Every Right Counts: Who misses out on immunization?

Vaccines are one of the most effective ways to protect children from disease. Yet a region’s relatively high childhood immunization rates can conceal stark inequalities.  

To mark the release of the latest WHO/UNICEF Estimates of National Immunization Coverage (WUENIC), this edition of the Every Right Counts series takes a closer look at which children are most likely to be un- or under-vaccinated in Europe and Central Asia (ECA). 

Drawing on household survey data and the newly published national estimates for 52 ECA countries, we have found both persistent and emerging gaps in immunization coverage across the region – meaning that some children are at greater risk of deadly, but vaccine-preventable, diseases. 

While ECA has some of the highest routine childhood immunization rates in the world, gaps remain. 

In fact, the number of zero-dose children is rising.

The map below presents the latest national immunization estimates from WHO and UNICEF, published in July 2024. Use the filters to explore the data by year and vaccine. 

Although overall immunization coverage remains high in ECA, the latest figures show a slight decline in regional averages for essential vaccines, such as DTP and the measles vaccine. 

Even small shifts can mean that tens of thousands more children are being left unprotected. 

For example, the average coverage for DTP1 fell from 96 per cent in 2023 to 95 per cent in 2024. This one percentage point drop equates to an estimated 74,600 more zero-dose children across the region. 

In Uzbekistan alone, declining uptake of DTP1 resulted in approximately 83,000 additional zero-dose children compared to the previous year. 

The graph below shows selected country-level trends in DTP1 coverage – highlighting where progress is being made and where it has stalled. 

To understand which children are missing out on immunization, we need to go beyond regional or national averages and examine inequalities within countries. 

Household survey data plays a vital role in revealing these gaps. Unfortunately, only nine countries in ECA have recent data from the Multiple Indicator Cluster Surveys (MICS), limiting the extent to which within-country inequities can be explored. Still, the available data point to clear patterns. 

One of the most striking divides is between rural and urban areas. In every country with available MICS data, children in rural areas are more likely to have received all recommended vaccinations than those in urban areas – a trend that runs counter to global patterns, where urban children typically have higher coverage. 

All references to Kosovo should be understood in reference to the United Nations Security Council Resolution 1244 (1999).

Unusual disparities between children from different wealth quintiles also emerge in countries with recent MICS data. 

In many of these countries, children from the poorest households are more likely to be vaccinated than those from the richest. This contrasts with the global norm, where wealthier families tend to have higher coverage. 

The data suggest that factors such as vaccine hesitancy, lower perceived risk, or mistrust in health systems may be contributing to lower uptake among wealthier households.

The pattern of inequity is more pronounced for certain ethnic groups. 

MICS data from Roma settlements show that Roma children are significantly less likely to be immunized than their non-Roma peers, with coverage lowest among the poorest Roma households. In Montenegro, for example, only 12 per cent of Roma children aged 24-35 months received the vaccinations recommended for their age, compared to 61 per cent of children nationally. 

These gaps reflect multiple barriers faced by Roma communities – including discrimination, poverty, and limited awareness of their rights to access healthcare. 

No child should be left behind in the fight against preventable diseases. 
 

Despite relatively high regional immunization coverage, the number of zero-dose children in Europe and Central Asia is rising – a clear warning sign that not all children are being protected. Across the region, patterns of under-vaccination vary. While children in Roma communities continue to face significant access barriers, lower coverage in urban and wealthier households points to growing mistrust and misinformation. 

Now is the time to act – before more children are left behind.

To explore immunization trends across the region, visit the TransMonEE Dashboard. To dig deeper into inequalities, including disaggregated data by wealth, location, and ethnicity, explore the ECA Child Inequity Dashboard. 

Because every child has the right to be protected — and Every Right Counts when tracking progress.