summary of WUENIC values for the third dose of DTP containing vaccine
WUENIC = reported coverage 118 (61%) countries
28 are supported by a survey within the last 5 years
52 had surveys more than 5 years ago
1 country has had no surveys
WUENIC < reported coverage 36 (18%) countries;
25 countries with >10%-point difference,
8 with >5% and <10% -point difference
WUENIC > reported coverage 6 (3%) countries;
2 countries with >10%-point difference,
2 with >5% and <10% -point difference
WUENIC = not available for 2020
due to no reported coverage data for
2020
35 (18%) countries
For 2020 global and regional coverage estimates, 2019 data were imputed for 2020
for the 35 non reporting countries. These 35 countries represent 5% of the global
target population.
Rule for survey inclusion / exclusion
Final survey reports that were either publicly reported and available or those received
from countries by the WHO and UNICEF working group prior to 6 July 2021 were
included in the 2020 revision of the WUENIC, sent to countries for review and
comment. If a country replied to the draft WUENIC with information on survey
results to consider, then the survey results were included in the final report if the
survey report included a methods description in addition to the survey coverage
estimates.
.
As in the past, only surveys with final reports are considered for inclusion. The
purpose for this restriction of including survey data between the Draft and Final
estimates is to hold true to a general principle not to make changes in underlying input
data or working group decisions that the Member States have not seen. Past
experiences with coverage survey results that changed between preliminary and final
reports dictate the importance of this restriction. In addition, preliminary survey
results often present vaccination coverage estimates based on the combination of
respondent recall and documented evidence but not by documented evidence alone,
making recall bias adjustment for multidose antigens impossible. If preliminary
survey results are available, they are noted in the right-side explanatory text in the
country reports.
Countries for which new surveys were included for the 2019 WUENIC revision:
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Demographic and Health Survey (DHS)
Bangladesh 2017-18
The Gambia 2019-20
Liberia 2019-20
Senegal 2019
Sierra Leone 2019
Turkey 2018
Multiple Indicator Cluster Survey (MICS)
Central African Republic 2018-2019
Costa Rica 2018
Cuba 2019
Algeria 2019
Guinea-Bissau 2018-2019
Guyana 2019-2020
Madagascar 2018
North Macedonia 2018-2019
Nepal 2019
State of Palestine 2019-2020
Serbia 2019
Sao Tome and Principe 2019
Thailand 2019
Tonga 2019
Other coverage surveys including vaccination coverage
Routine Vaccine Coverage Survey Coupled with the November 2019 Measles and
Rubella (RR) Post-Campaign Coverage Survey in Burkina Faso
Bangladesh EPI Coverage Evaluation Survey 2019
Eritrea National EPI Coverage Survey Report, 2020
South Africa National EPI Coverage Survey Report, 2019-20
18 surveys supported reported coverage (The Gambia, Sierra Leone, Turkey, Costa
Rica ,Cuba, Algeria ,Guinea-Bissau, Guyana, North Macedonia, Nepal, State of
Palestine, Serbia, Sao Tome and Principe, Thailand, Tonga, Burkina Faso, Eritrea and
South Africa
6 survey results served as the basis for the estimates (Bangladesh (2) , Liberia,
Senegal; Central African Republic, Madagascar,
Other surveys not used to estimate but included as comments
Spain –2017-2018 serosurvey including some vaccine-preventable disease data, but
not by single age cohort
Azerbaijan – 2018 and 2019 surveys using convenience sampling
Kiribati – 2018-2019 Social Development Indicator Survey – data not available in
standard format
Mexico – ENSANUT coverage reported separately for children with documented
evidence of vaccination vs. those for whom only recall was available
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In Nigeria, the working group had been made aware of preliminary results from a
2019 National Nutrition and Health Survey using the SMART methodology. The
Government of Nigeria reported a preliminary DTP3 coverage of 67% from the
survey. Because a final report was not shared, the result was not considered for this
revision. It is important to note that experts have raised concern with the
comparability of the sampling and survey methods of recent SMART NNHS surveys
in Nigeria vis-à-vis DHS/MICS surveys; thus, even if the survey results had been
finalized, there is no guarantee that the surveys would have informed the level of
WUENIC given that the working group has recently ignored the NNHS results due to
inconsistencies with DHS/MICS in the same or neighboring cohort years.
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Figure. Years since most recent survey with vaccination coverage estimates
Additional data sources:
Estimated population data2 from the UN Population Division are used as one of the
inputs utilized in the review of country data and when the working group considers
uncertainty in the WHO and UNICEF estimates. The World Population Prospects:
2019 revision data were used for informing the WUENIC Grade of Confidence (GoC)
and producing the global and regional average coverage estimates as well as for
computing the estimated number of un- and under-immunized children.
Direct communications with country teams between WUENIC Draft and
Finalization
WHO and UNICEF encourage countries to review and comment on the country
reports shared following the Draft production. In past years, regional or sub-regional
consultations have been held during May/June to go through select country data and
estimates. During the 2020 revision due to Covid-19 disruptions, WHO and UNICEF
held conference call consultations with country teams from Haiti, Lao PDR and
Pakistan.
2 United Nations, Department of Economic and Social Affairs, Population Division (2019). World
Population Prospects 2019, Online Edition.
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Changes between 2019 and 2020 WUENIC revision:
Database structure change.
None
Changes in estimates due to updates in empirical data between revisions result
from:
• Updated data submitted by Member States and previously reported time series
were revised.
• New survey data becoming available after 2019 revision (between 29 June
2020 and 6 July 2021)
• 2019 data reported late, and not included in 2019 revision of coverage
estimates (between 29 June 2020 and 6 July June 2021)
A list of countries with major changes in the estimated time series is provided in
Table 1.
Vaccine introduction and data availability
For vaccine introduction, or the introduction of additional doses into the routine
immunization schedule (such as the second dose of measles-containing vaccines or
Hepatitis B birth dose), WHO and UNICEF estimates of national immunization
coverage are produced beginning in the first year for which data are reported by
national authorities. In situations where a vaccine was introduced sub-nationally or
the introduction occurred after January, the WHO and UNICEF estimates of coverage
are based on computed coverage for the annual national target population.
The following lists of countries reflect those where WHO is aware that the country
has introduced the vaccine but for which there is insufficient data for generating
WUENIC.
Hepatitis B
Countries with infant immunization not in national schedule
DNK;FIN;HUN;ISL;SLV
Hepatitis B birth dose:
Data collection form was modified in 2017 (for 2016 data). Countries were asked to
report birth dose given in 24 hours and “all birth doses” (i.e., within and after 24
hours). This permitted revision of historical data and exclusion of countries where
data on birth dose given within 24 hours is not available.
Angola: Introduced in 2015 no birth dose given within 24 hours reported. No data
reported for 2016 and 2017.
Australia: No data reported on birth dose given within 24 hours.
Bosnia and Herzegovina: No data reported on birth dose given within 24 hours.
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Botswana: No data reported on birth dose given within 24 hours.
Estonia: Introduced in 2003. According to the national immunization schedule HepB
first dose should be given within 12 hours of birth. National reporting system doesn`t
seem able to provide the number of hepatitis B vaccine doses given within 24 hours of
birth.
Equatorial Guinea: Introduced in December 2018; reported only very few vaccine
doses administered; no coverage reported on birth dose given within 24 hours.
Gambia: No data reported on birth dose given within 24 hours.
Libya: No birth dose given within 24 hours reported.
Mauritania: Introduced in 2013. No data reported on birth dose given within 24
hours.
Nigeria: Introduced in 2014. No data reported on birth dose given within 24 hours.
Pakistan: Introduced in 2019, not able to distinguish between doses given in 24h or
after.
Paraguay: Introduced in 2017. No data reported on birth dose given within 24 hours.
Syria: Introduced in 2003.
* Russian Federation: Does not appear that hepatitis B birth dose is recommended;
reported national schedule information notes a recommended dose of hepatitis B at
day 1, but not necessarily within the first 24 hours. Data not collected by the country.
Canada reports partial HepB birth dose, but no data are reported.
Hib
Thailand: Introduced in June 2019. No reported data.
Additional 2 countries missing introduction CHN, RUS
Pneumococcal conjugate vaccine (PcV):
.
Austria: Introduced in 2014. No reported data.
Croatia: Introduced in 2019 . No reported data.
Monaco: Introduced in 2006. No reported data.
Malta: introduced in 2020 Only 1st and 2nd dose administered during 2020.
Malaysia: Introduced in December 2020 with catch-up vaccination for children born
since January 2020. No data reported.
North Macedonia: Introduced in 2019. No reported data.
Tajikistan: Introduced in 2020, no data reported.
N.B.: Countries may use different PCV schedules, namely 3 basic doses in infants
with no booster (3+0), 2 basic doses in infants with a later booster (2+1), or 3 basic
doses in infants with a booster (3+1). Some countries have been recently changing
their recommended PCV schedule. In most countries PCV3 represents the third dose
whether given before 12 months or at or after 12 months, but in some cases coverage
estimates may reflect the percentage of surviving infants who received two doses of
PCV prior to the 1st birthday.
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Second dose measles-containing vaccine:
Ireland: Introduced since 1982; data are not reported.
Rubella-containing vaccine:
Based on Measles estimates, but modified if partial introduction.
Democratic People’s Republic of Korea: introduced in 2019. Data not reported.
Rotavirus vaccine (Rota last dose):
Albania: Started for children born from August 2019. Reported only 1st dose for that
year. No data reported for 2020.
Andorra: Introduced in 2020. No reported data.
Japan: Introduced in 2020. No reported data.
Nepal: Introduced in 2020. No reported data.
North Macedonia: Introduced in 2019. No reported data.
Russian Federation: Introduced sub-nationally in 2016. No reported data.
Thailand: Introduced sub-nationally as part of a pilot project; no estimate produced.
Timor-Leste: Introduced in 2019. No reported data.
.
IPV:
Poland: No reported data as of 2019.
Yellow Fever:
Seychelles: Uses vaccine in routine schedule, estimate not made as country is not at
risk.
Cabo Verde: Uses vaccine in routine schedule, estimate not made as country is not at
risk.
Tome and Principe: Country no longer at risk; continued using vaccine in routine
schedule; estimates provided.
Table 1: Countries with important revisions in the WHO and UNICEF estimates
of national immunization coverage (WUENIC estimates) time series between
2019 and 2020 revisions
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Table 2: List of countries where WHO and UNICEF estimates of national
immunization coverage are different from reported data — based on DTP3
coverage in 2020:
Reported data: countries official estimates are treated as reported data unless the
working group decides to accept the reported administrative coverage data instead.
Administrative coverage data are accepted if the government official data are absent
or there is insufficient justification for government official estimate or the government
official estimate represents target coverage instead of achieved coverage.
The comment field in the table below provides an explanation of 2020 coverage
estimates; for a more comprehensive explanation, it is important to look at the
explanations of the complete time-series for different antigens from the specific
country profiles: http://apps.who.int/immunization_monitoring/globalsummary/wucoveragecountrylist.html
Gavi
Eligible
Phase
WHO
region
Country Est Adm Gov Comment Diff
x EMR Afghanistan 70 85 85 Reported data calibrated to 2016 levels. Estimate challenged by: D-R-
-15
x AFR Angola 51 72 72 Reported data calibrated to 2014 levels. Country indicates that due to Covid-19 restrictions most health facilities were only partially operational between March and July 2020. Reported administrative data reflect incomplete reporting. Programme reports subnational vaccine supply disruptions for all
-21
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antigens. WHO and UNICEF recommend assessment of the routine monitoring system. WHO and UNICEF are aware of a 2021 Demographic and Health Survey and await the final results. Estimate challenged by: D-R-
x AFR Benin 72 115 71 Estimate exceptionally based on the difference between administered doses 2019 to 2020 applied to the 2019 WUENIC estimate. Reported data excluded. Inconsistent decrease in reported denominator. Official estimate not explained and inconsistent with previous years. Reported data excluded due to sudden change in coverage from 82 level to 71 percent. Programme reports a one month vaccine stock-out at national level. Estimate challenged by: D-R-
1
x SEAR Bangladesh 98 110 93 Estimate based on extrapolation from data reported by national government. Reported data excluded. Nationally reported data for official coverage includes only valid doses administered. Estimate challenged by: D-
5
AMR Brazil 77 77 86 Estimate based on administrative report. Increase in reported coverage is unexplained but may reflect recovery from vaccine stockouts reported for 2019. Reported data excluded due to sudden change in coverage from 70 level to 86 percent. A nationwide study by Silveira et al. (doi.org/10.1016/j.vaccine.2021.04.046) observed that the COVID-19 pandemic was associated with a 20 percent decrease in childhood vaccinations though much of the decline was reversed by the end of 2020. No nationally representative household survey within the last 5 years. WHO and UNICEF recommend a high-quality survey to confirm reported levels of coverage. Estimate challenged by: R-
-9
AFR Botswana 95 77 NA Reported data calibrated to 2012 levels. Reported data excluded. Fluctuation in reported data suggest poor quality administrative recording
18
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and reporting. No nationally representative household survey within the last 5 years. WHO and UNICEF recommend a high-quality survey to confirm reported levels of coverage. WHO and UNICEF recommend an assessment of the administrative recording and reporting system. Country switched to DHIS2 information system and indicates some unquantified data loss. Programme reported a three month vaccine stock-out at national level. GoC=Assigned by working group. Reported coverage and denominator are inconsistent, and the estimate is confirmed only by survey for 2006 and 2012 birth cohorts.
x AFR Central African Republic
42 80 80 Reported data calibrated to 2017 levels. Reported data excluded. Fluctuations in reported data suggest poor quality administrative recording and reporting. Reported data excluded due to sudden change in coverage from 61 level to 80 percent. Programme notes issues with data quality and use including that the denominators come from projections from a 2003 census. Estimate challenged by: D-R-
-38
x AFR Côte d’Ivoire 80 90 90 Reported data calibrated to 2017 levels. WHO and UNICEF are aware of a 2021 Vaccination Coverage Survey and await the results. Estimate challenged by: D-R-
-10
x AFR Cameroon 69 81 81 Reported data calibrated to 2017 levels. Programme reports of home-based records (cards) stockout of unknown duration. Programme reports six months vaccine stock-out at national level and unknown for subnational levels. Estimate challenged by: D-R-
-12
x AFR Democratic Republic of the Congo
57 95 95 Reported data calibrated to 2016 levels. Reported data excluded. Review of trends in reported coverage during 2011-2016 suggests the administrative recording and reporting system was unable to identify declines in coverage
-38
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suggested by surveys. Estimate challenged by: D-R-
x AFR Comoros 87 74 91 Estimate exceptionally based on the difference between administrative coverage 2019 to 2020 applied to the 2019 WUENIC estimate. Programme notes that reported official coverage is informed by results from a 2016 coverage survey. WHO and UNICEF recommend an assessment of the administrative data. No nationally representative household survey within the last 5 years. WHO and UNICEF recommend a high-quality survey to confirm reported levels of coverage. Programme reports three month vaccine stock-out at national level. Estimate challenged by: D-R-
-4
AMR Costa Rica 95 97 97 Estimate based on extrapolation from data reported by national government. Reported data excluded. Data reported presents inconsistencies. Reported denominator for vaccines recommended among infants present an unexplained decline of 16 percent while numerators decline over ten percent. For vaccines recommended during the second year of life, namely MMR and PCV3, the denominator is consistent with previous years and numerators are similar to those reported for 2019. Estimates likely overestimate 2020 coverage levels. Estimate challenged by: D-
-2
x AFR Ethiopia 71 99 99 Reported data calibrated to 2017 levels. Estimate challenged by: D-R-
-28
x AFR Guinea 47 90 85 Reported data calibrated to 2016 levels. Reported data excluded. Estimates may not reflect actual changes in coverage as reported number of administered doses declined from 2019 to 2020. However, reported numerator and denominators have been inconsistent over time. Official coverage for the last three years follows an upwards trend, while administrative coverage and number of children vaccinated follows a declining trend for all vaccines recommended after birth. Estimate challenged by: D-R-
-38
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AFR Equatorial Guinea
53 65 65 Reported data calibrated to 2016 levels. Reported data excluded. Unexplained variation in reported target population as well as in reported number of children vaccinated. No nationally representative household survey within the last 5 years. WHO and UNICEF recommend a high-quality survey to confirm reported levels of coverage. GoC=Assigned by working group. Fluctuation in reported coverage across the time series suggests challenges in routine monitoring system.
-12
x AMR Haiti 51 83 83 Reported data calibrated to 2018 levels. Reported data excluded due to sudden change in coverage from 66 level to 83 percent. Programme reports a 12 month stockout of reconstitution syringes. Estimate challenged by: D-R-
-32
x AFR Kenya 89 85 85 Estimate based on difference in administered doses reported between 2019 and 2020 applied to the 2019 estimate. Reported denominator for 2020 is from projections of the 2019 census. Declining reported denominator for the last three years. WHO and UNICEF recommend a revision of historical denominators. WHO and UNICEF are aware of an ongoing DHS survey in 2021 and await the results. Programme reports a vaccine stock-out at national and subnational levels of less than one month. Estimate challenged by: R-
4
x WPR Cambodia 92 106 106 Reported data calibrated to 2013 levels. Reported data excluded because 106 percent greater than 100 percent. WHO and UNICEF are aware of an ongoing Demographic and Health Survey and await the final results. Estimate challenged by: D-R-
-14
x WPR Lao People’s Democratic Republic
79 91 91 Reported data calibrated to 2016 levels. Estimate challenged by: R-
-12
EMR Lebanon 71 81 81 Decline in reported coverage related to COVID-19 pandemic service disruptions. Although there are challenges with the reported data,
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the trend in coverage from 2019 to 2020 is reflected in the estimated coverage. Reported data excluded. Programme notes ongoing challenges with regards to accurate monitoring of the number of children vaccinated as well as the target population. Administrative data is collected from the public sector, while for private providers the numerator is estimated from vaccine purchase data. The denominator is derived from national statistical reports and UNHCR data inclusive of Lebanese and non-Lebanese children. Programme notes the absence of single year of age information for the target population, thereby requiring use of crude approximations. Reported data excluded due to sudden change in coverage from 93 level to 81 percent. The reported target population was the same for 2019 and 2020. Estimate challenged by: D-R-
x AFR Liberia 65 82 82 Reported data calibrated to 2018 levels. Programme reports a four month vaccine stockout at national and subnational levels. Estimate challenged by: D-R-S-
-17
EMR Libya 73 95 97 Prolonged instability continues. Available data to quantify the magnitude of the disruption of health service delivery are scarce. Programme reports three month vaccine stock-out at national and sub-national levels. As done for previous years, using this information and a strong assumption that immunization services have been severely disrupted during the vaccine stock-out, the estimate is based on a 25 percentage point reduction in coverage consistent with the duration of the stock-out. No nationally representative household survey within the last 5 years. WHO and UNICEF recommend a high-quality survey to confirm reported levels of coverage, as the situation permits. Estimate challenged by: D-R-
-24
x AFR Lesotho 87 95 95 Reported data calibrated to 2016 levels. Reported data excluded.
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Fluctuations in reported data suggest poor quality administrative recording and reporting. Estimate challenged by: D-R-
x AFR Madagascar 68 93 93 Reported data calibrated to 2017 levels. WHO and UNICEF are aware of a 2021 DHS and Vaccination Coverage Survey and await the final results. Programme reports one month vaccine stock-out at national and subnational levels. Estimate challenged by: D-R-
-25
x AFR Mali 70 90 71 Estimate exceptionally based on the difference between administative coverage 2019 to 2020 applied to the 2019 WUENIC estimate. Reported data excluded. Programme reports disruptions in performance related to insecurity and reductions in attendance to vaccination sessions related to the COVID-19 pandemic, especially in urban areas. Also issues with incomplete reporting linked to problems with connectivity. WHO and UNICEF are aware of a 2021 Vaccination Coverage Survey and await the results. Estimate challenged by: D-R-
-1
x AFR Mozambique 79 108 82 Estimate exceptionally based on the difference between administrative coverage 2019 to 2020 applied to the 2019 WUENIC estimate. Reported data excluded due to sudden change in coverage from 95 level to 82 percent. WHO and UNICEF are aware of an ongoing DHS survey and await the results. Programme reports a two month vaccine stock-out at national and subnational levels. Estimate challenged by: D-R-
-3
x AFR Mauritania 71 81 97 Estimate exceptionally based on the difference between administrative coverage 2019 to 2020 applied to the 2019 WUENIC estimate. Reported data excluded. Concern remains regarding the quality of the recording and reporting system. Programme reports changes in the Ministry of Health that affected the funding and operations of the Expanded Programme on Immunization, in addition to disruptions related to
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COVID-19. WHO and UNICEF are aware of ongoing DHS and await the final results. Estimate challenged by: D-R-
AFR Mauritius 93 84 95 Estimate based on difference in administrative coverage between 2019 and 2020 applied to the 2019 estimated coverage. Reported data excluded due to sudden change in coverage from 96 level to 84 percent. National estimates are adjusted to include immunizations occurring in the private sector. No nationally representative household survey within the last 5 years. WHO and UNICEF recommend a high-quality survey to confirm reported levels of coverage. Official estimate excluded because the difference between administrative and official coverage is unexplained. Official coverage estimates present an inconsistent trend between 2019 and 2020. Estimate challenged by: R-
9
x AMR Nicaragua 92 106 106 Estimate exceptionally based on the difference between administrative coverage 2019 to 2020 applied to the 2019 WUENIC estimate. Reported data excluded because 106 percent greater than 100 percent. No nationally representative household survey within the last 5 years. WHO and UNICEF recommend a high-quality survey to confirm reported levels of coverage. Estimate challenged by: D-R-
-14
x EMR Pakistan 77 83 80 Vaccine stock-out of unspecified duration. Estimate exceptionally based on the difference between administrative coverage 2019 to 2020 applied to the 2019 WUENIC estimate. Official estimates for 2019 and 2020 based on the results of TPVICS, a large vaccination coverage survey conducted in early 2021. Final TPVICS report not available at the time of reporting eJRF. Monthly coverage data showed a significant decline in coverage from March to May 2020 followed by increases as a result of intensive catch-up
-3
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vaccination activities. Estimate challenged by: D-R-
x WPR Papua New Guinea
39 45 45 Estimate informed by relative change in doses administered from 2018 levels to 2020. Estimate challenged by: D-R-
-6
AMR Paraguay 79 67 67 Reported data calibrated to 2015 levels. Programme reports a one month vaccine stock-out at national and subnational levels. Estimate challenged by: D-R-
12
EMR State of Palestine
99 102 NA Estimate based on extrapolation from data reported by national government. Reported data excluded because 102 percent greater than 100 percent. GoC=R+ S+ D+
-3
x AFR Senegal 91 96 96 Reported data calibrated to 2018 levels. Estimate challenged by: D-R-
-5
x EMR Somalia 42 73 73 Reported data calibrated to 2010 levels. Reported data excluded. Incomplete reporting noted by the country. WHO and UNICEF encourage periodic independent coverage assessment in addition to improving the coverage of immunization services. Programme reports a two month vaccine stock-out at national and subnational levels. Estimate challenged by: D-R-
-31
x AFR South Sudan 49 60 60 Estimate based on extrapolation from data reported by national government. Reported data excluded. Unexplained change in denominator from 2018 to 2019. Country reports that due to instability in the country, there is a large population movement in and out of the country which affects the denominator. Country also notes issues related to the accuracy of the numerator such as high turn over of vaccination staff coupled with limited capacity in tallying, recording and reporting of immunization data. WHO and UNICEF encourage continued efforts to improve recording and monitoring while the programme continues efforts to increase vaccination coverage. Estimate challenged by: D-
-11
AMR Suriname 51 65 65 Reported data calibrated to 2016 levels. WHO and UNICEF observe
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that recent survey results suggest lower levels of coverage than that reported by the programme during the past 10 years. Further investigation to understand underlying differences is warranted, and WHO and UNICEF recommend a high-quality independent empirical assessment to confirm reported levels of coverage. Decline in reported coverage is unexplained by country but aligns with COVID-19 pandemic service disruptions. Estimate challenged by: R-
EMR Syrian Arab Republic
49 68 68 Reported data calibrated to 2005 levels. Reporting from some districts is incomplete. The denominator used for administrative coverage has been estimated from the coverage of the polio campaigns of 2017 in addition to vaccinated children per health facility. The last population census was conducted in 2004. The target population is estimated and likely inaccurate due to the constant movement outside and inside the country. WHO and UNICEF are aware of the coverage evaluation survey conducted 2020-2021 and await the final results. Estimate challenged by: D-R-
-19
x AFR Chad 52 83 83 Reported data calibrated to 2017 levels. Reported target population declined between 2019 and 2020. Immunization estimates from MICS survey could not be produced due to an error in data collection. WHO and UNICEF recommend a high-quality vaccination coverage survey. Programme reports district level vaccine stock-out of unspecified duration. Estimate challenged by: D-R-
-31
x AFR Togo 82 89 89 Reported data calibrated to 2016 levels. Estimate challenged by: D-R-
-7
x AFR United Republic of Tanzania
86 102 95 Reported data calibrated to 2018 levels. Estimate challenged by: D-R-
-9
AMR Saint Vincent and The Grenadines
97 106 106 Estimate based on extrapolation from data reported by national government. Reported data excluded because 106 percent greater than
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100 percent. Fluctuation in reported data is attributed to small birth cohort. No nationally representative household survey within the last 5 years. WHO and UNICEF recommend a high-quality survey to confirm reported levels of coverage. GoC=R+ D+
WPR Samoa 79 89 89 Reported data calibrated to 2012 levels. Preliminary 2019-2020 MICS results suggest coverage of 39 percent. This survey may have coincided with period of reduced coverage. Fluctuation in reported data is attributed to small birth cohort. Estimate challenged by: D-R-
-10
x EMR Yemen 72 87 87 Reported data calibrated to 2012 levels. Despite the ongoing humanitarian crisis, reported coverage levels generally have not declined. Government indicates that official estimates are derived from the administrative coverage and that vaccination sites continue to send monthly reports to the district. Estimate challenged by: D-R-
-15
Est - WHO UNICEF coverage estimates 2020 revision
Adm – reported administrative coverage data
Gov - reported government official estimate of coverage
Diff - difference between reported data and WHO/UNICEF coverage estimates where the reported
data reflects the government official estimate if provided, otherwise it reflects the reported
administrative coverage data unless government official estimate excluded.