By Chris Adams

While public health officials in the United States have been grappling with the choices that some citizens make to skip their vaccinations, in much of the world the challenge is far simpler: Getting enough vaccines to immunize all those who want it.

Dr. Rahul Gupta, chief medical and health officer for health philanthropy March of Dimes, said  global vaccination worldwide – the proportion of the world’s children who receive recommended vaccines – is about 86%. Each year, he said, those vaccinations prevent 2 to 3 million deaths.

But there are another 1.5 million deaths that could be prevented if global immunization coverage improves. As it stands, an estimated 19 million children under the age of 1 have not received basic vaccinations.

There is also a big range in the number of vaccines countries put on their list of recommendations. While the United States and other countries in the Americas and Europe recommend more than 10, other nations only include seven, eight or nine vaccines.

“The idea is to push to get more countries to adopt more vaccines,” said Gupta.

Consider the DPT vaccine, for diphtheria, tetanus and pertussis. While the U.S. and many other nations have coverage at more than 95%, several countries in Africa and South Asia are at 60% or less. Coverage is increasing, for wealthy and poor countries alike – but it still has a long way to go.

The history of polio shows why public health officials push vaccinations. While the disease was eradicated in the United States in 1979, it lingered worldwide, with an estimated few hundred thousand cases into the late 1980s. In 1988, the World Health Assembly passed a resolution to eradicate the disease, and after that the number of cases plummeted as countries emphasized vaccination. It’s been virtually zero for the last two decades (22 cases in 2017).

“Even in countries where resources for national health programs are severely limited, it has been possible to achieve significant progress,” he told fellows.

The countries with the most unvaccinated children are developing nations, with Nigeria, India and Pakistan topping the list.