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Country-level immunization recovery and DTP1 no-dose proxy burden after COVID-19: a descriptive ecological analysis
Jinze Li1, Ziqi Wang1, Yuning Gong1
1University of Electronic Science and Technology of China Shahe Campus, No. 4, Section 2, North Jianshe Road, Chengdu, Sichuan 610054, PR China.
Background:
Global immunization averages can obscure entity-level shortfalls in access, series completion, measles coverage, and recovery from 2019. We assessed these signals.
Methods:
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.
Results:
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.
Conclusion:
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.
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