Countrywide analysis of vaccination rates in Ecuador from 2014 to 2024: Trends, inequalities and public health implications

National vaccination coverages are a key public health indicator and a cornerstone of disease prevention. In Ecuador, coverage rates have varied across age groups, highlighting both advancements and ongoing challenges. This study aims to analyze national vaccination coverage trends, identify regional disparities, and discuss possible factors influencing immunization rates in the country. A nationwide descriptive analysis of vaccination coverage in Ecuador was conducted using official coverage data from 2014 to 2024, derived from aggregate counts reported by health facilities and census-based population estimates, despite limitations due to the absence of a fully functional electronic immunization registry. The study examined vaccine administration across different age groups, including children under one year, children aged 12 to 59 months, school-age children (5 to 15 years), and adults. Descriptive statistics were applied to assess coverage trends over multiple years, and variations by geographic region were analyzed. Vaccination coverage in Ecuador showed marked fluctuations from after 2014 up to 2024. BCG coverage dropped from 90 % pre-pandemic to 75 % in 2021, peaked at 98 % in 2023, then declined to 85 % in 2024. Hepatitis B birth dose fell to 47 % in 2016, recovering to 72 % by 2024. HPV1 dropped from 98 % (2018) to 28 % (2021), rebounding to 82 % in 2023; HPV2 remained lower at 52 %. Adult Td coverage was consistently low (9 % in 2021; 40 % in 2024). Booster doses also declined during the pandemic. Regional disparities persisted, with some areas exceeding 90 % while others remained below 70 %. The national analysis of vaccination coverage in Ecuador highlights both progress and persistent gaps. While early childhood vaccines show high coverage, deficiencies remain in booster doses, adolescent immunization, and adult vaccination. Strengthening outreach, improving equitable access, and addressing regional disparities are essential to sustain immunization rates and prevent vaccine-preventable diseases. In addition, it is necessary to gain a better understanding of the problems and barriers that affect vaccination coverage to design tailored interventions. Further studies are needed to understand the causes of vaccination gaps between rural and urban areas, so as to develop strategies that reduce these inequalities.