The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have raised serious concerns over the stagnation in global immunization coverage since 2022, which has failed to return to pre-pandemic levels. In a newly published report, these global bodies highlight that approximately 2.7 million children remain un- or under-vaccinated, a situation that demands urgent global attention.

According to the latest WHO and UNICEF estimates of national immunization coverage (WUENIC), the number of children receiving three doses of the diphtheria, tetanus, and pertussis (DTP) vaccine—a key indicator of immunization coverage—has remained stagnant at 84 percent, covering 108 million children in 2023. Alarmingly, the number of children who did not receive a single dose of the DTP vaccine rose from 13.9 million in 2022 to 14.5 million in 2023.

The report underscores that more than half of the unvaccinated children live in fragile and conflict-affected countries where access to essential healthcare, nutrition, and security is severely limited, leaving them highly vulnerable to preventable diseases.

Catherine Russell, Executive Director of UNICEF, emphasized the need for a coordinated global effort to bridge the immunization gap. “The latest trends demonstrate 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,” she stated.

The report also highlights a worrying resurgence of measles outbreaks. In 2023, global measles vaccination rates fell short of the 95 percent coverage needed for elimination, with only 83 percent of children receiving their
first dose and 74 percent receiving their second dose. This left a significant gap in protection against outbreaks, disease, and preventable deaths.

Between 2018 and 2023, 103 countries, accounting for about 75 percent of the global infant population, experienced measles outbreaks, largely attributed to vaccination coverage falling below 80 percent. In contrast, 91 countries with high measles vaccination coverage (above 80 percent) successfully avoided outbreaks, demonstrating the crucial
role of robust vaccine coverage.

WHO’s Director-General, Tedros Ghebreyesus, emphasized the urgency of addressing these gaps. “Measles outbreaks are the canary in the coal mine, exposing and exploiting gaps in immunization and hitting the most vulnerable first. This is a solvable problem. The 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,” he asserted.

Despite the overall stagnation, the report also notes some encouraging trends. The phased introduction of new and underutilized vaccines, including those for human papillomavirus (HPV), meningitis, pneumococcal disease, polio, and rotavirus, is expanding the scope of protection, especially in the 57 countries receiving support from Gavi, the
Vaccine Alliance. Notably, the percentage of adolescent girls receiving at least one dose of the HPV vaccine, which protects against cervical cancer, increased from 20 percent in 2022 to 27 percent in 2023. This progress is attributed to successful implementation in countries like Bangladesh, Indonesia, and Nigeria, and the introduction of
a single-dose HPV vaccine schedule, which has contributed to the overall increase in coverage. Sania Nishtar, CEO of Gavi, highlighted the impact of these efforts.

“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. With vaccines now available to over 50 percent 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,” she said. Despite the progress, HPV vaccine coverage remains significantly short of the 90 percent target required to eliminate cervical cancer as a public health issue. High-income countries have a coverage rate of 56 percent, while in low- and middle-income countries, it stands at just 23 percent.

A recent poll of over 400,000 users on UNICEF’s U-Report platform revealed significant gaps in awareness, with 75 percent of respondents unaware or uncertain about HPV. However, when informed about the virus and its link to cancer, 52 percent expressed interest in receiving the vaccine. Financial constraints (cited by 41 percent) and lack of availability (34 percent) are major barriers to accessing the vaccine.