Summary

More than 11 million children under age five die each year in developing countries; nearly three-quarters of these deaths result from infectious diseases. The World Health Organization estimates that the deaths of at least four million of these children are linked to their lack of access to vaccines. GAO found that although global immunization coverage for six diseases originally targeted by the World Health Organization (diptheria, measles, pertussis, polio, tetanus, and tuberculosis) has improved significantly since the mid-1970s, coverage rates are low for children living in the poorest countries, particularly in urban slums and remote rural areas. Several interrelated factors have limited the availability of vaccines for children in the developing world, including (1) an inadequate health infrastructure, (2) the relatively higher cost of vaccines recently recommended by the World Health Organization, (3) insufficient information on disease burden and vaccine efficiency, and (4) changing priorities of international donors. In the 1990s, the U.N. Children's Fund and the U.S. Agency for International Development began to reduce their level of support for immunization.

GAO noted that: (1) while global immunization coverage for six diseases originally targeted by the World Health Organization (WHO) has improved significantly since the mid-1970s, coverage rates are low for children living in the poorest countries, particularly in urban slums and remote rural areas; (2) WHO data indicate that the poorest countries of the world have vaccination rates that are about 26 percent below the global average of 82 percent; (3) in fact, immunization coverage in some countries in sub-Saharan Africa has declined over the last decade; (4) some countries in this region reported in 1997 that they immunized less than a third of their children against the six diseases targeted by WHO; (5) many of the children who are not immunized live in countries that have experienced internal conflict in recent years; (6) although the level of coverage varies, few children in developing countries have access to the newer vaccines that have been added more recently to WHO's list of recommended vaccines; (7) several interrelated factors that poor countries have difficulty overcoming have limited the availability of vaccines for children in the developing world, including: (a) inadequate health infrastructure; (b) the relatively higher cost of vaccines recently recommended by WHO; (c) insufficient information on disease burden and vaccine efficacy; and (d) changing priorities of international donors; and (8) in the 1990s, the United Nations Children's Fund and the U.S. Agency for International Development have begun to reduce their level of support for immunization.