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-km2 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.
Bibliographical noteFunding Information:
Acknowledgements This work was primarily supported by grants from the Bill & Melinda Gates Foundation (OPP1182474, OPP11093011 and OPP1132415). S.I.H. is funded by additional grants from the Bill & Melinda Gates Foundation (OPP1119467 and OPP1106023). The opinions expressed in this paper are those of the authors and not necessarily those of the World Health Organization. J.-W.D.N. was supported by the Alexander von Humboldt Foundation. C.H. is partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084, and a grant co-funded by the European Fund for Regional Development through Operational Program for Competitiveness, Project ID P_40_382. Y.J.K. acknowledges support by the Research Management Centre, Xiamen University Malaysia (XMUMRF/2018-C2/ITCM/0001). K. Krishan is supported by a DST PURSE Grant and UGC Centre of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. B.L. acknowledges support from the NIHR Oxford Biomedical Research Centre and the BHF Centre of Research Excellence, Oxford. M.A.M. acknowledges NIGEB and NIMAD grants. A. Sheikh acknowledges support by Health Data Research UK. S.B.Z. acknowledges support from the Australian Government research training program (RTP) for his academic career.
Competing interests This study was funded by the Bill & Melinda Gates Foundation. Authors employed by the Bill & Melinda Gates Foundation provided feedback on initial maps and drafts of this manuscript. Otherwise, the funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the final report. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. O.O.A. is supported by DSI-NRF Centre of Excellence for Epidemiological Modelling and Analysis (SACEMA). C.A.T.A. reports personal fees from Johnson & Johnson (The Philippines), outside the submitted work. M.L.B. reports grants from the US Environmental Protection Agency, the National Institutes of Health (NIH) and the Wellcome Trust Foundation, during the conduct of the study. M.L.B. also reports honoraria and/or travel reimbursements from the NIH (for the review of grant proposals), American Journal of Public Health (participation as editor), Global Research Laboratory and Seoul National University, Royal Society London UK, Ohio University, Atmospheric Chemistry Gordon Research Conference, Johns Hopkins Bloomberg School of Public Health, Arizona State University, Ministry of the Environment Japan, Hong Kong Polytechnic University, University of Illinois–Champaign, and University of Tennessee–Knoxville. S. Basu reports grants from the NIH, grants from the US Centers for Disease Control and Prevention, grants from the US Department of Agriculture, grants from Robert Wood Johnson Foundation, personal fees from Research Triangle Institute, personal fees from Collective Health, personal fees from KPMG, personal fees from HealthRight360, personal fees from PLOS Medicine, personal fees from The New England Journal of Medicine, outside the submitted work. F.D. reports grants from the Bill & Melinda Gates Foundation, during the conduct of the study. A. Deshpande reports grants from the Bill & Melinda Gates Foundation, during the conduct of the study. S.J.D. reports grants from The Fleming Fund at the UK Department of Health & Social Care, during the conduct of the study. S.M.S.I. received funding from the National Heart Foundation of Australia. J.J.J. reports personal fees from AMGEN, personal fees from ALAB, personal fees from TEVA, personal fees from SYNEXUS, personal fees from BOEHRINGER INGELHEIM and personal fees from VALEANT, outside the submitted work. H.J.L. reports grants from GSK, outside the submitted work. W.M. is Program Analyst in Population and Development at the United Nations Population Fund (UNFPA), an institution which does not necessarily endorse this study. T. Pilgrim reports grants and personal fees from Biotronik, grants and personal fees from Boston Scientific and grants from Edwards Lifesciences, outside the submitted work. M.J.P. reports grants and personal fees from MSD, GSK, Pfizer, Boehringer Ingelheim, BMS, Novavax, Astra Zeneca, Sanofi, IQVIA and other pharmaceutical industries, personal fees from Quintiles, Novartis, Pharmerit and Seqirus, grants from Bayer, BioMerieux, WHO, EU, FIND, Antilope, DIKTI, LPDP, Budi, and other from Ingress Health, Pharmacoeconomics Advice Groningen (PAG Ltd), Asc Academics, outside the submitted work. M.J.P. holds stocks in Ingress Health and PAG Ltd and is advisor to Asc Academics, all of which are pharmacoeconomic consultancy companies, outside of submitted work. J. A. Singh reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio Health, Medscape, WebMD, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Spherix, Practice Point Communications, the NIH and the American College of Rheumatology, personal fees from the speaker’s bureau of Simply Speaking, stock options in Amarin Pharmaceuticals and Viking Pharmaceuticals, non-financial support from the steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arm’s length funding from 12 pharmaceutical companies, outside of the submitted work. J. A. Singh serves on the FDA Arthritis Advisory Committee, is a member of the Veterans Affairs Rheumatology Field Advisory Committee, and is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, all outside the submitted work. R.U. reports other financial activities from Deakin University, outside the submitted work. J.F.M. reports grants from the Bill and Melinda Gates Foundation, during the conduct of the study.
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