14.5 million children across the world missed out on any vaccination in 2023, according to the latest WHO and UNICEF estimates of national immunization coverage (WUENIC).
According to the report, the number of children who received three doses of the vaccine against diphtheria, tetanus and pertussis (DTP) in 2023 – a key marker for global immunization coverage – stalled at 84% (108 million). 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.
The new data reveal nearly 3 in 4 infants live in countries where low vaccine coverage is driving measles outbreaks. According to the report, of the 21 million, just under 60% of these children live in 10 countries: Afghanistan, Angola, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Sudan and Yemen.
The global health agency also stated that some populous countries contribute heavily to global figures, despite high rates of immunization coverage. For instance, in 2023, India accounted for 2 million zero-dose children, despite achieving 93 per cent coverage for a cohort of 22.7 million surviving infants.
“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.”
More than half of unvaccinated children live in the 31 countries with fragile, conflict-affected and vulnerable settings, where children are especially vulnerable to preventable diseases because of disruptions and lack of access to security, nutrition, and health services.
Additionally, 6.5 million children did not complete their third dose of the DTP vaccine, which is necessary to achieve disease protection in infancy and early childhood.
“These trends, which show that global immunization coverage has remained largely unchanged since 2022 and – more alarmingly – has still not returned to 2019 levels, reflect ongoing challenges with disruptions in healthcare services, logistical challenges, vaccine hesitancy and inequities in access to services,” WHO said in a statement.
What is the status of measles vaccination?
The data further show that vaccination rates against the deadly measles disease 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 through routine health services, while the number of children receiving their second dose modestly increased from the previous year, reaching 74% of children. These figures fall short of the 95% coverage needed to prevent outbreaks, avert unnecessary disease and deaths, and achieve measles elimination goals.
Over the last five years, measles outbreaks hit 103 countries – home to roughly three-quarters of the world’s infants. Low vaccine coverage (80% or less) was a major factor. In contrast, 91 countries with strong measles vaccine coverage did not experience outbreaks.
“Measles outbreaks are the canary in the coalmine, exposing and exploiting gaps in immunization and hitting the most vulnerable first,” 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.”
Around 1.6 million children in India have not been administered the measles vaccine in 2023. The report found that India is among 10 countries that account for 55 percent of children without measles vaccine globally.
It is important to highlight that India had reported a measles outbreak in at least five states in 2022 due to a drop in vaccination coverage for vulnerable kids during the COVID-19 pandemic years. Maharashtra reported the highest number of cases and deaths due to measles. Now, in 2023 the country has reported further dip in immunisation as compared to 2022.
What is the status of HPV vaccine coverage?
The new data also highlight some brighter spots in immunization coverage. The steady introduction of new and under-utilized vaccines, including for human papillomavirus (HPV), meningitis, pneumococcal, polio and rotavirus disease, continue to expand the breadth of protection, particularly in the 57 countries supported by Gavi, the Vaccine Alliance.
For example, the share of adolescent girls globally who received at least 1 dose of the HPV vaccine, which provides protection against cervical cancer, increased from 20% in 2022 to 27% in 2023. This was 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 helped boost vaccine 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, the Vaccine Alliance. “With vaccines now available to over 50% of eligible girls in African countries, we have much work to be done, but today we can see we have a clear pathway to eliminating this terrible disease.”
However, HPV vaccine coverage is well below the 90% target 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, underscoring the need for better vaccine accessibility and public awareness. When informed about the virus, its link to cancers, and the existence of a vaccine, 52% of respondents indicated they want to receive the HPV vaccine but are hindered by financial constraints (41%) and lack of availability (34%).
Moreover, India is among 51 countries that have not yet introduced free vaccination against the human papilloma virus (HPV).
While there’s been modest progress in some regions, including the African region and low-income countries, the latest estimates highlight the need to accelerate efforts to meet the Immunization Agenda 2030 (IA2030) targets of 90% coverage, and no more than 6.5 million ‘zero-dose’ children globally by 2030, WHO maintained.
