Beyond zero-dose: routine immunization retention gaps in the Dominican Republic, 2019-2025

Area of Science:

• Public Health
• Immunization Programs
• Global Health

Background:

• The Immunization Agenda 2030 (IA2030) aims to improve global vaccination coverage.
• Monitoring routine immunization performance is crucial for achieving IA2030 goals.
• The Dominican Republic's immunization program is evaluated during the IA2030 mid-term period.

Purpose of the Study:

• To assess routine immunization performance in the Dominican Republic from 2019 to 2025.
• To analyze key indicators including coverage, zero-dose and under-vaccinated children, dropout rates, and HPV vaccination.
• To identify subnational inequalities and post-pandemic recovery trends.

Main Methods:

• Utilized IA2030 dashboard data (2019-2024) and WHO/UNICEF HPV estimates (2025).
• Analyzed national and subnational immunization coverage, zero-dose and under-vaccinated populations.
• Tracked DTP1-to-DTP3 dropout rates and antigen-specific coverage, including HPV.

Main Results:

• Breadth of Protection Index increased from 77.92% (2019) to 85.62% (2025).
• Zero-dose children decreased to 5839 (below target), but under-vaccinated children rose to 19,463.
• DTP1-to-DTP3 dropout rate reached 10.3%; HPV vaccination increased to 56% but remains low.

Conclusions:

• Immunization recovery post-pandemic is uneven in the Dominican Republic.
• Persistent gaps in vaccine retention and significant subnational inequities require focused interventions.
• Continued monitoring and targeted strategies are essential to strengthen routine immunization services.