Country-level immunization recovery and DTP1 no-dose proxy burden after COVID-19: a descriptive ecological analysis of WUENIC, 2010-2024.

Publication date: Jul 28, 2026

Global immunization averages can obscure entity-level shortfalls in access, series completion, measles coverage, and recovery from 2019. We assessed these signals. The primary analysis used exact-2024-revision WHO/UNICEF WUENIC records for 194 countries/reporting entities during 2010-2024. We estimated recovery from 2019 and DTP1 no-dose proxy burden, quantified DTP3-MCV1 overlap, and assigned ordered phenotypes. We reproduced benchmarks and conducted source-status, target-population-weighted, threshold, and exact-2025-revision sensitivity analyses. Reproduced weighted 2024 estimates were 88. 94% for DTP1, 84. 56% for DTP3, and 84. 03% for MCV1. Unweighted country fixed-effects estimates for 2024 versus 2019 were – 1. 80 percentage points (95% CI -2. 75 to -0. 84) for DTP1, -2. 09 (-3. 25 to -0. 93) for DTP3, and – 1. 65 (-2. 72 to -0. 58) for MCV1; target-population-weighted estimates were closer to zero and imprecise. The DTP1 no-dose proxy count was 14. 26 million; the top 20 entities accounted for 74. 6%. Forty-five entities with DTP3 below 80% and MCV1 below 90% accounted for 72. 8% of the proxy count. Threshold changes reassigned at most 13. 4% of entities. With exact-2025-revision records and the endpoint fixed at 2024, aggregate metrics were similar, but 20 recovery-class and 19 phenotype assignments changed among 194 common entities. Aggregate coverage near 2019 levels coexisted with entity-level access, completion, measles, recovery, and data-review signals. Program managers should review them jointly, not as one ranking; assignments are descriptive and revision-specific, not validated risk scores.

Concepts Keywords
Managers DTP1 no-dose proxy
Measles DTP3 recovery
Vaccine Ecological study
Measles-containing vaccine
Routine immunization
WUENIC

Semantics

Type Source Name
disease MESH COVID-19
disease MESH measles
pathway KEGG Measles

Original Article

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