Explore the vast range of titles available.

Less than 30% of people in Africa received a dose of the COVID-19 vaccine even 18 months after vaccine development 1 . Here, motivated by the observation that residents of remote, rural areas of Sierra Leone faced severe access difficulties 2 , we conducted an intervention with last-mile delivery of doses and health professionals to the most inaccessible areas, along with community mobilization. A cluster randomized controlled trial in 150 communities showed that this intervention with mobile vaccination teams increased the immunization rate by about 26 percentage points within 48–72 h. Moreover, auxiliary populations visited our community vaccination points, which more than doubled the number of inoculations administered. The additional people vaccinated per intervention site translated to an implementation cost of US $33 per person vaccinated. Transportation to reach remote villages accounted for a large share of total intervention costs. Therefore, bundling multiple maternal and child health interventions in the same visit would further reduce costs per person treated. Current research on vaccine delivery maintains a large focus on individual behavioural issues such as hesitancy. Our study demonstrates that prioritizing mobile services to overcome access difficulties faced by remote populations in developing countries can generate increased returns in terms of uptake of health services 3 . A cluster randomized controlled trial in Sierra Leone shows that targeting access to vaccines in remote areas increases uptake, an approach that can be used to improve vaccine equity in developing countries.

•The term ‘vaccine hesitancy’ is increasingly used to explain sub-optimal vaccination coverage.•The accepted definition includes ‘confidence’, ‘complacency’ and ‘convenience’.•We contend the inclusion of ‘convenience’ is problematic.•Insufficient emphasis is given to the social determinants of vaccination.•Accurate terminology is needed for researchers and providers to address under-vaccination. Although vaccination uptake is high in most countries, pockets of sub-optimal coverage remain posing a threat to individual and population immunity. Increasingly, the term ‘vaccine hesitancy’ is being used by experts and commentators to explain sub-optimal vaccination coverage. We contend that using this term to explain all partial or non-immunisation risks generating solutions that are a poor match for the problem in a particular community or population. We propose more precision in the term ‘vaccine hesitancy’ is needed particularly since much under-vaccination arises from factors related to access or pragmatics. Only with clear terminology can we begin to understand where the problem lies, measure it accurately and develop appropriate interventions. This will ensure that our interventions have the best chance of success to make vaccines available to those who want them and in helping those who are uncertain about their vaccination decision.

Since its inception in 1974, the Essential Programme on Immunization (EPI) has achieved remarkable success, averting the deaths of an estimated 154 million children worldwide through routine childhood vaccination. However, more recent decades have seen persistent coverage inequities and stagnating progress, which have been further amplified by the COVID-19 pandemic. In 2019, WHO set ambitious goals for improving vaccine coverage globally through the Immunization Agenda 2030 (IA2030). Now halfway through the decade, understanding past and recent coverage trends can help inform and reorient strategies for approaching these aims in the next 5 years. Based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, this study provides updated global, regional, and national estimates of routine childhood vaccine coverage from 1980 to 2023 for 204 countries and territories for 11 vaccine-dose combinations recommended by WHO for all children globally. Employing advanced modelling techniques, this analysis accounts for data biases and heterogeneity and integrates new methodologies to model vaccine scale-up and COVID-19 pandemic-related disruptions. To contextualise historic coverage trends and gains still needed to achieve the IA2030 coverage targets, we supplement these results with several secondary analyses: (1) we assess the effect of the COVID-19 pandemic on vaccine coverage; (2) we forecast coverage of select life-course vaccines up to 2030; and (3) we analyse progress needed to reduce the number of zero-dose children by half between 2023 and 2030. Overall, global coverage for the original EPI vaccines against diphtheria, tetanus, and pertussis (first dose [DTP1] and third dose [DTP3]), measles (MCV1), polio (Pol3), and tuberculosis (BCG) nearly doubled from 1980 to 2023. However, this long-term trend masks recent challenges. Coverage gains slowed between 2010 and 2019 in many countries and territories, including declines in 21 of 36 high-income countries and territories for at least one of these vaccine doses (excluding BCG, which has been removed from routine immunisation schedules in some countries and territories). The COVID-19 pandemic exacerbated these challenges, with global rates for these vaccines declining sharply since 2020, and still not returning to pre-COVID-19 pandemic levels as of 2023. Coverage for newer vaccines developed and introduced in more recent years, such as immunisations against pneumococcal disease (PCV3) and rotavirus (complete series; RotaC) and a second dose of the measles vaccine (MCV2), saw continued increases globally during the COVID-19 pandemic due to ongoing introductions and scale-ups, but at slower rates than expected in the absence of the pandemic. Forecasts to 2030 for DTP3, PCV3, and MCV2 suggest that only DTP3 would reach the IA2030 target of 90% global coverage, and only under an optimistic scenario. The number of zero-dose children, proxied as children younger than 1 year who do not receive DTP1, decreased by 74·9% (95% uncertainty interval 72·1–77·3) globally between 1980 and 2019, with most of those declines reached during the 1980s and the 2000s. After 2019, counts of zero-dose children rose to a COVID 19-era peak of 18·6 million (17·6–20·0) in 2021. Most zero-dose children remain concentrated in conflict-affected regions and those with various constraints on resources available to put towards vaccination services, particularly sub-Saharan Africa. As of 2023, more than 50% of the 15·7 million (14·6–17·0) global zero-dose children resided in just eight countries (Nigeria, India, Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia, and Brazil), emphasising persistent inequities. Our estimates of current vaccine coverage and forecasts to 2030 suggest that achieving IA2030 targets, such as halving zero-dose children compared with 2019 levels and reaching 90% global coverage for life-course vaccines DTP3, PCV3, and MCV2, will require accelerated progress. Substantial increases in coverage are necessary in many countries and territories, with those in sub-Saharan Africa and south Asia facing the greatest challenges. Recent declines will need to be reversed to restore previous coverage levels in Latin America and the Caribbean, especially for DTP1, DTP3, and Pol3. These findings underscore the crucial need for targeted, equitable immunisation strategies. Strengthening primary health-care systems, addressing vaccine misinformation and hesitancy, and adapting to local contexts are essential to advancing coverage. COVID-19 pandemic recovery efforts, such as WHO's Big Catch-Up, as well as efforts to bolster routine services must prioritise reaching marginalised populations and target subnational geographies to regain lost ground and achieve global immunisation goals. The Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

Canine distemper virus (CDV) has recently emerged as an extinction threat for the endangered Amur tiger (Panthera tigris altaica). CDV is vaccine-preventable, and control strategies could require vaccination of domestic dogs and/or wildlife populations. However, vaccination of endangered wildlife remains controversial, which has led to a focus on interventions in domestic dogs, often assumed to be the source of infection. Effective decision making requires an understanding of the true reservoir dynamics, which poses substantial challenges in remote areas with diverse host communities. We carried out serological, demographic, and phylogenetic studies of dog and wildlife populations in the Russian Far East to show that a number of wildlife species are more important than dogs, both in maintaining CDV and as sources of infection for tigers. Critically, therefore, because CDV circulates among multiple wildlife sources, dog vaccination alone would not be effective at protecting tigers. We show, however, that low-coverage vaccination of tigers themselves is feasible and would produce substantive reductions in extinction risks. Vaccination of endangered wildlife provides a valuable component of conservation strategies for endangered species.

Annual vaccination against seasonal influenza is recommended for all persons ages ≥6 months in the U.S., as it is effective in reducing influenza-related illness and death. However, data show that only 44% of U.S. adults were vaccinated in the 2024–25 season. Previous research indicates that low vaccination uptake is linked to sociodemographic characteristics, region and health insurance status. We assessed trends in influenza vaccination coverage between 2017–18 and 2022–23 seasons and evaluated factors associated with uptake in U.S. Military Health System (MHS) beneficiaries during the 2022–2023 influenza season. We performed a cross-sectional study using all eligible beneficiaries ages 1–64 years between July 2017 and March 2023. We used chi-square tests to compare vaccination rates between the first and last season and multivariable logistic regression to assess factors associated with vaccination coverage in the 2022–23 season. We identified 6,006,857 eligible MHS beneficiaries over the six influenza seasons. Vaccination rates between the first and last influenza season increased from 33% to 36.5% (p-value < 0.0001). We observed significant decreases in vaccination rates over the study period among ages 5–17, dependent beneficiaries, and those in the Northeastern U.S. In 2022–23, female beneficiaries were more likely to be vaccinated than males (aOR 1.33, p-value < 0.0001). In addition, Black, Hispanic, and Asian/Pacific Islander beneficiaries had marginally higher rates of coverage as compared to White beneficiaries (aOR: 1.07, 1.10, 1.18, p-value < 0.0001). Our results indicate that overall influenza vaccination rates increased between 2017 and 2023, however, use of the EHR systems alone for tracking vaccination data tends to underestimate coverage in the MHS. Tailored strategies are needed to improve influenza vaccination uptake to prevent illness, hospitalization and death.

The American Cancer Society (ACS) presents an adaptation of the current Advisory Committee on Immunization Practices recommendations for human papillo-mavirus (HPV) vaccination. The ACS recommends routine HPV vaccination between ages 9 and 12 years to achieve higher on-time vaccination rates, which will lead to increased numbers of cancers prevented. Health care providers are encouraged to start offering the HPV vaccine series at age 9 or 10 years. Catch-up HPV vaccination is recommended for all persons through age 26 years who are not adequately vac-cinated. Providers should inform individuals aged 22 to 26 years who have not been previously vaccinated or who have not completed the series that vaccination at older ages is less effective in lowering cancer risk. Catch-up HPV vaccination is not recom-mended for adults aged older than 26 years. The ACS does not endorse the 2019 Advisory Committee on Immunization Practices recommendation for shared clinical decision making for some adults aged 27 through 45 years who are not adequately vaccinated because of the low effectiveness and low cancer prevention potential of vaccination in this age group, the burden of decision making on patients and clini-cians, and the lack of sufficient guidance on the selection of individuals who might benefit.

Chengdu, China, is facing an increasing burden of cervical cancer. Although human papillomavirus (HPV) vaccines have been introduced in China since 2016, vaccination coverage remains suboptimal, and data on regional disparities are limited. In 2021, Chengdu implemented a subsidized HPV vaccination program targeting girls aged 13–14 years. This study aims to evaluate HPV vaccination coverage among females aged 9–45 years in Chengdu from 2017 to 2023, stratified by age group, geographic area, and vaccine type, and to examine changes in vaccination coverage among girls aged 13–14 years following the city's enrollment in the pilot subsidy program. HPV vaccination data were sourced from the Sichuan Provincial Immunization Information System. Descriptive analyses assessed annual and cumulative vaccination coverage from 2017 to 2023 among females aged 9–45 years in Chengdu. An interrupted time series (ITS) analysis using a segmented regression model (SRM) was conducted to quantify changes in vaccination rates following program implementation among girls aged 13–14 years. From 2017 to 2023, first- and full-dose HPV vaccination coverage among females aged 9–45 years in Chengdu showed significant upward trends across age groups, geographic areas, and vaccine types. By 2023, cumulative first-dose coverage reached 34.17 %, with full-dose coverage at 24.40 %. Notably, vaccination rates for girls aged 13–14 years exhibited markedly higher first- and full-dose coverage compared to pre-program levels (β = 1.899, p-value = 0.002; β = 4.859, p-value <0.001, respectively). Following the HPV vaccination program in Chengdu, the vaccination rate for girls aged 13–14 years significantly increased. However, the overall vaccination rate for women aged 9–45 years remains relatively low, particularly among certain subpopulations. To enhance overall vaccination rates, strategic priorities should include targeted interventions for subpopulations with suboptimal coverage, expansion of pilot programs, and stronger political commitment to integrating the HPV vaccine into the National Immunization Program. •First- and full-dose HPV vaccine coverage rose markedly in Chengdu from 2017 to 2023.•Subsidized vaccination in 2021 caused a 500-fold increase among girls aged 13–14 years.•Interrupted time series confirmed significant program effects on vaccination uptake.•Socioeconomic disparities in HPV coverage persist across Chengdu's districts.•Nonavalent HPV vaccine had the highest uptake vs. bivalent and quadrivalent vaccines.

Vaccination of pregnant women (PW) is an essential public health measure with benefits for both mothers and newborns. Vaccination against seasonal influenza and pertussis have been recommended in Spain for almost a decade; however, the adherence to this recommendation is variable. The objective of this study was to assess pertussis vaccination coverage (PVC) and influenza vaccination coverage (IVC) among PW in the region of Madrid, Spain, and to explore the factors associated with vaccination. We conducted a retrospective cohort study using administrative registries. For PVC 197,984 PW who gave birth between 2019 and 2022 were included in the study. For IVC, 182,014 PW target of the 2018–19 to 2022–23 seasonal influenza campaigns were included. Generalized estimating equations were used to estimate factors associated with vaccination. The global VC in PW was 87.0 % for pertussis and 53.2 % for influenza. A peak was observed coinciding with the start of COVID-19 vaccination. Factors associated with lower probability of being vaccinated were mother born in a foreign country (Pertussis: aOR:0.73 (95 %CI:0.71–0.76); Influenza: aOR:0.71 (95 %CI:0.69–0.73)), enrolment in public healthcare insurance in last stages or after delivery (Pertussis: aOR:0.04 (95 %CI:0.04–0.05); Influenza: aOR:0.09 (95 %CI:0.08–0.11)) and home births (Pertussis: aOR:0.11 (95 %CI:0.08–0.16); Influenza: aOR:0.22 (95 %CI:0.15–0.31)). PW aged between 30 and 39 years old, with full term pregnancies, who live in areas with middle net incomes and have at least one chronic condition with indication for vaccination were more likely to be vaccinated. Significant challenges remain to improve vaccination uptake in PW, particularly concerning influenza. These findings may prove useful to tailor strategies to reach specific subgroups within the PW population. •Vaccination in pregnancy reduces disease burden in women and their infants.•In Madrid, Spain, vaccine coverage is lower for influenza than for whooping cough.•Vaccination uptake has decreased since COVID-19 pandemic.•Foreign, lower-income and adolescent women are less likely to get vaccinated.•Potential inequalities in maternal immunization coverage should be addressed.

Our objectives were to describe Human Papillomavirus vaccination coverage rates (HPV-VCR), policies, and practical steps for programme implementation that may be linked to high uptake in the population targeted by routine programmes across 30 European Union/European Economic Area Member States and Switzerland. Information from institutional websites and from articles indexed in Medline between 01/2006 and 01/2017 was reviewed and extracted using a standardised form. In 12/2017, a cross-sectional survey was administered to national experts, in order to update the compiled information. Data were available in 31 countries, and validated by national experts in 28 of them. National vaccination programmes targeted girls 9–15 years of age in 30 countries and boys in 11 countries. HPV-VCR in girls was monitored in 25 countries: VCR was reported ≥71%(high) in ten countries, 51–70% in seven, 31–50% in four, and ≤30%(very low) in four. In high VCR countries, HPV vaccination was mainly delivered through school health services, and invitation and reminders to attend for vaccination were used. In areas with very low VCR, vaccination tended to be opportunistic and no reminders were used. According to our findings, school delivery within structured vaccination programmes and the use of reminders tended to be associated with highest HPV-VCR.