Global progress in pneumonia vaccine access shows 40% of infants are left behind: how can we close the gap?

Authors: Rose Weeks, Jasmine Huber, and Dr. Anita Shet from the Global Advocacy for Pneumococcal Conjugate Vaccines (GAP) project at the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health.

Exciting new data published on July 18, 2023, by the World Health Organization (WHO) and United Nations Child Fund (UNICEF) show that for the first time ever, 6 out of 10 infants globally have received a full course of vaccination against pneumococcal disease. This welcome milestone comes after decades of gradual increases in access to pneumococcal conjugate vaccine (PCV), a life-saving vaccine that was first licensed for infants in the year 2000. As of July 2023, 155 countries use PCV in their routine immunization programs while 36 countries are yet to introduce PCV.

It is encouraging to see that the coverage of the full PCV schedule for infants, comprising three vaccine doses, has shown a more rapid increase in the past year compared to the progress observed over the previous five years. The news that global PCV coverage increased from the previously reported 2021 estimates of 51% is undeniably heartening. However, we need to be mindful as the 3-dose PCV coverage  in nations such as Brazil, Ethiopia, Mexico, and Nigeria continues to remain below levels achieved in 2019. This disparity highlights the need for continued efforts and targeted interventions to ensure equitable and sustained progress in these regions to protect the remaining infants against these vaccine-preventable illnesses and death.

Coverage of PCV, final dose, globally (2018-22, WUENIC)

Promise of progress in low-income countries. With greater awareness of the life-saving potential of PCV, global advocacy movements will accelerate access in the remaining Gavi-eligible countries. Chad, Guinea, Somalia, and South Sudan all plan to introduce PCV in the coming year. Gavi announced that South Sudan and Somalia, beset by humanitarian crises, would be supported for the co-financing fees for PCV upon introduction.

PCV access disparities abound in middle-income countries. Emerging analyses indicate that middle-income countries (MICs), particularly those that are not Gavi-eligible, have lower PCV coverage than low-income countries that are Gavi-supported. Newly released data showed that in 2022, PCV coverage in upper middle-income countries was a mere 37% compared to 64% and 65% in low middle-income and low-income countries, respectively. Progress is happening in the right direction, and advocates celebrated to see large MICs such as India and Indonesia commit at the 2^nd Global Forum on Childhood Pneumonia to increasing PCV3 coverage to 90% by 2030, aligning with the Immunization Agenda 2030 (IA2030) target.

Spotlighting PCV along with all routine childhood vaccinations. In contrast to the rapid increase in PCV3 coverage, coverage of routine vaccines against diphtheria, tetanus, and pertussis (DTP) has rebounded slowly from its pandemic decline, reaching 84% in 2022 and inching towards the global pre-pandemic coverage rate of 86% from 2019. There were also 14 million zero-dose children who did not receive a single dose of DTP in 2022. Yet major reductions from 2021 show the world is committed to accelerating progress, restoring routine vaccine coverage to at least 2019 levels before aiming for IA2030 targets.

Focus on ‘catch-up’ vaccination for PCV will protect children who missed their infant vaccines. While we applaud the 60% PCV coverage among infants in 2022, it is crucial to extend protection to older children as well. Ensuring that children outside the birth cohort who may have missed their infant PCV doses also have access to PCV ‘catch-up’ accelerates both direct and indirect protection, thereby hastening the impact of PCV. The inclusion of catch-up policies for routine vaccines holds the potential to strengthen the immunization system and reduce the burden of zero-dose children. Integrating catch-up campaigns at PCV introduction and instituting such policies within the national routine immunization program can bolster overall vaccine coverage, safeguarding more children for a healthier future.

The efforts of global agencies are to be commended, along with in-country catalytic advocacy movements and commitments from dedicated leaders to expand access to PCV. Together, these concerted and sustained efforts can recover progress lost during pandemic years and also close the remaining PCV access gap to reach the global goal of 90% PCV coverage by 2030.    

Read more:

• “Coverage still falls short of pre-pandemic levels putting children at grave risk from disease outbreaks”: View statement from WHO and UNICEF.
• “Global efforts for immunization recovery and strengthening are uneven”: Read statement from the Immunization Agenda 2030 Partnership Council.
• PLOS Global Public Health article: Reasons for reductions in routine childhood immunisation uptake during the COVID-19 pandemic in low- and middle-income countries: A systematic review.
• PLOS Global Public Health article: Expanding global vaccine manufacturing capacity: Strategic prioritization in small countries