Global Health:

Factors Contributing to Low Vaccination Rates in Developing Countries

NSIAD-00-4: Published: Oct 15, 1999. Publicly Released: Oct 19, 1999.

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Benjamin F. Nelson
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Office of Public Affairs
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Pursuant to a congressional request, GAO examined some of the key issues involving vaccine availability for children in developing countries, focusing on the: (1) locations where shortfalls in immunization coverage are most prevalent; and (2) factors that impede vaccine availability in these locations.

GAO noted that: (1) while global immunization coverage for six diseases originally targeted by the World Health Organization (WHO) has improved significantly since the mid-1970s, coverage rates are low for children living in the poorest countries, particularly in urban slums and remote rural areas; (2) WHO data indicate that the poorest countries of the world have vaccination rates that are about 26 percent below the global average of 82 percent; (3) in fact, immunization coverage in some countries in sub-Saharan Africa has declined over the last decade; (4) some countries in this region reported in 1997 that they immunized less than a third of their children against the six diseases targeted by WHO; (5) many of the children who are not immunized live in countries that have experienced internal conflict in recent years; (6) although the level of coverage varies, few children in developing countries have access to the newer vaccines that have been added more recently to WHO's list of recommended vaccines; (7) several interrelated factors that poor countries have difficulty overcoming have limited the availability of vaccines for children in the developing world, including: (a) inadequate health infrastructure; (b) the relatively higher cost of vaccines recently recommended by WHO; (c) insufficient information on disease burden and vaccine efficacy; and (d) changing priorities of international donors; and (8) in the 1990s, the United Nations Children's Fund and the U.S. Agency for International Development have begun to reduce their level of support for immunization.

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