Mapping routine measles vaccination in low- and middle-income countries
Local Burden of Disease Vaccine Coverage Collaborators, Alyssa N. Sbarra, Sam Rolfe, Jason Q. Nguyen, Lucas Earl, Natalie C. Galles, Ashley Marks, Kaja M. Abbas, Mohsen Abbasi-Kangevari, Hedayat Abbastabar, Foad Abd-Allah, Ahmed Abdelalim, Mohammad Abdollahi, Kedir Hussein Abegaz, Hailemariam Abiy Alemu Abiy, Hassan Abolhassani, Lucas Guimarães Abreu, Michael R. M. Abrigo, Abdelrahman I. Abushouk, Manfred Mario Kokou Accrombessi, Maryam Adabi, Oladimeji M. Adebayo, Victor Adekanmbi, Olatunji O. Adetokunboh, Davoud Adham, Mohsen Afarideh, Mohammad Aghaali, Tauseef Ahmad, Raman Ahmadi, Keivan Ahmadi, Muktar Beshir Ahmed, Fahad Mashhour Alanezi, Turki M. Alanzi, Jacqueline Elizabeth Alcalde-Rabanal, Birhan Tamene Alemnew, Beriwan Abdulqadir Ali, Muhammad Ali, Mehran Alijanzadeh, Cyrus Alinia, Reza Alipoor, Vahid Alipour, Hesam Alizade, Syed Mohamed Aljunid, Ali Almasi, Amir Almasi-Hashiani, Hesham M. Al-Mekhlafi, Khalid A. Altirkawi, Bekalu Amare, Saeed Amini, Mostafa Amini-Rarani, Fatemeh Amiri, Arianna Maever L. Amit, Dickson A. Amugsi, Robert Ancuceanu, Catalina Liliana Andrei, Mina Anjomshoa, Fereshteh Ansari, Alireza Ansari-Moghaddam, Mustafa Geleto Ansha, Carl Abelardo T. Antonio, Ernoiz Antriyandarti, Davood Anvari, Jalal Arabloo, Morteza Arab-Zozani, Olatunde Aremu, Bahram Armoon, Krishna K. Aryal, Afsaneh Arzani, Mehran Asadi-Aliabadi, Samaneh Asgari, Zahra Atafar, Marcel Ausloos, Nefsu Awoke, Beatriz Paulina Ayala Quintanilla, Martin Amogre Ayanore, Yared Asmare Aynalem, Abbas Azadmehr, Samad Azari, Ebrahim Babaee, Alaa Badawi, Ashish D. Badiye, Mohammad Amin Bahrami, Atif Amin Baig, Ahad Bakhtiari, Senthilkumar Balakrishnan, Maciej Banach, Palash Chandra Banik, Aleksandra Barac, Zahra Baradaran-Seyed, Adhanom Gebreegziabher Baraki, Sanjay Basu, Mohsen Bayati, Yibeltal Tebekaw Bayou, Neeraj Bedi, Masoud Behzadifar, Michelle L. Bell, Dessalegn Ajema Berbada, Kidanemaryam Berhe, Suraj Bhattarai, Zulfiqar A. Bhutta
Abstract
Abstract The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs) 1–4 . Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19) 5–8 . Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km 2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.