Global childhood immunization levels stagnated in 2023, leaving an additional 2.7 million children un- and under-vaccinated compared to pre-pandemic levels in 2019, according to the latest data from the World Health Organization (WHO) and UNICEF.
The WHO and UNICEF’s estimates of national immunization coverage (WUENIC) provide the most comprehensive dataset on immunization trends for vaccines against 14 diseases. The data highlights the urgent need for continued catch-up, recovery, and strengthening of immunization systems.
“The latest trends demonstrate that many countries continue to miss far too many children,” said UNICEF Executive Director Catherine Russell. “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.”
In 2023, the number of children receiving three doses of the diphtheria, tetanus, and pertussis (DTP) vaccine, a key marker of global immunization coverage, stalled at 84% (108 million children). 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 live in 31 countries characterized by fragile, conflict-affected, and vulnerable settings, where disruptions and lack of access to security, nutrition, and health services make children especially susceptible to preventable diseases.
Additionally, 6.5 million children did not complete their third dose of the DTP vaccine, essential for disease protection in infancy and early childhood.
The data also reveals concerning trends for measles vaccination. Nearly 35 million children had no or only partial protection against this deadly disease in 2023. Only 83% of children worldwide received their first dose of the measles vaccine through routine health services, and while the number of children receiving their second dose increased modestly to 74%, these figures fall short of the 95% coverage needed to prevent outbreaks and achieve measles elimination.
Over the past five years, measles outbreaks have affected 103 countries, which are home to about three-quarters of the world’s infants. Countries with low vaccine coverage (80% or less) were particularly hard hit, whereas 91 countries with strong measles vaccine coverage avoided outbreaks.
“Measles outbreaks are the canary in the coalmine, exposing and exploiting gaps in immunization and hitting the most vulnerable first,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “This is a solvable problem. Measles vaccine is cheap and can be delivered even in the most difficult places. WHO is committed to working with all our partners to support countries in closing these gaps and protecting the most at-risk children as quickly as possible.”
Despite these challenges, there are bright spots in immunization coverage. The introduction of new and under-utilized vaccines, including those for human papillomavirus (HPV), meningitis, pneumococcal, polio, and rotavirus disease, has expanded protection, particularly in the 57 countries supported by Gavi, the Vaccine Alliance.
For example, the percentage of adolescent girls worldwide who received at least one dose of the HPV vaccine, which protects against cervical cancer, increased from 20% in 2022 to 27% in 2023. This improvement was driven by strong vaccine introductions in Gavi-supported countries such as Bangladesh, Indonesia, and Nigeria. The adoption of a single-dose HPV vaccine schedule also contributed to increased coverage.
“The HPV vaccine is one of the most impactful vaccines in Gavi’s portfolio, and it is incredibly heartening that it is now reaching more girls than ever before,” said Dr. Sania Nishtar, CEO of Gavi. “With vaccines now available to over 50% of eligible girls in African countries, we have much work to do, but today we can see a clear pathway to eliminating this terrible disease.”
However, HPV vaccine coverage remains far below the 90% target needed to eliminate cervical cancer as a public health problem, reaching only 56% of adolescent girls in high-income countries and 23% in low- and middle-income countries.
A recent poll of over 400,000 users of UNICEF’s digital platform for young people, U-Report, revealed that over 75% are unaware or unsure of what HPV is. When informed about the virus, its link to cancers, and the existence of a vaccine, 52% of respondents indicated they wanted the HPV vaccine but were hindered by financial constraints (41%) and lack of availability (34%).
While there has been modest progress in some regions, including the African region and low-income countries, the latest estimates underscore the need to accelerate efforts to meet the Immunization Agenda 2030 (IA2030) targets. These targets aim for 90% coverage and no more than 6.5 million ‘zero-dose’ children globally by 2030.
The IA2030 Partnership Council calls for increased investment in innovation and ongoing collaboration. It recommends that partners enhance their support for country leadership to improve routine immunization as part of integrated primary healthcare programs, backed by robust political support, community leadership, and sustainable funding.
To achieve these ambitious goals, a coordinated and comprehensive effort is essential. Governments, healthcare providers, and communities must work together to ensure that every child receives the life-saving vaccines they need, paving the way for a healthier future for all.
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