2018 Immunization Coverage Data at Subnational Level A descriptive analysis 31 July 2018 WHO IVB/EPI www.who.int

2018 data collection of immunization subnational administrative data Data requested: Denominator (number of children targeted), numerator (number of children vaccinated) and coverage For the 1st and 3rd dose of DTP- containing vaccines (DTP1, DTP3) and 1st dose of measles containing vaccine (MCV1) For the 2nd subnational administrative level (referred as Admin2, often known as district) Aggregated for the whole calendar year (from 1 January through 31st December 2016) From 194 WHO Member States Data received: Data for additional antigens, doses and vaccines: BCG, DTP2, DTP4, HepB birth dose, HepB1, HepB2, HepB3, Hib1, Hib2, Hib3, IPV1, MCV2, OPV0, PAB, PCV1, PCV2, PCV3, Pol1, Pol2, Pol3, RCV1, RCV2, Rota1, RotaC, TT2+, VAD1, Varicella and YFV Reported to be Admin1 and/or Admin2 From 141 WHO Member States Data received as of 15 July 2018 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 2

141 member states from all WHO regions shared 2017 subnational data These are all the countries for which data was received: 144 countries. A lot of countries shared data given that it is the first year subnational is collected through the JRF. Thanks to many regions already collecting in the past. We still see disparities between regions, with WPRO and EMRO lagging behind. AFR: Nigeria data shared but withdrew after they had the results from their coverage survey and realised that they have some strong quality issues with their administrative system. Data received cover many Gavi eligible countries: 65 (out of 73) shared their subnational data. 8 Gavi eligible countries that did not report their 2016 subnational data are: Djibouti, Cambodia, Kiribati, Mongolia, Nigeria, Papua New Guinea, Solomon Islands, Viet Nam. 31 July 2018 | 2017 Immunization Coverage Data at subnational Level

Subnational administrative data available from 141 WHO Member States Data received from nearly 24,000 Admin2, in which live 70% of the global surviving infants Data completeness: 54 countries reported on admin1 level only, 7 on admin2 level only, and 80 on both admin1 and admin2 levels Data is reported from about 2,300 admin1 and nearly 23,000 admin2 Subnational administrative data available from 141 WHO Member States (53 countries with no subnational administrative data available – this includes 8 small countries with no subnational geographical divisions) Population size: From the reported data, the smallest admin2 has only 1 targeted child for immunization, and the largest admin2 is Bangalore Urban in India with a target population over 180,000 children Over 70% of the world's surviving infants live in countries reporting subnational administrative data 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 4

Data completeness: illustration 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 5

Population size & coverage: illustration Find more country visuals on: http://apps.who.int/gho/dat a/view.other.immu-admin2- dtp3?lang=en. 2017 DTP3 Coverage Each bubble correspond to an admin2 of the country. Bubble size is proportionnal to the number of children in the target group. 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 6

DTP3 Admin2 coverage data Target population (rounded average and median) per admin 2 Distribution of reported Admin2 DTP3 coverage by coverage range Average Median African Region 7,287 5,492 Region of the Americas 718 197 Eastern Mediterranean Region 3,493 2,484 European Region 701 339 South-East Asia Region 18,862 6,068 Western Pacific Region 6,962 3,013 Global 4,050 563 DTP3 data reported from about 22,000 admin2 Total Number of children vaccinated with 3 doses of DTPcv in all admin2: over 83,000,000 Reaching GVAP goal: countries report 70% of their admin2 have more than 80% DTP3 coverage 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 7 GVAP 2011-2020

DTP1 Admin2 coverage data Target population (rounded average and median) per admin 2 Distribution of reported Admin2 DTP1 coverage by coverage range Average Median African Region 7,287 5,492 Region of the Americas 718 197 Eastern Mediterranean Region 3,493 2,484 European Region 701 339 South-East Asia Region 18,862 6,068 Western Pacific Region 6,962 3,013 Global 4,050 563 DTP1 data reported from about 22,000 admin2 Total Number of children vaccinated with 1 dose of DTPcv in all admin2: over 79,000,000 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 8

MCV1 Admin2 coverage data Target population (rounded average and median) per admin 2 Distribution of reported Admin2 MCV1 coverage by coverage range Average Median African Region 7,287 5,492 Region of the Americas 707 196 Eastern Mediterranean Region 3,493 2,484 European Region 701 339 South-East Asia Region 18,862 6,068 Western Pacific Region 6,962 3,013 Global 3,989 545 MCV1 data reported from over 22,000 admin2 Total Number of children vaccinated with 1 dose of MCV in all admin2: over 78,000,000 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 9

Dropout at Admin1 level Global World Subnational Dropout by Administrative Level for 2017 Colored by percentage of (DTP1-DTP3) / (DTP1) vaccinations. Approximately sizeed by sum of surviving infants for Admin1 regions. Countries without subnational data colored light grey. 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 10

Dropout at Admin1 level African region AFR Subnational Dropout by Administrative Level for 2017 Colored by percentage of (DTP1-DTP3) / (DTP1) vaccinations. Approximately sizeed by sum of surviving infants for Admin1 regions. Countries without subnational data colored light grey. 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 11

Dropout at Admin1 level Region of the Americas AMR Subnational Dropout by Administrative Level for 2017 Colored by percentage of (DTP1-DTP3) / (DTP1) vaccinations. Approximately sizeed by sum of surviving infants for Admin1 regions. Countries without subnational data colored light grey. 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 12

Dropout at Admin1 level Eastern Mediterranean region EMR Subnational Dropout by Administrative Level for 2017 Colored by percentage of (DTP1-DTP3) / (DTP1) vaccinations. Approximately sizeed by sum of surviving infants for Admin1 regions. Countries without subnational data colored light grey. 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 13

Dropout at Admin1 level European region EUR Subnational Dropout by Administrative Level for 2017 Colored by percentage of (DTP1-DTP3) / (DTP1) vaccinations. Approximately sizeed by sum of surviving infants for Admin1 regions. Countries without subnational data colored light grey. 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 14

Dropout at Admin1 level South-East Asian region SEAR Subnational Dropout by Administrative Level for 2017 Colored by percentage of (DTP1-DTP3) / (DTP1) vaccinations. Approximately sizeed by sum of surviving infants for Admin1 regions. Countries without subnational data colored light grey. 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 15

Dropout at Admin1 level West Pacific region WPR Subnational Dropout by Administrative Level for 2017 Colored by percentage of (DTP1-DTP3) / (DTP1) vaccinations. Approximately sizeed by sum of surviving infants for Admin1 regions. Countries without subnational data colored light grey. 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 16

Limitations in the sub-national administrative data reported Data completeness Interpretation bias Data quality Not all member states included: 27% not included 22,000+ reported Admin2 represent about two third of all Admin2 worldwide Admin2 coverage data mainly originates from 3 regions: Africa, the Americas and South-East Asia Some of the data received as Admin2 is actually for the 1st, 3rd or even lower level Also, some Admin1 may refer to 2nd subnational administrative level. This may explain some of the disparities in terms of district sizes. Some reported districts not linked to a specific geographical place (eg. migrant population, army camps, etc). These non- geographically based population often don’t have a denominator The diversity in reporting limits comparability across countries. Numerator errors: introduced when tallying, summarizing, and reporting the administered doses by health facilities and district administrations Inaccurate denominators: population estimates often based on census data and derived estimates, leading to distortions over time as certain districts may grow faster than others Numerator / denominator mismatches: population mobility creates mismatches between numerator and denominator, aggravated in countries with important migratory movements 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 17

Notes Please share your comments, questions and analysis to WHO through vpdata@who.int (subject line: Subnational data); When using them, always source WHO products, data and information related to the immunization subnational administrative data: "Subnationally reported immunization system performance data for calendar year 2017 submitted on the joint annual data collection process."; The slides, materials and visuals will be updated periodically. Last update: 31 July 2018. Visit our page: http://who.int/entity/immunization/monitoring_surveillance/data/subnational/en/index. html . 31 July 2018 | 2017 Immunization Coverage Data at subnational Level 18

WHO Switzerland vpdata@who.int 20, Avenue Appia 1211 Geneva Thank you WHO Switzerland vpdata@who.int 20, Avenue Appia 1211 Geneva www.who.int