Background and Objectives:
Childhood vaccinations have considerably averted morbidity and mortality from Vaccine-Preventable Diseases (VPD) worldwide. Despite a high overall national vaccination coverage in Israel, there are communities with suboptimal coverage and recurrent VPD outbreaks (e.g. measles). These communities mainly reside in the Jerusalem district. We aimed to evaluate the vaccination coverage in the Jerusalem district compared to the national rates and describe the challenge of addressing these communities.

Methods:
Childhood vaccinations are included in Israel’s National Health Insurance Law. Community-based health clinics provide free vaccination to all children. Vaccinations are not mandatory. The vaccination coverage data for 2017-2022 were retrieved from the National Immunization Registry. The vaccines evaluated were Diphtheria, Tetanus, acellular Pertussis, polio, Haemophilus influenzae b (DTaP-IPV-Hib4: dose 4) and Measles-Mumps-Rubella/Measles-Mumps-Rubella-Varicella (MMR /MMRV1), both scheduled at age 12 months. The national population is 9.3 million, children (0-17 years) consist a third of the population. The national birth cohort is 185,000 with 35,000 in the Jerusalem district.

Results:
The overall national vaccination coverage rates (%) were adequate and lower in the Jerusalem district. The mean vaccination coverage rates for DTaP-IPV-Hib4 and MMR /MMRV1 were 95.1±2.1 and 97.5±1.6 in the country overall, compared to 88.4±4.8 and 96.3±2.6 in the Jerusalem district, respectively. A trend of decline was observed during the COVID-19 pandemic years (2020-2022), nationally and prominently in Jerusalem. The decline was more noticeable in the DTaP-IPV-Hib4 (90.7% nationally and 78.8% in Jerusalem in 2022) than in MMR /MMRV1 (94.2% nationally and 91.5% in Jerusalem in 2022). Vaccination campaigns and supplemental immunization activities are carried out constantly in the Jerusalem district hard-to-vaccinate communities

Conclusion:
While aggregated vaccination coverage rates are nationally high, disaggregated data reveal gaps among population groups. Vaccinations gaps have been reported globally and deepened during the COVID-19 pandemic. Sustainable public health programs and community-based campaigns are essential.