article · Nature
Measles remains a significant cause of illness and death among children under five years old, with over ninety-nine percent of cases occurring in low- and middle-income countries. To understand spatial immunity patterns and monitor progress towards international targets, routine first-dose measles-containing vaccine coverage was mapped across 101 low- and middle-income countries from 2000 to 2019 at high spatial resolution. Following notable gains between 2000 and 2010, coverage declined in over half of all assessed districts between 2010 and 2019, leaving many nations far from the Global Vaccine Action Plan target of eighty percent coverage in all districts. While vaccine coverage was lower in rural areas, a higher overall proportion of unvaccinated children lived in urban settings. These granular estimates offer decision-makers evidence to tailor routine immunisation programmes to both rural and urban challenges.
Measles is preventable through routine immunisation, yet uneven healthcare access leaves millions of young children at risk. Pinpointing local gaps in coverage allows public health authorities to detect under-immunised communities, allocate resources efficiently, and tailor vaccination delivery to the distinct challenges of rural remoteness and dense urban environments.
The spatial data model serves as an applied decision-support tool ready for immediate use by public health authorities, non-governmental organisations, and health programme planners. Although not a commercial consumer product, the tool directly enables targeted intervention design, vaccine supply-chain planning, and resource deployment to address immunisation gaps in specific administrative districts.
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Abstract The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs) 1–4 . Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19) 5–8 . Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km 2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.
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DOI: 10.1038/s41586-020-03043-4
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