The CEE/CIS region as a whole has achieved the goal of 90 per cent immunization coverage against measles by 2003. The challenge now is to reach the last 10 per cent of children - those in remote areas, the urban poor, minorities and children in conflict situations - who still do not benefit from basic immunization.
Protection against measles in CEE/CIS has improved at an average rate of 0.8 percentage points since 1992. The region is likely to be able to sustain and even extend this coverage. Cases of vaccine-preventable disease are falling, and in 2002 Europe - including all CEE/CIS countries - was certified polio-free.
Of the 20 countries in the region, 15 have already achieved the 90 per cent goal for measles immunization and 3 others - Bosnia and Herzegovina, Serbia and Montenegro, and Tajikistan - are likely to reach it, each needing an annual rate of increase smaller than it has already realized between 1992 and 2003. Bosnia and Herzegovina's improvement in immunization from the end of the civil war in 1995 was dramatic; it actually exceeded the target of 90 per cent coverage in 2001 before falling beneath it in 2003.
Nevertheless, even in a region with such positive overall indicators for immunization, there are two countries in which improvements are required if they are to meet the goal: Turkey and Georgia. Turkey has sustained nearly 90 per cent coverage of the BCG vaccine against tuberculosis for more than a decade, proving what is possible, but its reach with other vaccines has been much more hit-and-miss. Its measles immunization actually attained the 90 per cent mark in 2001 before falling away to 75 per cent in 2003. With routine coverage against measles at 73 per cent in 2003, Georgia will have to double its average annual rate of increase: from 1.2 percentage points for the period 1990-2003 to 2.4 percentage points during the period 2004-2010.
The generally high immunization coverage in the region has enabled a focus on children who have hitherto been hard to reach. National monitoring and surveillance systems have been adapted to support disaggregated data. In addition, Georgia and Serbia and Montenegro carried out targeted catch-up campaigns for immunization of children of the Roma ethnic group and of internally displaced children. The focused campaign in Serbia and Montenegro was particularly effective and also involved the birth registration of all previously unregistered children.