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Increasing global immunisation coverage. Source: Country income categories (World Bank) as of July 2009 (2008 GNI per capita); annual coverage estimates (WHO/UNICEF) weighted by annual number of surviving infants (UNDP).
In the eighties, a concerted effort by UNICEF and WHO to extend basic vaccinations to all children through the Expanded Programme on Immunization campaign saw DTP3 coverage (three doses of diphtheria, tetanus and pertussis vaccines) in low-income countries climb from 20% to 62% in just 10 years.
After 1990, global attention shifted to other pressing health problems such as HIV/AIDS and, from 1990 to 1999, DTP3 rates floated between 60% and 65% in low-income countries.
GAVI provides new vaccines and funding
GAVI put diphtheria-tetanus-pertussis back on the agenda' of Health Ministers in developing countries in two ways.
First, the Alliance added two new and more efficient combination vaccines to its portfolio, both of which included DTP3:
- tetravalent offered protection with hepatitis B with DTP3;
- pentavalent incorporated protection against both hepatitis B and haemophilus influenzae type b (Hib) with DTP3.
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Immunisation service support
Second, GAVI's cash-based support for strengthening immunisation services (ISS) focused on DTP3 coverage rates.
Under the terms of this pioneering programme, GAVI made an upfront three-year investment in a country's immunisation services; thereafter, for each additional child reached with three doses of DTP3, the country received US$ 20.
An independent assessment in 2006 showed that GAVI's ISS programme contributed to increases in DTP3 coverage, especially in countries starting with the lowest levels.1
- Coverage in low-income countries increased from 66% to 79% between 2000 and 2008.
- The Scaled-up coverage in low-income countries drove global DTP3 coverage to 82% in 2008, meaning 82% of all children under one year of age were receiving the full three-dose schedule of the DTP vaccine.2
1Lu C, Michaud CM, Gakidou E, Khan L, Murray CJ. Effect of the Global Alliance for Vaccines and Immunisation on diphtheria, tetanus, and pertussis vaccine covverage: an independent assessment. Lancet. 2006 Sep 23; 368(9541):1088-95
2World Health Organization. WHO/UNICEF estimates of national immunisation coverage. 2010 Feb 24 [cited 2011 May].