New and Underutilized Vaccines Included in National Schedules by 2021
By the end of 2021, among 194 countries, universal HepB-BD was included in the national immunization schedules in 111 (57%) countries, RV in 116 (60%), PCV in 152 (78%), and RCV in 173 (89%). HepB-BD, targeting only select populations, was included in the routine immunization schedules of 24 (12%) countries, mostly in the WHO European Region (EUR) (20 of 24 countries). Hib vaccine was included in the national immunization schedules of all but two (99%) countries (China and Russia). Beyond the first year of life, HPV vaccine, DTPCV4, and MCV2 were included in the national immunization schedules of 114 (59%), 140 (72%), and 183 (94%) countries, respectively.
New and Underutilized Vaccine Introductions, 2016–2021
During 2016–2021, among vaccines recommended during the first year of life, the numbers and percentage of countries that had implemented national vaccine introduction increased most for RV vaccine, from 84 (43%) countries to 116 (60%) (Table) (Supplementary Figure, https://stacks.cdc.gov/view/cdc/130137). During 2016–2021, among vaccines provided during the second year of life and beyond, the number of new HPV vaccine introductions was higher than the number of introductions of any other recommended vaccine; the number of countries that had introduced HPV vaccine nationally increased 65%, from 69 countries in 2016 to 114 in 2021. During the same period, the number of countries that had introduced MCV2 increased by 12%, from 164 countries in 2016 to 183 in 2021; countries introducing DTPCV4 increased by 4%, from 135 countries in 2016 to 140 in 2021. By 2021, 33 (17%) of 194 countries provided all eight of these WHO-recommended new and underutilized vaccines as part of the routine immunization schedule; 56 (29%) countries had included all five vaccines recommended during the first year of life.
During 2016–2021, an average of 31 new introductions of these eight WHO-recommended new and underutilized vaccines occurred annually (representing a decline in introductions of approximately one third [34%]), compared with an average 47 new introductions annually during 2010–2015.§ The annual number of new vaccine introductions declined sharply at the start of the COVID-19 pandemic, from 48 in 2019 to 15 in 2020 (Figure 1). In 2021, there were 26 vaccine introductions, including one HepB-BD, three DTPCV4, six PCV, five RV, four MCV2, and seven HPV introductions.
Number of countries with new vaccine introductions, by vaccine and year — worldwide,* 2016–2021
Abbreviations: DTPCV4 = first booster dose of diphtheria, tetanus, and pertussis–containing vaccine; HepB-BD = hepatitis B vaccine birth dose; Hib = Haemophilus influenzae type b vaccine; HPV = human papillomavirus vaccine; MCV2 = second dose of measles-containing vaccine; PCV = pneumococcal conjugate vaccine; RCV = rubella-containing vaccine; RV = rotavirus vaccine.
*Vaccine introduction data for DTPCV4 was unavailable for 2016. For all other vaccines, no value indicates no introductions occurred for that year.
New and Underutilized Vaccine Introductions, by World Bank Income Status and WHO Region
By 2021, among 28 low-income countries, 20 (71%) had yet to introduce HPV vaccine into their routine immunization schedule compared with 53 (50%) of 107 middle-income countries and seven (12%) of 59 high-income countries (Figure 2). RV vaccine had not yet been introduced in 25%, 39%, and 49% of low-, middle- and high-income countries, respectively. As well, minimal progress toward DTPCV4 and HepB-BD vaccine introductions was made across all country income categories during 2016–2021.
Percentage of countries that introduced selected World Health Organization–recommended vaccines* into their national immunization schedule, by income status† — worldwide, 2016–2021
Abbreviations: DTPCV4 = first booster dose of diphtheria, tetanus, and pertussis–containing vaccine; HepB-BD = hepatitis B vaccine birth dose; HPV = human papillomavirus vaccine; USD = U.S. dollars.
*Vaccines with lowest introduction in low-income countries' national immunization schedules as of 2021. HepB-BD indicates the introduction of universal HepB-BD into the national immunization schedule. In addition, 24 countries had implemented HepB-BD selective introduction, of which 22 were high-income and two were middle-income countries.
†Country income categories were defined using the 2022 World Bank income classification except for Cook Islands, Niue, and Venezuela. Cook Islands is classified as high-income and Niue is classified as middle-income based on Central Intelligence Agency classification (https://www.cia.gov/the-world-factbook/countries/). Venezuela is classified as middle-income based on that country's most recent World Bank classification (2019). Gross national income: low income <1,085 USD; middle income = 1,086–13,205 USD; and high income >13,205 USD.
Among the 152 vaccine introductions implemented during 2016–2021, 58 (38%) were in the African Region (AFR); 28 (18%) in the Region of the Americas (AMR); 23 (15%) in the Western Pacific Region (WPR); 21 (14%) in EUR; 17 (11%) in the South-East Asia Region (SEAR); and five (3%) in the Eastern Mediterranean Region (EMR). As of 2021, by vaccine, the largest proportion of countries that had not introduced HepB-BD (72%), DTPCV4 (79%), MCV2 (19%), and RCV (34%) were in AFR. Among 21 countries in EMR, 19 (90%) had yet to introduce HPV vaccine. By schedule, an average of 29% of countries in AFR had yet to introduce one or more of five WHO-recommended infant vaccines followed by 27% in SEAR, 25% in EUR, 22% in EMR, 20% in AMR, and 14% in WPR. Beyond the infant schedule, an average of 51% countries in AFR had yet to introduce at least one of HPV, DTPCV4, or MCV2 into the national immunization schedule, followed by 40% in EMR, 30% in SEAR, 23% in WPR, 9% in EUR, and 4% in AMR.
Morbidity and Mortality Weekly Report. 2023;72(27):746-750. © 2023 Centers for Disease Control and Prevention (CDC)