Global childhood immunization coverage stagnated in 2023, with an additional 2.7 million children left un- and under-vaccinated compared to pre-pandemic levels in 2019. This alarming trend, reported by the World Health Organization (WHO) and UNICEF, highlights a critical need for concerted catch-up and system-strengthening efforts.
STALLED IMMUNIZATION EFFORTS
The latest WHO and UNICEF estimates of national immunization coverage (WUENIC) provide comprehensive data on vaccination trends against 14 diseases. These estimates underscore the urgency of addressing immunization gaps through global cooperation.
KEY INSIGHTS
“The latest trends demonstrate that many countries continue to miss far too many children,” said UNICEF Executive Director Catherine Russell. Closing the immunization gap demands a global effort, with investments in primary healthcare and community workers to ensure every child is vaccinated and overall healthcare is strengthened.
DIPTHERIA, TETANUS, AND PERTUSSIS (DTP) COVERAGE
In 2023, the number of children receiving three doses of the DTP vaccine stalled at 84% (108 million). Disturbingly, the number of children who did not receive any dose increased from 13.9 million in 2022 to 14.5 million in 2023.
VULNERABLE POPULATIONS
More than half of these unvaccinated children live in 31 countries characterized by fragile, conflict-affected, and vulnerable settings. These children are especially at risk of preventable diseases due to disruptions and lack of access to security, nutrition, and health services. Additionally, 6.5 million children did not complete their third DTP dose, essential for disease protection in infancy and early childhood.
CHALLENGES IN IMMUNIZATION
The stagnation in global immunization coverage since 2022, and the failure to return to 2019 levels, reflect persistent challenges. These include disruptions in healthcare services, logistical issues, vaccine hesitancy, and inequities in access to services.
MEASLES OUTBREAKS
Low vaccine coverage has already driven measles outbreaks. Nearly 35 million children remain un- or under-vaccinated against this deadly disease. In 2023, only 83% of children received their first dose of the measles vaccine, while the second dose coverage increased modestly to 74%. These figures fall short of the 95% needed to prevent outbreaks and achieve elimination goals.
GLOBAL IMPACT
Over the last five years, measles outbreaks have hit 103 countries, home to three-quarters of the world’s infants. Countries with low vaccine coverage (80% or less) were significantly impacted, while 91 countries with strong coverage avoided outbreaks.
“Measles outbreaks are the canary in the coalmine, exposing and exploiting gaps in immunization,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “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 to close these gaps and protect the most at-risk children as quickly as possible.”
HPV VACCINE PROGRESS
Despite these challenges, there are brighter spots in immunization coverage. The introduction of new and under-utilized vaccines, such as the human papillomavirus (HPV) vaccine, has shown positive trends. The proportion of adolescent girls receiving at least one dose of the HPV vaccine increased from 20% in 2022 to 27% in 2023, driven by strong introductions in countries supported by Gavi, the Vaccine Alliance.
HPV COVERAGE INSIGHTS
“The HPV vaccine is one of the most impactful vaccines in Gavi’s portfolio,” said Dr. Sania Nishtar, CEO of Gavi. “With vaccines now available to over 50% of eligible girls in African countries, we see a clear pathway to eliminating cervical cancer.” However, HPV vaccine coverage remains well below the 90% target, reaching only 56% of adolescent girls in high-income countries and 23% in low- and middle-income countries.
NEED FOR INCREASED AWARENESS
A recent poll of over 400,000 users of UNICEF’s U-Report revealed that over 75% are unaware or unsure of what HPV is. When informed, 52% expressed a desire to receive the vaccine but were hindered by financial constraints (41%) and lack of availability (34%).
CALL TO ACTION
While some regions, including the African region and low-income countries, have made modest progress, accelerating efforts is crucial 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 collaboration. The council recommends partners support country leadership to improve routine immunization as part of integrated primary health care programs, backed by robust political support, community leadership, and sustainable funding.
