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In 1974, the World Health Organization (WHO) established the Expanded Program on Immunization* to provide protection against six vaccine-preventable diseases through routine infant immunization (1). Based on 2015 WHO and United Nations Children's Fund (UNICEF) estimates, global coverage with the third dose of diphtheria-tetanus-pertussis vaccine (DTP3), the first dose of measles-containing vaccine (MCV1) and the third dose of polio vaccine (Pol3) has remained stable (84%-86%) since 2010. From 2014 to 2015, estimated global coverage with the second MCV dose (MCV2) increased from 39% to 43% by the end of the second year of life and from 58% to 61% when older age groups were included. Global coverage was higher in 2015 than 2010 for newer or underused vaccines, including rotavirus vaccine, pneumococcal conjugate vaccine (PCV), rubella vaccine, Haemophilus influenzae type b (Hib) vaccine, and 3 doses of hepatitis B (HepB3) vaccine. Coverage estimates varied widely by WHO Region, country, and district; in addition, for the vaccines evaluated (MCV, DTP3, Pol3, HepB3, Hib3), wide disparities were found in coverage by country income classification. Improvements in equity of access are necessary to reach and sustain higher coverage and increase protection from vaccine-preventable diseases for all persons. WHO and UNICEF derive national coverage estimates through an annual country-by-country review of all available data, including administrative and survey-based reviews (2, 3). To analyze equity of vaccination coverage, countries were categorized by World Bank income classification (low, lower-middle, upper-middle, high) based on 2015 per capita gross national income (GNI) (4) and eligibility for financial support from Gavi, the Vaccine Alliance (Gavi), for new vaccine introduction at any time since 2005 (5). Eligibility for Gavi support is typically based on a country's GNI per capita; the threshold for support started at US1, 000 per capita in 2000 and increased to US1, 580 by 2016.
Casey et al. (Thu,) studied this question.