[Developing countries] At present, fewer than 20% of the 80 million children born annually in developing countries are being fully immunized. Morbidity and mortality from diphtheria, pertussis, tetanus, measles, poliomyelitis and tuberculosis are still very high. While the reported numbers of cases and deaths may underestimate the extent of the consequences of these six diseases, they are thought to cause some 5 million deaths among children under 5 years, while blinding, crippling, or otherwise permanently disabling an additional 5 million. As is the case with the large numbers of childhood deaths estimated to be due to, for example, diarrhoeal diseases and malaria, these deaths usually occur in the context of severe malnutrition and interacting diseases; and the figures published for individual diseases usually involve considerable overlap. The leading killers are measles, pertussis and neonatal tetanus. The first two diseases affect most unimmunized children under 5 and have case-fatality rates ranging between 1% and 10%, the higher rates being more commonly observed among younger and/or less well nourished children. Although evidence on the subject is relatively scanty, it is thought that neonatal tetanus probably affects fewer than 2% of children born to unimmunized mothers in developing countries, but 70-90% of those infected die.
[Industrialized countries] In 1993 it was reported that, in certain pockets of the USA, fewer than half of all pre-school children have been immunized against standard diseases (compared with more than 80% in some NM / WHO-serviced countries). Cost is part of the reason; vaccinations that were about $7 in 1982 are now more than $200. Many insurance companies, and in some states government benefits, do not cover the expense. But states that do buy and distribute vaccines do not have significantly better immunization rates. The contributory reasons are inconvenient clinic hours, a scarcity of health workers, long waiting lines and a lack of information. Insufficient immunization accounted for the USA measles epidemic of 1989-90.