New report sheds light on immunisation gaps across middle-income countries in Asia

Successes, gaps and areas for urgent attention in the national immunisation programs of 13 ASEAN (Association of South East Asian Nations) and SAARC (South Asian Association for Regional Cooperation) countries have been highlighted in a recent World Health Organization (WHO) study. 

The research – published in Comparative Country Studies – takes stock of the current status of immunisation in 13 countries across South East Asia and South Asia, with a particular focus on how they are navigating the complexities of vaccine delivery and program governance amid evolving support landscapes.

The study examines countries that have previously benefited from donor support – particularly from Gavi, the Vaccine Alliance – and which are now managing the transition to domestic funding. 

Using the WHO’s Essential Programme on Immunization (EPI) review framework, the study team – which included Professor Shenglan Tang (Innovation Lab for Vaccine Delivery Research; VaxLab), Dr Xinyu Zhang (VaxLab) and NCIRS expert Dr Shu (Melinda) Chen (Senior Research Officer, Global Health) – draws on secondary data from government websites, international organisations, peer-reviewed research and internal reports to identify progress and challenges in the countries under review.
 

Significant progress – but disparities remain

While many countries in the region have made substantial progress in introducing new vaccines and increasing vaccine coverage, vaccine uptake remains inconsistent, the WHO research shows. 

Of the 13 countries, only Myanmar and Indonesia had introduced all WHO-recommended vaccines nationwide as at 2024. Notably, vaccination coverage rates for all vaccines in those two countries was also below 80 per cent (Myanmar) and 90 per cent (Indonesia) – below the average for lower-middle income countries.

The rotavirus vaccine was the least adopted among the countries under review and had been included in the national immunisation programs of only five of the 13 nations. 

Coverage rates for human papillomavirus (HPV) and pneumococcal conjugate vaccines were also suboptimal, even as most of the countries reported coverage rates over 90 per cent for vaccines that are already part of their national immunisation programs.
 

Major challenges identified

The report identifies four common barriers to achieving universal vaccine coverage in the 13 countries:

1. Persistent inequities: Significant disparities in vaccine coverage exist both between and within the countries. Marginalised populations are the most acutely affected.
2. Post-Gavi challenges: Countries ‘graduating’ from Gavi support face increasing difficulties in sustaining immunisation services without external funding.
3. Delays in vaccine introduction: Many middle-income countries struggle with the timely introduction of WHO-recommended vaccines due to health system constraints.
4. COVID-19 disruptions: The COVID-19 pandemic significantly impacted routine immunisation services across the region, and long recovery periods are expected.
    

Recommendations for action

To address these challenges, the report recommends the following key actions for both national governments and international partners:

• Strengthen support for middle-income countries: International organisations must refine strategies to prevent backsliding in vaccine coverage as countries transition out of donor support.
• Tackle inequities: National strategies should prioritise reaching under-served populations to close vaccine coverage gaps.
• Build resilient systems: Stronger integration of immunisation into broader health systems is essential for sustainability.
• Recover from COVID-19 disruptions: Countries need support and planning to restore and maintain immunisation services post-pandemic.
• Promote peer learning: Regional forums and knowledge exchanges can help countries adopt successful practices and tailor local solutions.
   

A call for collaboration

The report concludes that improving vaccine coverage across the region will necessitate adaptive, country-specific approaches, coupled with strong regional cooperation. 

Sharing of resources, best practices and policy innovations can help ensure all countries – regardless of income status – move closer to the universal coverage goals set out in the Immunization Agenda 2030.

The study was conducted with funding support from the Gates Foundation.
 

Read the full report