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WHO UNICEF Immunization Coverage Estimates
2018 revision (completed 15 July 2019)
The estimates are based on data and information available to WHO and UNICEF as of
28 June 2019.
The data are available from both WHO and UNICEF web sites:
http://www.who.int/immunization/ monitoring_surveillance/routine/coverage/en/index4.html
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 and
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.
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.
2
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 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 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.
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.
3
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 GPEI’s 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 cVDPV cases and vaccine associated paralytic
polio (VAPP). In 2018-19, >2-doses of IPV, whether full or fractional, are
recommended by SAGE to induce long-lasting protection against poliomyelitis.
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
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.
4
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 during 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 2019 and 2020 to better disentangle the
complexities that have arisen. It may well be that in the 2019 revision (to be
completed July 2020), the WHO and UNICEF 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:
5
• 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.
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.
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, 2019
During 2019, reported immunization service delivery performance data were received
through the Joint Reporting Form on Immunization from 188 of 195 WHO and
UNICEF member states. Countries not reporting as of 28 June 2019 were Belarus,
France, Israel, Kuwait, Montenegro and North Macedonia.
Summary of WUENIC values for the third dose of DTP containing vaccine
WUENIC = reported coverage 130 (67%) countries
WUENIC < reported coverage 46 (23%) countries; 24 countries with >10%-point difference, 3
with >5% <10% -point difference
WUENIC > reported coverage 11 ( 6%) countries; 5 countries with >10%-point difference 6
with >5% <10% -point difference
WUENIC = prior year value due
to no reported coverage data for
2018
8 ( 4%) countries
6
The figure below highlights selected countries where WUENIC tend to be
underdetermined, meaning that the evidence available to us at a given point in time
may be insufficient to determine a reflective coverage estimate. For example, current
WUENIC for Libya suggest very high coverage levels that some argue are
inconsistent with their perception of the situation in the country. Unfortunately, there
are currently no alternative data to challenge the reported coverage levels. Similarly,
in Central African Republic and Somalia, WUENIC has remained stable since the last
available survey data given the challenges of the reported coverage data from the
countries.
Figure. Selected countries where WUENIC may be misinformed
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 8 May 2019 were
included in the 2018 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. 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
7
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 where survey results were available at country level but not released in
preliminary format by DHS or MICS:
Demographic Republic of Congo
Papua New Guinea
Indonesia
Countries for which new surveys were included for the 2018 WUENIC revision:
Demographic and Health Survey (DHS)
• Final Reports
o Albania 2017-2018
o Benin 2017-2018
o Haiti 2016-2017
o Jordan 2016-2017
o Maldives 2016-2017
o Pakistan 2017-2018
o Philippines 2017
o Senegal 2017
o South Africa 2016
o Tajikistan 2017
• Preliminary Report
o Mali 2018
o Nigeria 2018
o Zambia 2018
Multiple Indicator Cluster Survey (MICS)
• DPRK 2017
• Iraq 2018
• Kyrgyzstan 2018
• Laos 2017
• Sierra Leone 2017
• Tunisia 2018
Other coverage surveys including vaccination coverage
• Afghanistan Health Survey 2018
• Angola IBEP 2008-2009
• Bangladesh EPI Coverage Evaluation Survey 2016
• Chad L’Enquete de Couverture Vaccinale 2017
• Cote D’Ivoire Enquete de Couverture Vaccinale Systematique 2018
8
• Guinea Bissau Relatorio do Inquerito de Cobertura Vacinal 2017
• Indonesia Laporan Nasional Riskesdas 2018
• Nigeria National Nutrition and Health Survey (NNHS) 2018
• Romania Analiza Rezultatelor Estimarii Acoperirii Vaccinale La Varsta de 18
Luni Cpiii Nascuti in Luna Iulie, 2016
• Sao Tome Enquête nationale de couverture vaccinale 2017
• South Sudan EPI Vaccination Coverage Survey 2017
• Timor‐Leste Vaccine Coverage Cluster Survey 2018
• Uganda National Immunization Coverage Survey (UNICS) 2017
It may be useful to note that WUENIC was informed by the survey value from the
above survey in Bangladesh, Benin, Haiti, Iraq, Laos, Nigeria, South Africa, South
Sudan, Timor-Leste and Uganda. The survey results noted above from Indonesia and
Romania were excluded from consideration. And, in the 17 remaining countries with
new survey results available, the survey supported reported coverage data from the
programme.
As noted above, preliminary DHS results were available for Mali, Nigeria and Zambia.
Per current practice, results were noted on the right-side explanatory text. In Mali, the
reported official government estimates for 2018 were based on the preliminary DHS
results; WUENIC was informed by the reported official government coverage for
Mali in 2018. In Nigeria, the preliminary DHS results are similar to those of the 2018
National Nutrition and Health Survey (e.g., NNHS, DTP3 = 57% with no recall
adjustment; pDHS, DTP3 = 50% with no recall adjustment). And, in Zambia, the
preliminary DHS results are consistent with the reported administrative coverage and
support the WUENIC.
In DRC, PNG and Indonesia, the working group was made aware of survey results;
however, because survey reports were not officially published as preliminary reports
on DHS/MICS websites, these results were not officially considered in any way. From
the unofficial information available, the MICS results in DRC suggest lower
vaccination coverage than WUENIC and lower coverage levels when compared to
prior surveys. In PNG, the DHS results also suggest lower vaccination coverage levels.
And, in Indonesia, survey results are consistent with current WUENIC.
9
Figure. Years since most recent survey with vaccination coverage estimates
Additional data sources:
Estimated population data1 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 UN Population Division
released the 2019 revision of the World Population Prospects following the release of
the draft WUENIC to the member states. Thus, the World Population Prospects: 2017
revision data were used in the derivation of the WUENIC Grade of Confidence (GoC).
The World Population Prospects: 2019 revision data were used for producing the
global and regional average coverage estimates as well as for computing the estimated
number of un- and under-immunized children.
Changes between 2017 and 2018 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.
1 United Nations, Department of Economic and Social Affairs, Population Division (2019). World
Population Prospects 2019, Online Edition.
10
• New survey data becoming available after 2017 revision (between 3 July 2017
and 9 May 2018)
• 2017 data reported late, and not included in 2017 revision of coverage
estimates (between 5 July 2018 and 28 June 2019)
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
Norway: Vaccine introduced in 2017, no coverage reported.
Japan: Hep B for infants introduced in 2016, no coverage reported.
United Kingdom of Great Britain and Northern Ireland: Vaccine introduced in 2017,
no coverage reported.
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.
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.
11
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.
Paraguay: Introduced in 2017. No data reported on birth dose given within 24 hours.
Sao Tome and Principe: Introduction year is unknown; no data reported.
Syria: Introduced in 2003.
Vanuatu: Birth dose administered, other antigens based on survey results, no
sufficient information to make birth dose estimates.
* 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.
Pneumococcal conjugate vaccine (PcV):
Austria: Introduced in 2014. No reported data.
Belarus: Partially introduced in 2017. No reported data.
Monaco: Introduced in 2006. No reported data.
Romania: Introduced in October 2017. No reported data.
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.
Second dose measles-containing vaccine:
Papua New Guinea: Introduced in January 2016 (schedule is M6, M9 and M18, M7).
Ireland: Introduced since 1982; data are not reported.
Rubella-containing vaccine:
Based on Measles estimates, but modified if partial introduction.
Rotavirus vaccine (Rota last dose):
Sweden: Introduced sub-nationally in 2014. No reported data.
Russian Federation: Introduced sub-nationally in 2016. No reported data.
Thailand: Introduced subnationally as part of a pilot project; no estimate produced.
Bulgaria: Vaccine noted in the schedule in JRF 2018; no reported data.
12
IPV:
No estimates are produced for the following countries that have IPV in their schedule
but did not report 2018 data.
Egypt: Vaccine introduced in July 2018; no data reported.
Malawi: Planned introduction for June 2018.
Mongolia: Planned introduction for April 2019.
Poland: No reported data for 2018.
Zimbabwe: Planned introduction for May 2019.
Table 1: Countries with changes in the WHO and UNICEF estimates of national
immunization coverage (WUENIC estimates) time series between 2016 and 2017
revisions*
Angola Revision of estimates prior to 2012 as a result of new survey data. (D)
Benin Revision of estimates during 2015-17 as a result of new survey data. (D)
Côte d’Ivoire Revision of estimates as a result of reported data and new survey (D)
Djibouti Revision of estimates the result of supporting reported data at the end of the
time-series. (U)
Guinea-Bissau Revision of estimates the result of new survey data. (D)
Honduras Revision of estimates the result of supporting reported data at the end of the
time-series. (D)
Haiti Revision of estimates the result of new survey data. (D)
Indonesia Revision of estimates the result of working group decision with respect to
survey results vis-à-vis reported administrative data. (D)
Iraq Revision of estimates the result of new survey data and supporting reported
data. (U)
Lao PDR Revision of estimates the result of new survey data. (D)
Lebanon Revision of estimates the result of new survey data. (U)
Mexico Revision of estimates the result of supporting reported data at the end of the
time-series. (D)
Mali Revision of estimates the result of working group decision with respect to
survey results vis-à-vis reported official government estimate. (U)
Nigeria Revision of estimates the result of new survey data. (U)
Philippines Revision of estimates the result of supporting reported data at the end of the
time-series. (D)
Solomon Islands Revision of estimates the result of supporting reported data at the end of the
time-series. (D)
South Sudan Revision of estimates the result of new survey data. (U)
Timor-Leste Revision of estimates the result of new survey data. (U)
South Africa Revision of estimates the result of new survey data. (U)
Uganda Revision of estimates the result of new survey data and supporting reported
data. (U)
Venezuela Revision of estimates the result of supporting reported data at the end of the
time-series. (D)
*Countries with changes <5%-points in few years and few antigens not listed here.
D – estimates time series revised and decreased compared to previous revision.
UP – Estimates time series revised and increased compared to previous revision.
13
Table 2: List of countries where WHO and UNICEF estimates of national
immunization coverage are different from reported data — based on DTP3
coverage in 2018:
Reported data: countries official estimates are treated as reported data unless the
working group decides to accept the reported administrative coverage data.
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 2018 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 3
WHO
region Country Est Adm Gov Comment Diff
x EMR Afghanistan 66 87 87 Reported data excluded. Estimate based
on calibration using reported data from
2016 level. Unexplained temporal change
in reported numerator and denominator
values. Significant increase in
denominator from 2016. Denominator
obtained from aggregation of health
facility micro-plans. Numerator increase
from 2016 to levels comparable to levels
from 2015. Estimate challenged by: D-R-
–21
AFR Angola 59 84 84 Estimate based on calibration using
reported data from 2014 level. WHO and
UNICEF recommend assessment of the
routine monitoring system. Estimate
challenged by: D-R-
–25
x SEAR Bangladesh 98 114 90 Estimate based on extrapolation from data
reported by national government.
Reported data excluded. Nationally
reported data for official coverage
includes only valid doses administered.
WHO and UNICEF are aware of an
ongoing 2019 MICS survey and await the
final results. Estimate challenged by: D-
8
x AFR Benin 76 107 82 Estimate based on calibration using
reported data from 2016 level. Reported
data excluded because 107 percent greater
than 100 percent. Programme reports one
month vaccine stock-out at national level.
Reported government official estimate
based on prior year WUENIC value.
Estimate challenged by: D-R-
–31
x WPR Cambodia 92 98 NA Estimate based on calibration using
reported data from 2013 level. 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-
–6
14
x AFR Central
African
Republic
47 74 74 Estimate based on calibration using
reported data from 2012 level. Reported
data excluded. Fluctuations in reported
data suggest poor quality administrative
recording and reporting. Reported data
excluded due to sudden change in
coverage from 53 to 74 percent. WHO
and UNICEF are aware of 2019 MICS
and await the final results. Estimate
challenged by: D-R-
–27
x AFR Chad 41 77 77 Estimate based on calibration using
reported data from 2016 level. Reported
data excluded. Decline in reported
coverage is due in part to 25 percent
increase in target population between
2016 and 2017. WHO and UNICEF
encourage continued efforts to improve
recording and monitoring while also
increasing coverage. There is an ongoing
2019 MICS survey and WHO and
UNICEF await the results. Estimate
challenged by: D-R-
–36
x AFR Côte d’Ivoire 82 99 94 Estimate based on calibration using
reported data from 2017 level. Estimate
challenged by: D-R-
–12
x AFR DR Congo 81 94 94 Estimate based on calibration using
reported data from 2012 level.
Programme reports two month vaccine
stock-out at national level. Programme
has communicated preliminary results
from the 2017-18 MICS survey
suggesting coverage of 48 percent
(without adjustment for recall) for the
2016 and/or 2017 birth cohorts. WHO
and UNICEF are aware of the 2017-18
MICS survey and await the final results.
Estimate challenged by: D-R-
–13
AFR Equatorial
Guinea
25 46 46 Estimate based on calibration using
reported data from 2015 level. Reported
data excluded. Unexplained decline in
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. WHO and UNICEF received a
subnational EPI survey conducted in 2016
in only 9 districts (50 percent).
GoC=Assigned by working group.
Fluctuation in reported coverage across
the time series suggests challenges in
routine monitoring system.
–21
x AFR Ethiopia 72 95 95 Estimate based on calibration using
reported data from 2014 level. WHO and
UNICEF are aware of an ongoing 2019
DHS survey and await results. Estimate
challenged by: D-R-
–23
WPR Fiji 99 85 NA Estimate based on calibration using
reported data from 2007 level. Reported
data excluded. Reported data excluded
14
15
due to sudden change in coverage from
98 to 85 percent. WHO and UNICEF are
aware of a national coverage survey
conducted during 2013-14 and await the
final results. Estimate challenged by: R-
x AFR Guinea 45 100 75 Estimate based on calibration using
reported data from 2015 level. Reported
data excluded. Unexplained temporal
change in reported numerator and
denominator values. WHO and UNICEF
are aware of the DHS 2018 and await the
final results. WHO and UNICEF
recommend assessment of the routine
monitoring system. Estimate challenged
by: D-R-
–30
x AFR Guinea-
Bissau
88 82 82 Estimate of 88 percent assigned by
working group. Estimate based on survey
result. WHO and UNICEF encourage
activities to improve the recording and
reporting practices. WHO and UNICEF
are aware of the 2018-19 MICS survey
and await the final results.
GoC=Assigned by working group.
6
x AMR Haiti 64 79 79 Estimate of 64 percent assigned by
working group. Estimate based on survey
results. WHO and UNICEF recommend
continued focus on improved recording
and monitoring of immunization service
delivery and periodic independent
coverage assessment in addition to
improving coverage of immunization
services. Estimate challenged by: D-R-
–15
x SEAR India 89 99 99 Estimate based on extrapolation from data
reported by national government.
Reported data excluded. Country reports
that 2018 data are provisional. Increase in
reported coverage is due in part to a 12
percent decline in reported target
population compared to the prior year.
Although India has undertaken many
activities to address low vaccination
coverage levels (e.g., Mission
Indradhanush, strengthened
microplanning and additional
monitoring/accountability mechanisms),
reported coverage levels are likely an
overestimate given results from a 2018
coverage evaluation survey of 190
Intensified Mission Indradhanush
districts. While the 2018 survey results
suggest improvements in vaccination
coverage compared to the 2015-16
National Family Health Survey,
numerous districts had estimated
coverage levels less than 90 percent for
DTP3 and MCV1. WHO and UNICEF
are aware of an ongoing 2018-19 NFHS
and await the final results.
GoC=Assigned by working group. No
accepted empirical data.
–10
16
SEAR Indonesia 79 93 76 Estimate based on calibration using
reported data from 2011 level. WHO and
UNICEF are aware of a 2017 DHS survey
and await final results. Preliminary results
support official reported data for the 2016
birth cohort. See results below for 2016.
Adjustments used to obtain reported
official government estimate is
unexplained. Calibration applied to
administrative coverage levels. Estimate
challenged by: D-R-
–14
x AFR Kenya 92 81 81 Estimate based on calibration using
reported data from 2012 level. WHO and
UNICEF are aware of plans to conduct a
DHS survey in 2020. Increase in reported
coverage from 2017 to 2018 is
exceptionally large at such high levels of
coverage. Estimated coverage for 2018
may represent an overestimation.
Estimate challenged by: R-
11
x WPR Lao PDR 68 84 84 Estimate based on calibration using
reported data from 2016 level. Estimate
challenged by: D-R-
–16
EMR Lebanon 83 94 94 Estimate based on calibration using
reported data from 2014 level. Reported
data excluded. Reported data not
consistent with 2016 EPI coverage
evaluation survey results across all
vaccines. Estimate challenged by: D-R-
–11
x AFR Lesotho 93 83 83 Estimate based on calibration using
reported data from 2013 level. Reported
data excluded. Fluctuations in reported
data suggest poor quality administrative
recording and reporting. WHO and
UNICEF are aware of an ongoing MICS
survey and await the final results.
Estimate challenged by: D-R-
10
x AFR Liberia 84 97 97 Estimate based on calibration using
reported data from 2012 level. WHO and
UNICEF are aware of the 2019 DHS and
await final results. Estimate challenged
by: D-R-
–13
x AFR Madagascar 75 91 91 Estimate based on calibration using
reported data from 2011 level. WHO and
UNICEF encourage continued efforts to
improve the administrative recording and
reporting system and await the results
from 2018 MICS survey. Estimate
challenged by: D-R-
–16
x AFR Mauritania 81 85 90 Estimate based on estimated coverage
from 2017. Reported data excluded.
Administrative data do not support an
increase in reported official coverage.
WHO and UNICEF are aware of ongoing
DHS and await the final results. Estimate
challenged by: R-
–9
x AFR Mozambique 80 116 90 Estimate based on extrapolation from data
reported by national government.
Reported data excluded because 116
percent greater than 100 percent.
Reported data excluded due to sudden
–36
17
change in coverage from 99 level to 116
percent. No explanation provided on how
government estimates were derived.
Adjustment from the administrative
coverage is not consistent across
vaccines. The increase in reported
administrative coverage is likely an
artefact of a five percent decrease in the
reported target population between 2017
and 2018. No nationally representative
household survey within the last 5 years.
WHO and UNICEF recommend a high-
quality survey to verify reported levels of
coverage. Estimate challenged by: D-
x AMR Nicaragua 98 109 109 Estimate based on extrapolation from data
reported by national government.
Reported data excluded because 109
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-
–11
x WPR Papua New
Guinea
61 45 50 Estimate based on calibration using
reported data from 2005 level.
Programme reports do not include private
sector providers. Programme notes
administrative reporting completeness is
78 percent. 2016-2018 DHS Key
Indicators Report suggests coverage of 42
percent. GoC=Assigned by working
group. Fluctuation in reported coverage
across the time series suggests challenges
in routine monitoring system.
11
AMR Paraguay 88 76 76 Estimate based on calibration using
reported data from 2015 level. Estimate
challenged by: R-
12
WPR Samoa 34 44 44 Estimate based on calibration using
reported data from 2012 level. Decline in
reported coverage may be partly
explained by an interruption in
vaccination amid public concern
following two deaths related to MMR
vaccination. WHO and UNICEF are
aware of plans to conduct a MICS survey
in 2019. Fluctuation in reported data is
attributed to small birth cohort. Estimate
challenged by: D-R-
–10
x EMR Somalia 42 69 69 Estimate based on calibration using
reported data from 2010 level. Reported
data excluded. WHO and UNICEF
recommend continued focus on improved
recording and monitoring of
immunization service delivery, and
periodic independent coverage
assessment in addition to improving
coverage of immunization services.
Estimate challenged by: D-R-
–27
AFR South Africa 74 84 82 Estimate based on calibration using
reported data from 2015 level. Estimate
challenged by: D-R-
–8
18
EMR Syrian Arab
Republic
47 66 66 Estimate based on calibration using
reported data from 2005 level. Low levels
of coverage, associated with the
interruption of health services during a
period of civil unrest, continue. Estimate
challenged by: D-R-
–19
WPR Tonga 81 100 99 Estimate based on calibration using
reported data from 2011 level.
Programme has expressed disagreement
with the WHO and UNICEF estimates
reflecting the results of the 2012
Demographic and Health Survey
providing evidence of the vaccination
experience for the 2011 birth cohort. In a
2015 health sector review report, the
Government notes that the home-based
records seen during the survey may not
have been up-to-date and their concern
that caregiver recall of vaccination history
is inaccurate. Results from the 2012
Demographic and Health Survey suggest
coverage among children with
documented evidence in home-based
records are consistent with reported high
vaccination coverage levels by the
government. The survey suggests that 48
percent of children currently maintained a
home-based record at the time of the
survey. There is recognition that there
may have been problems with caregiver
recall of vaccination history in the survey.
It is relevant to note, however, that the
survey did identify children with no
evidence of vaccination. WHO and
UNICEF recommend an independent
assessment of the recording and reporting
in collaboration with the programme
during the coming 12 months. Estimate
challenged by: R-
–18
EUR Ukraine 50 69 69 Estimate based on extrapolation from data
reported by national government.
Reported data excluded due to sudden
change in coverage from 50 level to 69
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. GoC=R+ D+
–19
x EMR Yemen 65 80 80 Estimate based on calibration using
reported data from 2012 level. Despite the
ongoing humanitarian crisis, coverage
levels reported do not seem to have
declined significantly. Government
reports that official estimates are derived
from the administrative coverage and that
vaccination sites continue to send
monthly reports to the district.
Disruptions to health services have been
reported with about half of the health
facilities non-functional but vaccination
outreach rounds are being conducted.
–15
19
Estimate challenged by: D-R-
Est - WHO UNICEF coverage estimates 2018 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.
