Each year, 66 million children, half of all children globally, are born in middle-income countries that are not eligible for support by Gavi, the Vaccine Alliance. Of these children, 1 in 3 are not getting all the vaccines they need not only putting their lives at risk but increasing the risk of outbreaks that threaten regional and global health.
The Immunization Agenda 2030 (IA2030) Working Group on Middle-Income Countries recently released an in-depth brief on “Access to Immunization in Middle-Income Countries", which highlights immunization performance in these countries, from 2019 to 2022 and progress towards global goals. The brief reviews four bottlenecks slowing progress towards achieving the IA2030 goals and highlights major initiatives supporting these countries.
The new analysis points to striking differences in performance between groups of countries based on their funding eligibility. For example, non-Gavi-eligible middle-income countries navigate vaccine markets with poor price transparency and comparability which results in some countries paying 12 times more than others.
Additionally, coverage of vaccines against pneumococcal disease, rotavirus and human papillomavirus (HPV) is lower than IA2023 targets due to lagging introductions of the vaccines in countries. While HPV vaccine introductions have gained momentum in upper-middle-income countries, with about 70% of such countries having the vaccine in their national immunization programmes, only 31% of non-Gavi-eligible lower-middle-income countries had introduced the HPV vaccine by 2022.
The brief also highlights the risk of disease outbreaks in middle-income countries, particularly for measles, as efforts to eliminate disease transmission have stalled. Fewer than half of the non-Gavi-eligible middle-income countries had eliminated measles transmission in 2022, and large and disruptive measles outbreaks are already increasing.
Countries are still facing the bottlenecks identified by SAGE nearly a decade ago: decision-making, demand and delivery, financial sustainability, and affordable access to supply. In order to improve introductions and coverage of newer vaccines, strong evidence-based decision-making is needed to support how vaccines are prioritized and delivered.
Additionally, middle-income countries need to sustain or increase financing of vaccines, and vaccine suppliers must improve availability and affordability of vaccines for these countries, while countries consider procuring from a diverse manufacturing base.
Finally, the brief found that middle-income countries have high and growing internal inequities in vaccine coverage. In order reduce inequities, countries must work to create a stronger demand for vaccines in communities and tailor vaccine outreach to local contexts.
Concerted action is needed to address the persistent challenges facing non-Gavi-eligible middle-income countries to bolster health systems and safeguard the well-being of millions of under-protected children worldwide.
The IA2030 Working Group on Middle-Income Countries will issue additional IA2030 analyses related to middle-income countries looking deeper into each of the four bottlenecks later this year.
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