Immunization Agenda 2030 brief: An in-depth review of access to immunization in middle-income countries

Executive summary

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, 17 million are not getting all the vaccines they need. By reaching 90% coverage of vaccines targeted by the Immunization Agenda 2030 (IA2030), tens of thousands of lives could be saved annually, and children’s health improved, in these countries. Further, sustainably improving coverage will help avert regional epidemics that overwhelm health system infrastructure and exacerbate inequities.

This brief highlights immunization performance in these countries from 2019 to 2022, visualizing a selection of IA2030 Impact Goals and Strategic Priority indicators from the IA2030 Monitoring and Evaluation Framework and scorecard. It also reviews four bottlenecks slowing progress and highlights major initiatives supporting middle-income countries. The analysis points to striking differences in performance between groups of countries based on their funding eligibility. These findings underscore the imperative for concerted and intensified efforts to address these critical gaps.

Immunization Performance in MICs: Key findings

• Immunization systems in non Gavi-eligible middle-income countries (MICs) are highly reactive to shocks. These countries weathered serious pandemic backsliding in vaccine coverage, although many have recovered thanks to government commitments.
• Non-Gavi-eligible MICs have high and growing internal inequities in vaccine coverage.
• Often due to lagging introductions, coverage of vaccines against pneumococcal disease, rotavirus, and human papillomavirus (HPV) in these countries is much lower than IA2030 targets.
• Non-Gavi-eligible MICs navigate vaccine markets with poor price transparency and comparability, with some countries paying 12 times more than others.