Coverage and number of infants not vaccinated for DTP3 by country, 2020

Immunization Regional Snapshot 2020South Asia

In 2020, 5.3 out of 33.9 million surviving infants in the region did not receive the three recommended doses of DTP vaccine

More than 5 million still not fully vaccinated

In 2020, the regional coverage of MCV1 was 88 per cent compared to the global target of 95 per cent

BCG DTP1 DTP3 Polio3 MCV1 MCV2 HepB3 Hib3 Rota PCV3 HPV

Afghanistan 87 78 70 75 66 43 70 70 62 68 –

Bangladesh 99 99 98 98 97 93 98 98 – 99 –

Bhutan 98 96 95 96 93 92 96 96 – 90 81

India 85 87 85 85 89 81 85 85 82 21 –

Maldives 99 99 99 99 99 96 99 99 – – 68

Nepal 92 89 84 84 87 74 84 84 – 80 –

Pakistan 91 83 77 83 83 74 77 77 80 80 –

Sri Lanka 99 96 96 96 96 96 96 96

IPV1

65

96

93

81

99

73

85

96 – – 51

Countries with dark blue color, India and Pakistan, have the lowest coverages with the highest number of infants unvaccinated for DTP3. Bhutan, Maldives, and Sri Lanka have the highest coverage levels with lowest numbers of unvaccinated infants for DTP3.

No. of Unvaccinated Children

Cove

rage

(%)

LOWER

HIGHER

MOREFEWER

Note: This map is not to scale. It does not reflect a position by UNICEF on the legal status of any country or area or the delimitation of any frontiers. Please find more information on how to interpret the map on page 3.

4 out of 8 countries in the region sustained the target coverage of 90% or above for DTP3 for the past three years

Half of the countries sustained at least 90% coverage for DTP3

Measles regional coverage below the global target

Afghanistan

Bangladesh

Bhutan

India

Nepal

Pakistan

Sri LankaMaldives

NOTE: Due to COVID-19 pandemic, more countries than usual did not report coverage data to UNICEF and WHO.Find the full list of the 35 countries that did not report coverage data on page 3. For the regional and globalaggregations, the coverage rates were imputed for the countries that did not report.

Global and regional coverage of DTP3, 2000–2020

In 2020, the regional coverage of DTP3 was 84 per cent, which is 6 per cent points lower lower than regional coverage in 2019. India and Pakistan, with an estimated 4.8 million infants not vaccinated for

DTP3, accounted for 90 per cent of the total ROSA un- and under-vaccinated surviving infants.

Coverage (%) and numbers of infants un- and under-vaccinated for DTP, 2020

>=90%80~89%50~79%<50% Note: Figures reflect the rounded number of unvaccinated infants for DTP3.

55

6561

68

76

76

85

96 96 95

88

92

88

9490

77

84 84

69

78

9391 89

85

93 92

43

60

93

87

91

72

59

83

84 ROSA83 Global

77 ESAR

93 EECA

95 Non- programme

88 MENA

77 LACR

65 WCAR

92 EAPR

30

40

60

80

50

70

90

100

2000 2005 2010 2015 2020

Cove

rage

(%)

India85%3,505,000

Pakistan77%1,309,000

Afghanistan70%347,000

Vaccination coverage (%) by country, 2020

Note: Please find the acronym definitions on page 3.

*No coverage estimates available. Find the complete list of countries that did not report coverage data for 2020 on page 3.

Immunization Regional Snapshot 2020 I South Asia UNICEF

Sources: WHO-UNICEF Estimates of National Immunization Coverage (WUENIC), revision 2020 / The World Population Prospects – 2019 revision, UN Population Division, New York, USA.

Number of unvaccinated (DTP1) and under-vaccinated (DTP3) infants, 2000–2020

Top 3 countries with the most unvaccinated (DTP1) and under-vaccinated (DTP3) infants, 2018–2020

Under−vaccinatedUn−vaccinated

Note: Countries with high coverage (>=95%) in 2020 and a change in coverage within 2% from 2019: Bangladesh, Bhutan, and Maldives.

Regional Vaccination Trends, 2000–2020

0

2

4

6

8

10

12

14

2010 20152000 2005 2020

Num

ber o

f inf

ants

(mill

ions

)

MCV1 and DTP3 coverage change from 2019 to 2020, by country

Note: Country with high coverage (>=95%) in 2020 and a change in coverage within 2% from 2019: Bangladesh, and Maldives.

70

80

90

100

757065 80 85 90 95 100

Coverage (%) in 2020

Cove

rage

(%) i

n 20

19

75

80

85

90

95

100

70807570 85 90 95 100

Coverage (%) in 2020

Cove

rage

(%) i

n 20

19Under−vaccinatedUn−vaccinated

MCV1 DTP3

Decrease more than -5% Decrease 2% to 5% Change within 2% Increase more than 5%Increase 2% to 5%

Note: Zero-dose is defined as un-vaccinated children for DTP1

0

20

40

60

80

100

2000 2005 2010 2015 2020

Cove

rage

(%)

0

20

40

60

80

100

2000 2005 2010 2015 2020

Cove

rage

(%)

0

20

40

60

80

100

2000 2005 2010 2015 2020

Cove

rage

(%)

Polio3

DTP3

IPV1

MCV1

PCV3

RotaC

68 74

84768582 8489

85

10

82

60

8475

87

DTP1

1 6

67

69

7985

1

80

58

88

MCV2

19

3

72

10

40

4.4

2.3 2.6 3.2 3.5 3.7

3.8 3.9 4.2

4.2 5.

6 6.1 6.

8

6.8

6.7

6.4 7.

6 8.2 8.5

8.6 9.0 1.

0

1.1 1.

3 1.3 1.2 1.4 2.0 2.

6 2.6

2.7

2.7 3.

5

3.8 5.

4

5.1

5.3 4.

3 4.8 5.

3 5.3 5.

2

2018

2018

2018

2019

2019

2019

2020

2020

2020

Afghanistan

Pakistan

India

0 1000 2000500 1500 3500Number of infants (in thousands)

3,038

1,403

1,639

467

702

702

968

567

732

342

340

394

255

288

218

93

35

103

2500 3000

IndiaBhutan

Nepal

Sri Lanka

Afghanistan

Bangladesh

Maldives

Pakistan

India

Nepal

Pakistan

Sri Lanka

Afghanistan

BangladeshBhutanMaldives

Immunization Regional Snapshot 2020 I South Asia UNICEF

Source: Global Routine Immunization Strategies and Practices (GRISP): a companion document to the GLobal Vaccine Action Plan (GVAP). ISBN 978 92 4 151010 3 (NLM classification: WA 115).https://www.who.int/immunization/programmes_systems/policies_strategies/GRISP_infographic_EN.pdf?ua=1

Note: Estimates for the year 2020 are not available for the above listed 35 countries. For the regional and global aggregations, the coverage rates were imputed for the countries that did not report.

Vaccine coverage: Percentage of infants (children under one year of age) who received certain vaccine-doses. For example, coverage of DTP3 is the percentage of infants that received all three doses of diphtheria, tetanus, and pertussis (DTP) vaccine.

Un-vaccinated: An infant that did not receive any vaccine. In this regional profile, un-vaccinated is defined as an infant that did not receive any DTP vaccine (not vaccinated for DTP1).

Under-vaccinated: An infant that received some but not all the recommended vaccine-doses on the national schedule. In this regional profile, under-vaccinated is defined in relation to the DTP vaccination series not the entire national immunization schedule.

Vaccine-Doses: • Bacillus Calmette-Guerin (BCG): vaccine against tuberculosis• Diphtheria, tetanus, and pertussis vaccine, first dose (DTP1) and third dose (DTP3)• Hepatitis B vaccine, third dose (HepB3)• Haemophilus influenzae type B vaccine, third dose (Hib3)• Poliomyelitis vaccine, third dose (Polio3)• Measles containing vaccine, first dose (MCV1) and second dose (MCV2) • Rotavirus vaccine, last dose (Rota)• Pneumococcal vaccine, third dose (PCV3) • Human Papillomavirus vaccine, last dose (HPV): vaccine to protect against certain types of human papillomavirus that can lead to cancer or genital warts• Yellow Fever vaccine (YFV)

The bi-scale map shows both the level of coverage and the total number of infants not vaccinated for DTP3.

Definitions of immunization terms

Albania, Algeria, Armenia, Bahamas, Belgium, Bosnia and Herzegovina, Cook Islands, Croatia, Cyprus, Czechia, Fiji, France, Gambia, Germany, Guinea-Bissau, Hungary, Iceland, Kuwait, Marshall Islands, Monaco, Morocco, Namibia, Netherlands, Niue, Oman, Peru, Poland, Portugal, Republic of North Macedonia, Sao Tome and Principe, Serbia, Singapore, South Korea, Thailand, Trinidad and Tobago

Countries without 2020 reported data

Interpretation of graphs

GRISP: Global Routine Immunization Strategies and PracticesCoordinating Actions to Achieve Disease Prevention for All

Tailored strategies that identify undervaccinated and unvaccinated persons and regularly provide them with the vaccines they need

Strategies to reach

Strategic multiyear plans and operational annual plans outlining and coordinating strategies and activities, monitored quarterly

Strategic and operational plans

Assurance that sufficient and adequately appropriated funds reach the operational level of the programme regularly

Operational level funding

Regular and systematic capacity building, skills development and supportive supervision for

vaccinators and district managers

Vaccinator and manager skills

The most important factor for all other eight investments to succeed: A capable national team—supplied with sufficient resources and authority—to excellently manage each country's national immunization program

National team

Expanded routine immunization schedules that

cover people's entire lives

Life course vaccination

An information system that identifies and tracks each person's vaccination status

Accurate information system

Modernized vaccine supply chains and management to ensure the correct amounts of the right potent vaccines are available at each vaccination session

Modern vaccine supply chain

Community support

Shared responsibility for immunization delivery between communities and the immunization programme to reach uniformly high

coverage through high demand and quality services

Less than 80% coverage and ranked in the group of countries with the most number of under-vaccinated infants within the region. 80% to 89% coverage and ranked in the group of countries with the most number of under-vaccinated infants within the region.

Greater than or equal to 90% coverage and ranked in the group of countries with the most number of under-vaccinated infants within the region.

Less than 80% coverage and ranked in the middle group of countries in terms of number of under-vaccinated infants within the region.

80% to 89% coverage and ranked in the middle group of countries in terms of number of under-vaccinated infants within the region.

Greater than or equal to 90% coverage and ranked in the middle group of countries in terms of number of under-vaccinated infants within the region.

Less than 80% coverage and ranked in the group of countries with the least number of under-vaccinated infants within the region.

80% to 89% coverage and ranked in the group of countries with the least number of under-vaccinated infants within the region.

Greater than or equal to 90% coverage and ranked in the group of countries with the least number of under-vaccinated infants within the region.

The DTP3 coverage change from 2019 to 2020 scatter plot shows the change in DTP3 coverage between 2019 and 2020. Countries that experienced more than 5 percentage point drop in coverage since the previous year are labelled in dark red. Similarly, countries that experienced more than 5 percentage point increase in coverage since the previous year are labelled in dark blue. Countries with no significant changes (less than 2 percentage points) are labelled in yellow.

The GRISP framework outlines the specific strategies and activities required to ensure the lifesaving power of routine immunization is accessible to all—regardless of who they are or where they live. It breaks down into the following nine areas: