Recent data from the World Health Organization (WHO) and UNICEF revealed that global childhood immunization coverage remained stagnant in 2023. This left an additional 2.7 million children un- and under-vaccinated compared to pre-pandemic levels in 2019. The latest estimates of national immunization coverage (WUENIC) provided the most comprehensive dataset on vaccination trends for 14 diseases, highlighting the urgent need for catch-up, recovery, and system-strengthening efforts.
India, in particular, had the second highest number of children who did not receive any vaccine in 2023, with 1.6 million “zero-dose” children, following Nigeria with 2.1 million. The report also noted that India had the third highest number of “measles zero-dose children” at 1.6 million, with Nigeria and the Democratic Republic of Congo taking the top spots.
UNICEF emphasized the gravity of the situation, noting that many countries continue to miss far too many children. Closing the immunization gap requires a global effort, with governments, partners, and local leaders investing in primary healthcare and community workers to ensure every child gets vaccinated, and that overall healthcare is strengthened.
DTP Vaccination Coverage Stalled
The findings showed that the coverage for the diphtheria, tetanus, and pertussis (DTP) vaccine, a key marker for global immunization coverage, stalled at 84% in 2023. However, the number of children who did not receive a single dose of the vaccine increased from 13.9 million in 2022 to 14.5 million in 2023. More than half of these unvaccinated children lived in 31 countries with fragile, conflict-affected, and vulnerable settings, where access to health services, nutrition, and security is severely limited. Additionally, 6.5 million children did not complete their third dose of the DTP vaccine, necessary for effective disease protection in early childhood.
Measles Outbreaks Linked to Low Vaccine Coverage
Vaccination rates for measles also stalled, leaving nearly 35 million children with no or only partial protection. In 2023, only 83% of children worldwide received their first dose of the measles vaccine, while the number of children receiving their second dose modestly increased to 74%. These figures fall short of the 95% coverage needed to prevent outbreaks and achieve measles elimination goals. Over the past five years, measles outbreaks occurred in 103 countries, home to approximately three-quarters of the world’s infants, with low vaccine coverage being a significant factor.
WHO highlighted that measles outbreaks expose and exploit gaps in immunization, affecting the most vulnerable first. This issue is seen as solvable, as the measles vaccine is inexpensive and can be delivered even in challenging environments. WHO is committed to working with partners to support countries in closing these gaps and protecting the most at-risk children as quickly as possible.
Progress in HPV Vaccine Coverage
The data also highlighted some positive trends, particularly in the introduction of new and under-utilized vaccines. The coverage of the human papillomavirus (HPV) vaccine among adolescent girls increased from 20% in 2022 to 27% in 2023, largely driven by strong introductions in Gavi-supported countries such as Bangladesh, Indonesia, and Nigeria. The use of the single-dose HPV vaccine schedule also contributed to this increase.
Gavi, the Vaccine Alliance, noted that the HPV vaccine is now reaching more girls than ever before. With vaccines now available to over 50% of eligible girls in African countries, there is still much work to be done, but there is a clear pathway to eliminating cervical cancer.
Despite this progress, HPV vaccine coverage remains well below the 90% target needed to eliminate cervical cancer as a public health problem. A recent poll of over 400,000 users of UNICEF’s digital platform, U-Report, revealed that over 75% of young people were unaware or unsure of what HPV is, underscoring the need for better vaccine accessibility and public awareness.
Urgent Action Needed
The latest estimates highlighted the need to accelerate efforts to meet the Immunization Agenda 2030 (IA2030) targets of 90% coverage and reducing the number of ‘zero-dose’ children to no more than 6.5 million globally by 2030. The IA2030 Partnership Council called for increased investment in innovation, ongoing collaboration, and robust local action to reach everyone, everywhere with vaccines.
The 2023 WHO/UNICEF report, based on member states’ data up to July 1, 2024, and the 2024 World Bank Development Indicators Online, highlighted the critical need for political support, community leadership, and sustainable funding to improve routine immunization and integrated primary health care programs.
The WHO/UNICEF estimates of national immunization coverage began to be produced in 1999 and initially covered just five vaccines. In 2001, revisions were made to the methodology, the process was rolled out across countries, and the first WUENIC estimates were published. Since then, the methodology has been improved, the estimates have been produced every year, and vaccination coverage estimates are now made for 195 countries and 16 vaccines/antigens/doses. A worrying number of children still receive no essential childhood immunizations. In 2023, there were 11 million ‘zero-dose children’ in Gavi-supported countries, a 0.5 million increase since 2022. India had the second highest number of such children at 1.6 million, just after Nigeria with 2.1 million. Additionally, India was among the top ten countries accounting for 55% of children without measles vaccines globally.
https://www.unicef.org/india/what-we-do/immunization
https://www.gavi.org/vaccineswork/global-immunisation-2023-7-things-you-need-know