The Europe and Central Asia (ECA) region12 has consistently demonstrated its effective healthcare systems to achieve high immunization coverage. In 2023, the region achieved DTP1 (Diphtheria, Tetanus, Pertussis) and DTP3 coverage rates of 97 and 95 per cent, respectively, along with a slight improvement in MCV1 (Measles-Containing-Vaccine) coverage of 95 per cent, an improvement from 94 per cent observed the previous year. These figures reflect the strength of healthcare infrastructures, the commitment of health workers, and the successful integration of immunization services into primary healthcare systems. Key factors to success include home-visit programs and well-trained healthcare workforce, both of which have played vital roles in maintaining these high coverage rates.
12 UNICEF’s Europe and Central Asia Region includes all countries in Europe and Central Asia.
However, beneath these impressive figures lie persistent challenges. The overall averages mask significant disparities between countries, highlighting the need for targeted interventions to address the hidden inequities and close immunity gaps effectively.
Moreover, measles outbreaks, which follow a cyclical pattern every 4–5 years, serve as a stark reminder of hidden immunity gaps13 :
13 World Health Organisation (WHO), Measles/Rubella dashboard, accessed on 16 Dec 2024.
These gaps, often obscured by aggregated data, undermine regional achievements and can lead to preventable disease outbreaks. Alarmingly, 36 per cent of global measles cases recorded between January and August 2024 originated from the ECA region, with five out of the ten countries reporting the highest incidence rates worldwide located in this region. In addition, the year 2024 has witnessed one of the largest whooping coughs (pertussis) outbreaks in recent years, with infection resurging across many countries in the region.
Finally, while high coverage rates are celebrated, they often mask inequities and pockets of unvaccinated or under-immunized populations. The number of zero-dose children has increased during the pandemics due to interruptions in immunization services. Although countries are gradually recovering from the pandemics, significant efforts are needed to close the gaps and ensure equitable vaccine coverage14 :
14 WHO, Immunization Data. Accessed on 16 December 2024.
The inequities within countries play an important role in closing immunization gaps, with marginalized groups such as the Roma community, disproportionately affected by vaccine-preventable diseases. These children often face systemic barriers, including mistrust of healthcare systems, limited access to services, and geographical isolation. Data reveals that Roma children are 1.83 times less likely to be vaccinated with the DTP3 vaccine compared to their peers.15
15 UNICEF ECARO, Breaking barriers: An analytical report on Roma children and women in Kosovo (UNSCR 1244), Montenegro, North Macedonia and Serbia: A summary of findings from four MICS surveys in Roma settlements, p. 18.
Recent surveys have highlighted disparities in immunization coverage, exposing discrepancies between administrative data and survey findings. These differences suggest that coverage rates may be overstated in certain areas, emphasizing the need for precise data collection and analysis to uncover hidden vulnerabilities and effectively reach all children.
Tackling these challenges requires a multi-pronged approach that prioritizes equity and precision. Enhanced surveillance systems are critical for identifying zero-dose children and under-immunized populations. UNICEF’s Immunization Dashboard, accessible on the UNICEF website, provides analytical data at both national and subnational levels.16 Additionally, MICS (Multiple Indicator Cluster Surveys) are being used in several countries to collect disaggregated immunization data.
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Additionally, UNICEF has been working with countries in developing tailored strategies that focus on marginalized communities. Outcome targeted interventions ensure that every child is protected against vaccine-preventable diseases. A notable success story is the involvement of Roma health mediators in Kosovo (S/RES/1244, 1999)17, which significantly improved vaccination coverage rates, demonstrating the effectiveness of community-based approach.
17 References to Kosovo are to be understood in the context of the United Nations Security Council Resolution 1244 from 1999: S/RES/1244 (1999).
Immunization is among the most effective health interventions, with profound impacts on reducing child mortality and improving public health outcomes. Yet, the financing environment is becoming increasingly complex due to economic challenges, donor dependencies, and rising costs of new vaccines. UNICEF is supporting the countries to enhance capacities for efficient public budgets planning, increasing allocations to immunization, and strengthening primary healthcare systems to improve service delivery and workforce capacity.
Finally, strengthening partnerships and advocacy is essential to drive country-specific responses and foster policy changes that address immunization gaps. Collaboration between governments, international organizations, and local communities can ensure that interventions are tailored to meet the unique challenges of each country. Advocacy efforts are critical to elevate immunization as a national priority, secure sufficient resources, and integrate equity-focused strategies into health policies. By leveraging on these partnerships, countries can not only close immunity gaps but also build resilient healthcare systems capable of reaching every child and ensuring sustainable public health outcomes.
United Nations Economic Commission for Europe
Palais des Nations, Geneva
