Mohammad Hanief
Despite steady global immunization coverage and modest gains in childhood vaccinations, more than 14 million infants worldwide received no routine vaccines in 2024, according to a report released on Tuesday by the World Health Organization (WHO) and UNICEF. These so-called “zero-dose” children remain vulnerable to preventable diseases like diphtheria, tetanus, and whooping cough-conditions that have been largely eliminated in countries with strong vaccination programs.
The report shows that 89% of infants globally-around 115 million children-received at least one dose of the diphtheria, tetanus, and pertussis (DTP) vaccine last year. Meanwhile, 85% (approximately 109 million) completed the full three-dose series, representing an increase of 171,000 and 1 million children, respectively, compared to 2023.
While these figures reflect a steady recovery following the setbacks caused by the COVID-19 pandemic, global health leaders are warning against complacency. The number of zero-dose children rose to 14.3 million, exceeding the 2024 target by 4 million and remaining 1.4 million higher than in 2019-the benchmark year used to track progress under the Immunization Agenda 2030.
“Vaccines save lives, allowing individuals, families, communities, economies, and nations to flourish,” Dr.TedrosAdhanomGhebreyesus, WHO director-general has said in a press release and further added that It’s encouraging to see a continued increase in the number of children being vaccinated, although we still have a lot of work to do. Drastic cuts in aid, coupled with misinformation about the safety of vaccines, threaten to unwind decades of progress.
The WHO and UNICEF data, collected from 195 countries, paints a mixed picture of immunization efforts across income levels and regions. Since 2019, 131 countries have managed to maintain at least 90% coverage for the first dose of the DTP vaccine-a key benchmark for routine childhood immunization programs. However, of the countries that were below that threshold in 2019, only 17 improved their rates in the past five years.
In contrast, 47 countries experienced stalled or declining progress, including 22 nations that had previously reached the 90% coverage milestone but have since regressed.
Global health officials are particularly concerned about children living in areas affected by conflict, fragility, and humanitarian crises. Although these settings represent only 26 countries, they account for a staggering 50% of all zero-dose children. The number of children missing out on vaccines in these areas rose sharply from 3.6 million in 2019 to 5.4 million in 2024, highlighting the outsized impact of instability on healthcare systems.
“Fragile health systems, supply disruptions, and displacement continue to hinder vaccination efforts,” said Catherine Russell, executive director of UNICEF. “No child should die from a disease we know how to prevent.”
While the data reflects severe challenges in fragile states, it also reveals some positive developments. In 57 low-income countries supported by Gavi, the Vaccine Alliance, vaccination coverage has improved steadily over the past year. The number of under- and unvaccinated children in these countries declined by roughly 650,000, thanks to renewed investments and expanded immunization campaigns.
“In 2024, lower-income countries protected more children than ever before,” said Dr.SaniaNishtar, CEO of Gavi. “Coverage rates are increasing across all Gavi-supported vaccines. Yet population growth, fragility, and conflict present major hurdles to achieving equity, leaving the most vulnerable children and communities at risk.”
At the same time, experts are sounding the alarm about declining vaccine coverage in upper-middle- and high-income countries-nations that have historically led the way in immunization rates. Even small drops in vaccine uptake in these countries can significantly increase the risk of disease outbreaks, particularly in densely populated areas.
Several factors have contributed to these emerging declines, including misinformation, complacency, and increasing vaccine hesitancy among the public. These trends, if left unchecked, could reverse decades of global progress against vaccine-preventable diseases.
In addition to tracking DTP coverage, the WHO and UNICEF report highlights progress-and persistent challenges-in expanding the reach of other vaccines. Among the most notable is the rise in coverage for the human papillomavirus (HPV) vaccine, which protects against cervical cancer and other HPV-related diseases.
In 2024, 31% of eligible adolescent girls received at least one dose of the HPV vaccine-a significant jump from 17% in 2019. Most of the gains came from countries adopting a single-dose schedule and scaling up national programs, especially with Gavi’s support. Still, this figure falls well short of the 90% global target set for 2030.
Measles, another major concern, also saw a slight improvement. 84% of children received the first dose of the measles vaccine, and 76% received the second. However, coverage remains far below the 95% threshold needed to prevent outbreaks. As a result, over 30 million children remain under-protected, and the number of countries experiencing large or disruptive measles outbreaks nearly doubled-from 33 in 2022 to 60 in 2024.
These outbreaks are a stark reminder that even small coverage gaps can quickly spiral into public health emergencies, especially in communities with limited access to healthcare services.
The latest immunization data arrives at a critical juncture. While global vaccine demand remains high and many countries continue to make progress, funding shortfalls, political instability, and the rise of anti-vaccine sentiment present serious risks to long-term health outcomes.
The global vaccination landscape is at a crossroads. On one hand, new vaccine technologies, simplified delivery strategies, and increased collaboration are creating unprecedented opportunities to protect the next generation. On the other, long-standing inequities, new geopolitical challenges, and a shifting information environment threaten to stall or reverse progress.
With just five years left to meet the Immunization Agenda 2030 goals, health experts say the next phase will require not just international coordination, but political will, community trust, and sustained investment.
The stakes could not be higher. In a world where vaccines can prevent suffering and save millions of lives, ensuring that every child, everywhere, receives their full course of immunizations is not only a moral imperative-it’s a matter of global health security.
