Which countries still use thimerosal‑preserved multi‑dose vials for routine childhood immunizations in 2026?

1. High‑income countries: phase‑out as the dominant story, with exceptions in practice

Regulators and manufacturers in high‑income regions moved quickly to remove or reduce thimerosal in childhood vaccines beginning around 1999–2001, and the European Union reports no vaccines containing thiomersal as a preservative in routine use ^[1], while U.S. policy and practice have removed or reduced thimerosal from most routinely recommended childhood vaccines except some multi‑dose influenza products ^{[2] [5]}.

2. The United States: largely thimerosal‑free for children, but multi‑dose flu vials remain

U.S. public‑health sources say thimerosal was taken out of routine childhood vaccine formulations in the early 2000s and that, except for influenza vaccines supplied in multi‑dose vials, routine childhood vaccines for children 6 and under are produced without thimerosal for the U.S. market ^{[2] [5]}; contemporary reporting likewise emphasizes that multi‑dose flu vaccine presentations remain available with thimerosal in the U.S. ^{[1] [6]}.

3. Low‑ and middle‑income countries: pragmatic reliance on multi‑dose vials

Global health reporting and older policy reviews show that multi‑dose vials preserved with thimerosal remain an essential tool for immunization programs in many LMICs because they are cheaper, easier to transport and reduce cold‑chain burden compared with single‑dose vials—an operational reality repeatedly noted by WHO, Gavi and vaccine policy analyses ^{[3] [4] [7]}.

4. International tensions: U.S. funding pressure and the downstream effects

Recent investigative reporting documents a policy shift in which U.S. funding to Gavi was conditioned on phasing out thimerosal‑containing vaccines in Gavi’s portfolio—an ultimatum that illustrates both the geopolitical leverage around vaccine formulation and the real programmatic stakes for countries that depend on multi‑dose vials ^{[3] [7] [8]}.

5. Evidence on safety and the drivers of policy, not a country‑by‑country checklist

Scientific reviews and U.S. advisory committees have repeatedly concluded that extensive evidence does not show thimerosal in vaccines causes neurodevelopmental disorders, and regulatory decisions to remove it were largely precautionary and operational rather than based on demonstrated harm; this history explains why policy varies by risk tolerance, supply economics and vaccine presentation choices rather than by a simple safety calculus ^{[9] [1] [5]}.

6. What the reporting cannot say — and what would be needed to answer the question directly

None of the supplied sources provides a comprehensive, up‑to‑date roster of individual countries that still administer routine childhood immunizations from thimerosal‑preserved multi‑dose vials in 2026; answering that precisely would require country‑level procurement or Ministry of Health data, Gavi/WHO vaccine presentation inventories, or manufacturer distribution records for 2025–2026, which are not included in the reporting provided here ^{[3] [4]}.

Conclusion

The available reporting establishes a global pattern—high‑income settings largely phased out thimerosal in childhood vaccines (the EU reports none), the U.S. retains thimerosal in certain multi‑dose influenza products, and many LMICs continue to use thimerosal‑preserved multi‑dose vials for routine immunizations because of cost and logistics—but it does not support a definitive country list for 2026 without additional, country‑level procurement or policy data ^{[1] [2] [3] [4]}.