全球疾病负担2023疫苗覆盖协作组Mustafa Alkhawam团队研究了1980年至2023年全球、区域和国家儿童常规疫苗接种覆盖率趋势及2030年预测。这一研究成果于2025年6月24日发表在《柳叶刀》杂志上。

基本免疫规划（EPI）自1974年成立以来取得了显著成功，通过常规儿童疫苗接种，在全世界避免了约1.54亿儿童死亡。然而，近几十年来，覆盖面不平等现象持续存在，进展停滞不前，COVID-19大流行进一步加剧了这种情况。2019年，世卫组织制定了通过《2030年免疫议程》提高全球疫苗覆盖率的宏伟目标。现在已经过了十年的一半，了解过去和最近的覆盖趋势有助于为今后5年实现这些目标提供信息和调整战略。

该研究以《2023年全球疾病、伤害和风险因素负担研究》为基础，提供了204个国家和地区1980 - 2023年世卫组织为全球所有儿童推荐的11种疫苗剂量组合的常规儿童疫苗覆盖率的最新全球、区域和国家估计。该分析采用先进的建模技术，考虑了数据偏差和异质性，并整合了新的方法来模拟疫苗规模扩大和COVID-19大流行相关的中断。为了了解历史覆盖率趋势和实现2030年可持续发展目标仍需取得的进展，该研究组对这些结果进行了一些二次分析：(1)该研究组评估了COVID-19大流行对疫苗覆盖率的影响；(2)该研究组预测到2030年选定的生命周期疫苗的覆盖率；(3)该研究组分析了在2023年至2030年之间将零剂量儿童数量减少一半所需的进展。

总体而言，从1980年到2023年，针对白喉、破伤风和百日咳（第一剂[DTP1]和第三剂[DTP3]）、麻疹（MCV1）、脊髓灰质炎（Pol3）和结核病（卡介苗）的原始扩大免疫疫苗的全球覆盖率几乎翻了一番。然而，这种长期趋势掩盖了最近的挑战。2010年至2019年期间，许多国家和领土的覆盖率增长放缓，包括在36个高收入国家和领土中，有21个国家和领土的至少一剂疫苗覆盖率下降（不包括卡介苗，在一些国家和领土，卡介苗已从常规免疫计划中删除）。疫情加剧了这些挑战，自2020年以来，这些疫苗的全球接种率急剧下降，截至2023年仍未恢复到2019冠状病毒病大流行前的水平。覆盖近年来开发和引进的新疫苗，如肺炎球菌病（PCV3）和轮状病毒(完整系列；在疫情期间，由于持续引进和扩大规模，RotaC和第二剂麻疹疫苗（MCV2）在全球范围内持续增加，但速度低于没有大流行时的预期。到2030年对DTP3、PCV3和MCV2的预测表明，只有DTP3才能达到2030年全球覆盖率90%的目标，而且这只是在乐观的情况下。

1980年至2019年，全球1岁以下未接种百白破疫苗的零剂量儿童数量下降了74.9%(95%不确定区间为72.1 - 73.3)，其中大部分下降发生在20世纪80年代和21世纪头十年。2019年之后，零剂量儿童的数量在2021年上升到COVID - 19时代的峰值1860万（17.6 - 20.0）。大多数零剂量儿童仍然集中在受冲突影响的地区和可用于疫苗接种服务的资源受到各种限制的地区，特别是撒哈拉以南非洲。截至2023年，全球1570万（14.6 - 17.0）零剂量儿童中有50%以上居住在8个国家（尼日利亚、印度、刚果民主共和国、埃塞俄比亚、索马里、苏丹、印度尼西亚和巴西），这凸显了持续存在的不平等现象。这强调了制定有针对性、公平的免疫战略的关键必要性。加强初级卫生保健系统，解决疫苗错误信息和犹豫问题，并适应当地情况，对于提高覆盖率至关重要。COVID-19疫情的恢复工作，如世卫组织的“大追赶”行动，以及加强常规服务的努力，必须优先惠及边缘化人群，并以次国家地区为目标，以收复失地并实现全球免疫目标。

研究结果表明，研究团队对当前疫苗覆盖率的估计和到2030年的预测表明，要实现《2030年行动计划》的目标，例如与2019年的水平相比将零剂量儿童减少一半，以及实现生命周期疫苗DTP3、PCV3和MCV2的全球覆盖率达到90%，将需要加快进展。在许多国家和地区，有必要大幅提高覆盖率，撒哈拉以南非洲和南亚面临的挑战最大。需要扭转最近的下降趋势，以恢复拉丁美洲和加勒比地区以前的覆盖率水平，特别是百白破一、百白破三和三种疫苗的覆盖率。

附：英文原文

Title: Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030: a systematic analysis for the Global Burden of Disease Study 2023

Author: Emily Haeuser, Sam Byrne, Jason Nguyen, Catalina Raggi, Susan A McLaughlin, Catherine Bisignano, Ashley A Harris, Amanda E Smith, Paulina A Lindstedt, Georgia Smith, Samuel James Herold, Olivia D Nesbit, Taylor Noyes, Noga Shalev, Latera Tesfaye Olana, Mohammad Amin Aalipour, Hasan Aalruz, Mitra Abbasifard, Faezeh Abbaspour, Hedayat Abbastabar, Samar Abd ElHafeez, Emad M. Abdallah, Reda Abdel-Hameed, Atef Abdelkader, Sherief Abd-Elsalam, Wakgari Mosisa Abdisa, Meriem Abdoun, Arman Abdous, Deldar Morad Abdulah, Adam Abdullahi, Auwal Abdullahi, Toufik Abdul-Rahman, Kulmira Abdykerimova, Armita Abedi, Asrat Agalu Abejew, Roberto Ariel Abeldao Zuiga, Syed Hani Abidi, Olumide Abiodun, Rahim Abo Kasem, Richard Gyan Aboagye, Hassan Abolhassani, Ulric Sena Abonie, Abdullahi Tunde Aborode, Nagah Mohamed Abourashed, Mohamed Abouzid, Dmitry Abramov, Lucas Guimares Abreu, Dariush Abtahi, Rana Kamal Abu Farha, Bilyaminu Abubakar, Eman Abu-Gharbieh, Hana J Abukhadijah, Salahdein Aburuz, Anirudh Balakrishna Acharya, Meshack Achore, Juan Manuel Acuna, Ousman Adal, Lisa C. Adams, Abdu A Adamu, Tajudeen Adesanmi Adebisi, David Adedia, Kamoru Ademola Adedokun, Oluwatobi Emmanuel Adegbile, Oyelola A Adegboye, Nurudeen A Adegoke, Olumide Thomas Adeleke, Juliana Bunmi Adetunji, Mache Tsadik Adhana, Ripon Kumar Adhikary, Usha Adiga, Mohd Adnan, Qorinah Estiningtyas Sakilah Adnani, Prince Owusu Adoma, Leticia Akua Adzigbli, Giuseppina Affinito, Aanuoluwapo Adeyimika Afolabi, Habeeb Abiodun Afolabi, Rotimi Felix Afolabi, Saira Afzal, Suneth Buddhika Agampodi, Dhiraj Motilal Agarwal, Sepehr Aghajanian, Constanza Elizabeth Aguilera Arriagada, Williams Agyemang-Duah, Mahsa Ahadi, Aqeel Ahmad, Danish Ahmad, Khurshid Ahmad, Rabbiya Ahmad, Shoaib Ahmad, Tauseef Ahmad, Ayman Ahmed, Haroon Ahmed, Meqdad Saleh Ahmed, Muktar Beshir Ahmed, Mushood Ahmed, Naveed Ahmed, Syed Anees Ahmed, Simeon Okechukwu Ajakwe, Dolapo Emmanuel Ajala, Gizachew Taddesse Akalu, Oluwasefunmi Akeju, Roland Eghoghosoa Akhigbe, Karolina Akinosoglou, Mohammed Ahmed Akkaif, Hammad Akram, Ashley E Akrami, Alaa Al Amiry, Salah Al Awaidy, Hanadi Al Hamad, Mohammad Khaled Al nawayseh, Omar Al Omari, Yazan Al Thaher, Omar Ali Mohammed Al Zaabi, Mohammad Ahmmad Mahmoud Al Zoubi, Yazan Al-Ajlouni, Ziyad Al-Aly, Khurshid Alam, Mohammad Khursheed Alam, Nazmul Alam, Rasmieh Mustafa Al-amer, Turki M Alanzi, Jude Oluwapelumi Alao, Fahmi Y. Al-Ashwal, Mohammed Albashtawy, Mohammad T AlBataineh, Abdulelah Mastour Aldhahir, Mohammed S Aldossary, Shereen M. Aleidi, Tekletsadik Tekleslassie Alemayehu, Ayman Al-Eyadhy, Ali M Alfalki, Fahad D Algahtani, Abdelazeem M Algammal, Ashraf Alhumaidi, Abid Ali, Irfan Ali, Liaqat Ali, Mohammad Daud Ali, Rafat Ali, Shahid Ali, Syed Shujait Ali, Montaha Al-Iede, Sheikh Mohammad Alif, Hamid Alinejad Rokny, Morteza Alipour, Samah W Al-Jabi, Adel Al-Jumaily, Ahmad Alkhatib, Mustafa Alkhawam

Issue&Volume: 2025-06-24

Abstract:

Background

Since its inception in 1974, the Essential Programme on Immunization (EPI) has achieved remarkable success, averting the deaths of an estimated 154 million children worldwide through routine childhood vaccination. However, more recent decades have seen persistent coverage inequities and stagnating progress, which have been further amplified by the COVID-19 pandemic. In 2019, WHO set ambitious goals for improving vaccine coverage globally through the Immunization Agenda 2030 (IA2030). Now halfway through the decade, understanding past and recent coverage trends can help inform and reorient strategies for approaching these aims in the next 5 years.

Methods

Based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, this study provides updated global, regional, and national estimates of routine childhood vaccine coverage from 1980 to 2023 for 204 countries and territories for 11 vaccine-dose combinations recommended by WHO for all children globally. Employing advanced modelling techniques, this analysis accounts for data biases and heterogeneity and integrates new methodologies to model vaccine scale-up and COVID-19 pandemic-related disruptions. To contextualise historic coverage trends and gains still needed to achieve the IA2030 coverage targets, we supplement these results with several secondary analyses: (1) we assess the effect of the COVID-19 pandemic on vaccine coverage; (2) we forecast coverage of select life-course vaccines up to 2030; and (3) we analyse progress needed to reduce the number of zero-dose children by half between 2023 and 2030.

Findings

Overall, global coverage for the original EPI vaccines against diphtheria, tetanus, and pertussis (first dose [DTP1] and third dose [DTP3]), measles (MCV1), polio (Pol3), and tuberculosis (BCG) nearly doubled from 1980 to 2023. However, this long-term trend masks recent challenges. Coverage gains slowed between 2010 and 2019 in many countries and territories, including declines in 21 of 36 high-income countries and territories for at least one of these vaccine doses (excluding BCG, which has been removed from routine immunisation schedules in some countries and territories). The COVID-19 pandemic exacerbated these challenges, with global rates for these vaccines declining sharply since 2020, and still not returning to pre-COVID-19 pandemic levels as of 2023. Coverage for newer vaccines developed and introduced in more recent years, such as immunisations against pneumococcal disease (PCV3) and rotavirus (complete series; RotaC) and a second dose of the measles vaccine (MCV2), saw continued increases globally during the COVID-19 pandemic due to ongoing introductions and scale-ups, but at slower rates than expected in the absence of the pandemic. Forecasts to 2030 for DTP3, PCV3, and MCV2 suggest that only DTP3 would reach the IA2030 target of 90% global coverage, and only under an optimistic scenario. The number of zero-dose children, proxied as children younger than 1 year who do not receive DTP1, decreased by 74·9% (95% uncertainty interval 72·1–77·3) globally between 1980 and 2019, with most of those declines reached during the 1980s and the 2000s. After 2019, counts of zero-dose children rose to a COVID 19-era peak of 18·6 million (17·6–20·0) in 2021. Most zero-dose children remain concentrated in conflict-affected regions and those with various constraints on resources available to put towards vaccination services, particularly sub-Saharan Africa. As of 2023, more than 50% of the 15·7 million (14·6–17·0) global zero-dose children resided in just eight countries (Nigeria, India, Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia, and Brazil), emphasising persistent inequities.

Interpretation

Our estimates of current vaccine coverage and forecasts to 2030 suggest that achieving IA2030 targets, such as halving zero-dose children compared with 2019 levels and reaching 90% global coverage for life-course vaccines DTP3, PCV3, and MCV2, will require accelerated progress. Substantial increases in coverage are necessary in many countries and territories, with those in sub-Saharan Africa and south Asia facing the greatest challenges. Recent declines will need to be reversed to restore previous coverage levels in Latin America and the Caribbean, especially for DTP1, DTP3, and Pol3. These findings underscore the crucial need for targeted, equitable immunisation strategies. Strengthening primary health-care systems, addressing vaccine misinformation and hesitancy, and adapting to local contexts are essential to advancing coverage. COVID-19 pandemic recovery efforts, such as WHO's Big Catch-Up, as well as efforts to bolster routine services must prioritise reaching marginalised populations and target subnational geographies to regain lost ground and achieve global immunisation goals.

DOI: 10.1016/S0140-6736(25)01037-2

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01037-2/abstract