The year 2005 is a milestone in which to assess not only progress towards the specific immunization goals and the MDG of reducing under-five mortality by 2015, but other international goals and targets as well.
At the UN General Assembly Special Session on Children in 2002, the international community adopted the specific target of ensuring by 2010 the full immunization of children under one year of age at 90 per cent nationally, with at least 80 per cent coverage in every district or equivalent administrative unit. Other key immunization targets formed part of the 'World Fit for Children' agenda:
- Reduce measles deaths by half by 2005
- Certify the global eradication of polio by 2005
- Eliminate maternal and neonatal tetanus by 2005
- Extend the benefits of new and improved vaccines and other preventive initiatives to children in all countries.
National and district coverage (DPT3)
Global immunization coverage increased dramatically during the 1980s but then levelled out during the 1990s. An estimated 20 per cent of children under one year of age in 1980 were immunized with DPT3 (three doses of the combined vaccine against diphtheria, pertussis and tetanus); coverage rose to 75 per cent by 1990 and remained between 70 per cent and 75 per cent until 2000, keeping up with population growth. In 2003 coverage was slightly higher: 78 per cent, although well short of the 2010 target of 90 per cent (3).
With coverage in the mid- to high-80s per cent, three regions - East Asia/Pacific, Latin America/Caribbean and Middle East/North Africa - are inching toward the 90 per cent target for DPT3; coverage in the Central and Eastern Europe/Commonwealth of Independent States (CEE/CIS) region has declined to 88 per cent in 2003 from a high of 91 per cent in 1988.
Coverage in South Asia (71 per cent) and sub-Saharan Africa is substantially lower, and of the two African regions, Eastern/Southern Africa (72 per cent) has performed better than West/Central Africa (48 per cent).
Forty-one developing countries have now met the target for 2010 established at the UN Special Session on Children of 80 per cent coverage in every district for DPT3. Many other countries, in Africa and elsewhere, have made progress towards increasing coverage in their lowest-performing districts and developed strategies for accessing the hard-to-reach with immunization.
To improve coverage, national and district planning needs to target underserved and unreached populations in all areas as a priority and be accompanied by specific strategies and sufficient resources to reach them. Many countries, for example, use the Reach Every District (RED) approach, which seeks greater equity and availability of routine immunization services. Most countries use a combination of routine services and supplementary activities.