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Just as a high rate of children dropping out of school points to problems in an education system, a high immunization drop-out rate -- the percentage of infants who begin but do not complete the full course of six vaccinations in their first year -- spotlights problems in a health system. Taking the BCG (tuberculosis) vaccination, given shortly after birth, as the starting point, and measles, administered at nine months, as the last vaccine a baby receives, it is possible to chart a country's success or failure in immunization.

In half of the 127 countries reporting on both of these immunizations, over 90% of babies immunized against BCG are also immunized against measles, suggesting that they have received the full course of vaccinations. This means that their parents have been able to take them to the health centre five times in the first year of life, a sign that immunization services are accessible, approachable and reliable.

In the 27 countries listed, however, at least 20% more infants receive BCG immunization than are vaccinated against measles. The Central African Republic records the highest drop-out rate of all reporting countries, almost 50%, with 94% of infants immunized against tuberculosis and only 46% against measles.

Only one industrialized country has a substantial drop-out rate: Japan, with a rate of 23%. Because of high health care and nutrition standards, measles is less of a threat to children in the industrialized world. However, it can be 'exported' to the developing world, putting children in the poorer countries at risk.