Health and Nutrition

The Issue

The Challenges

UNICEF in Action



Immunization is one of the most cost-effective public health interventions to date, saving millions of lives and protecting countless children from illness and disability.

As a direct result of immunization, the region maintains a polio free status, but measles outbreaks and pockets of unacceptably low vaccination rates are reminders that achieving universal routine immunization coverage must be a priority across the region. Failing to do so could be devastating - leading to high disease burden and grave social and economic consequences.

Coverage in the region

Despite significant progress, vaccines continue to be under-used in some countries in the region, putting children at risk of contracting infection.

The percentage of children receiving three doses of the diphtheria, tetanus and pertussis (DTP) vaccine before the age of one is often used to determine how well countries are providing routine immunization services. DTP3 coverage varies among countries in the region, from 99 to 82 per cent, with Ukraine having one of the lowest coverage rates in the world at 23 per cent.


Outbreaks have the potential to cross national borders, reaching other countries with immunity gaps. The best defence against the continued transmission of vaccine-preventable childhood diseases is a vaccine-protected population and a strong and responsive health system.  All countries must continue to work to strengthen coverage by reaching the most vulnerable children and reducing equity gaps.  The region collectively benefits when ALL countries achieve and maintain high coverage.

There has been a significant increase in coverage of the measles vaccine (MCV2) in the last 15 years from 63 per cent in 2000 to 91 per cent in 2015. That said, an estimated 525,045 children (as of April 2017) in the region remain unimmunized, placing them at risk of contracting the infection and even dying from this vaccine preventable disease.

Measles affects almost all countries in the region. Last year, large outbreaks were registered in five countries in the region and measles is endemic in nine countries.

The immunization coverage rate for measles in Romania is only 88 per cent. As of 21 April 2017, there were nearly 5,000 known cases of measles in the country and there have been 22 reported deaths.

Despite relatively high reported coverage, in 2015/16, Tajikistan is also responding to a measles outbreak with 205 confirmed cases as of the beginning of April 2017.

In Ukraine, the ongoing conflict in the east and the economic recession left the Government without the resources needed to provide adequate investment in their immunization programme. As a result, routine vaccine stocks were depleted and led to a polio outbreak, with two confirmed cases in 2015. Critical shortages of essential medicines and vaccines prompted the Ministry of Health to request international organizations such as UNICEF to assist in the procurement as an interim measure, while the reform of the procurement system takes place. UNICEF procured and delivered the first supplies in 2016 and continues to support procurement of vaccines on behalf of the Government.

UNICEF’s programme

UNICEF advocates for, and supports the development and maintenance of, a strong and robust health system, capable of routinely reaching and prioritizing the most vulnerable children with life-saving immunizations. We also support governments to develop national immunization plans, identify and address coverage gaps, as well as encourage and support efforts to regularly sustain these vital services.

To build and maintain public trust, we help equip caregivers and parents with the knowledge to counteract misinformation and promote the benefits of immunization. This is done by supporting national communication strategies, training front-line health workers on how to educate parents and caregivers on immunization and disease outbreaks.

In our efforts to improve immunization services and access, we are working with national governments, the WHO, the Global Alliance for Vaccines and Immunisation (GAVI), other international agencies and non-governmental organizations, and vaccine manufacturers. Together we are providing quality-assured vaccine supplies, funding and technical assistance to strengthen national capacities on programme management, reaching the unimmunized, introducing new vaccines and public communication campaigns.

Challenges to immunization in the region

  • In-country inequities and reduced access (namely, Roma children and other minority groups, refugees and migrant children, children living in urban poverty).
  • A recent decrease in donor support and inadequate financing.
  • Growing vaccine hesitancy, misinformation and mistrust in a number of countries.
  • Inadequate monitoring of vaccine coverage in some countries leading to breakdowns in availability and services.
  • Supply security for self-procuring countries and sustainable financing of vaccine procurement.

Related articles and stories

Governments must invest in immunizing the most vulnerable children

UNICEF reaches almost half of the world’s children with life-saving vaccines

Turkmenistan ensures sustainable investments in essential vaccines for all children

> UNICEF's work on immunization globally



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