An analysis of household survey data in 89 low- and middle-income countries (LMICs) shows that despite advances in scaling up new vaccines, the global number of unvaccinated children has remained high over the past decade. Data from 154 surveys conducted between 2000 and 2019 was used to assess within-country, economic-related inequality in the prevalence of one-year-old children with zero doses of diphtheria–tetanus–pertussis (DTP) vaccine. Zero-dose DTP prevalence data were disaggregated by household wealth quintile. Difference, ratio, slope index of inequality, concentration index, and excess change measures were calculated to assess the latest situation and change over time, by country income grouping for 17 countries with high zero-dose DTP numbers and prevalence.
Findings:
The median prevalence of zero-dose DTP was 7.6% across 89 LMICs.
Within-country inequalities mostly favored the richest quintile, with 19 of 89 countries reporting a rich–poor gap of ≥20.0 percentage points.
Low-income countries had higher inequality than lower–middle-income countries and upper–middle-income countries (difference between the median prevalence in the poorest and richest quintiles: 14.4, 8.9, and 2.7 percentage points, respectively).
Zero-dose DTP prevalence among the poorest households of low-income countries declined between 2000 and 2009 and between 2010 and 2019, yet economic-related inequality remained high in many countries.
Widespread economic-related inequalities in zero-dose DTP prevalence are particularly pronounced in low-income countries and have remained high over the previous decade.
Any organization or individual working in the field of immunization economics can submit findings, opportunities, calls to action, or other relevant work below to be shared with our community.