This analysis examined routine immunization performance in the Dominican Republic during the mid-term monitoring window of the Immunization Agenda 2030 (IA2030). The assessment synthesized IA2030 dashboard data for 2019–2024 and incorporated updated 2025 World Health Organization/UNICEF (WUENIC) and WHO/UNICEF HPV estimates to evaluate national and subnational routine immunization outcomes.
The analysis focused on multiple complementary indicators to describe both access and retention: national vaccine coverage across antigens, counts of zero-dose children (those who have not received any routine vaccines), counts of under-vaccinated children, the DTP1-to-DTP3 dropout rate as a measure of retention, antigen-specific coverage through 2025, and subnational inequality through 2024.
Data sources explicitly reported in the abstract include the IA2030 dashboard for 2019–2024 and updated 2025 WUENIC and WHO/UNICEF HPV estimates. Using these sources, the authors analyzed:
The abstract describes population counts and percentage indicators derived from these data sources; further methodological detail beyond the data sources and selected indicators is not provided in the abstract.
The study reports the Breadth of Protection Index as a composite measure of protection across routine vaccines. According to the abstract, the index increased from 77.92% in 2019 to 85.62% in 2025. The 2025 value was calculated in accordance with the WHO definition. This upward trend indicates improved breadth of antigen coverage at the national level during the assessment period, as captured by the IA2030 and WHO/UNICEF data used.
The number of zero-dose children in the Dominican Republic declined over the period analyzed: from 8,262 in 2019 to 5,839 in 2025. The 2025 count of zero-dose children was reported as being below the expected trajectory for 2025 (the expected trajectory value reported in the abstract is 6,009).
Despite progress in reducing zero-dose children, the count of under-vaccinated children rose during the same period, increasing from 14,459 to 19,463. This divergence—fewer children with no doses but more children failing to complete recommended schedules—highlights retention and follow-up challenges within the routine program.
The authors report a national DTP1-to-DTP3 dropout rate that reached 10.3% by the end of the period examined. The DTP1-to-DTP3 dropout metric is widely used to measure retention between the first and third doses of diphtheria–tetanus–pertussis-containing vaccine; a higher dropout rate indicates gaps in follow-up and completion of multi-dose schedules.
In this assessment, the combination of a declining zero-dose count and a rising under-vaccinated population together with a notable dropout rate signals persistent retention gaps in the routine immunization system during the IA2030 mid-term period.
The study highlights that completed HPV vaccination coverage among girls improved substantially, increasing from 6% to 56% across the analysis period. Despite this large relative increase, HPV completed coverage remained the lowest among the selected indicators reported in the abstract, indicating continued room for improvement in adolescent vaccination and HPV program delivery.
The abstract reports that post-pandemic recovery in routine immunization was uneven and that subnational inequities persisted through 2024. While national-level indices such as the Breadth of Protection Index and reductions in zero-dose counts show progress, the analysis documents geographic disparities and retention challenges at subnational levels. The abstract does not provide detailed subnational figures in the summary.
The authors conclude that, although some indicators improved (notably the Breadth of Protection Index and reductions in zero-dose children), the overall picture shows persistent retention gaps, rising counts of under-vaccinated children, appreciable DTP3 dropout, and subnational inequities. These findings point to the need for targeted actions to strengthen follow-up, completion of vaccine schedules, and equity in service delivery.
The abstract does not present detailed methods beyond the data sources used, nor does it include granular subnational data, specific programmatic interventions tested, or stepwise recommendations; those details would need to be consulted in the full text. The authors declare no competing interests in the conflict-of-interest statement.