Disparities and barriers to life-course vaccination in Ethiopia: Evidence from a household survey

Achieving equitable access to life-course vaccination is a central objective of the global Immunization Agenda 2030 (IA2030). Ethiopia has made notable gains in routine immunization; however, disparities remain, particularly in underserved, pastoralist, and conflict-affected regions. This study assessed vaccination coverage, disparities, and barriers to service utilization across four regions of Ethiopia. A community-based cross-sectional survey was conducted in 57 woredas (districts) of Afar, Amhara, Oromia, and Tigray Regional states. Trained health workers administered digital questionnaires with GPS-enabled devices to caregivers, and eligible individuals subsequently received vaccines. The study enumerated 1.2 million households comprising 5.3 million individuals, including children under five, adolescent girls (9-14 y), pregnant women, and person aged 12 y and above. Descriptive and geospatial analyses were applied to examine coverage levels and disparities. The findings were revealed that 9.1% were zero dose, and 11.2% under-immunized, with measles-containing vaccine (MCV1) coverage at 88.3% among children aged 12-59 months. In addition, 79.6% of pregnant women were received tetanus-diphtheria (Td) vaccine, 75.3% of adolescent girls received Human Papilloma Virus (HPV) vaccine, while only almost half 53.8% of individuals aged 12 y and above received COVID-19 vaccine. Marked regional disparities were emerged: Afar recorded the highest zero-dose prevalence (24%), whereas Amhara and Tigray reported disparity levels below 10%. Despite progress in routine immunization, inequities persist, disproportionately affecting remote and marginalized populations. Addressing these gaps requires integrating geospatial microplanning, expanding mobile outreach, and applying culturally tailored demand-generation strategies to ensure equitable vaccine access and advance IA2030 targets.