Global childhood immunization levels stalled in 2023 leaving many without life-saving protection – PAHO/WHO
New data reveals that nearly 3 in 4 babies live in countries where low vaccination coverage causes measles outbreaks
15 July 2024 | Geneva/New York – Global childhood immunization coverage stagnated in 2023, leaving 2.7 million more children unvaccinated or under-vaccinated compared with pre-pandemic levels in 2019, according to data released today by the World Health Organization (WHO) and UNICEF.
The latest WHO/UNICEF estimates of national immunization coverage (WUENIC), which provide the world’s largest and most comprehensive dataset on immunization trends against 14 diseases, underscore the need for continued efforts to recover, catch up and strengthen the system.
“The latest trends show that many countries are still missing out on 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 health care and community workers to ensure all children are vaccinated and overall health care is strengthened.”
According to the results, the number of children who received three doses of the diphtheria, tetanus and pertussis (DTP) vaccine in 2023 – a key indicator for global immunization coverage – stagnated 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.
More than half of unvaccinated children live in 31 countries with fragile, conflict-affected and vulnerable settings, where children are especially vulnerable to preventable diseases due to disruptions and lack of access to safety, nutrition and health services.
In addition, 6.5 million children did not complete their third dose of DTP vaccine, which is necessary to achieve protection against the disease in infancy and early childhood.
These trends, which show that global immunization coverage has remained virtually unchanged since 2022 and, more alarmingly, has not yet returned to 2019 levels, reflect ongoing challenges with disruptions in health care services, logistical challenges, vaccine hesitancy and inequalities in access to services.
Low vaccination coverage is already causing measles outbreaks
The data also show that vaccination rates against the deadly measles disease have stagnated, leaving nearly 35 million children unprotected or partially protected.
In 2023, only 83% of children worldwide received the first dose of measles vaccine through routine health services, while the number of children receiving the second dose increased modestly from the previous year to 74%. These figures fall short of the 95% coverage needed to prevent outbreaks, avoid unnecessary illness and death, and achieve measles elimination goals.
Over the past five years, 103 countries, home to about three-quarters of the world’s infants, experienced measles outbreaks. Low vaccination coverage (80% or less) was a major factor. In contrast, 91 countries with good measles vaccination coverage did not experience outbreaks.
“Measles outbreaks are a warning sign that exposes and exploits gaps in immunization, affecting 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 challenging places. WHO is committed to working with all our partners to help countries close these gaps and protect the most at-risk children as quickly as possible.”
Progress in vaccination coverage in the Americas
The report shows that in 2023, the Americas region continued its efforts to halt the ongoing decline in vaccination coverage, which began in 2010 and was exacerbated by the COVID-19 pandemic.
Dr. Jarbas Barbosa, Director of the Pan American Health Organization (PAHO), WHO regional office for the Americas, welcomed the progress made in the region: “The Americas region is showing positive results, undoubtedly due to the efforts of the countries’ health professionals, the investments made, the political commitment and the responsible population that recognizes the importance of vaccination.”
The PAHO director highlighted that, today, the Americas is the only WHO region that exceeds the pre-pandemic vaccination levels of 2019, “which indicates a considerable acceleration in recovery.” But he warned that some countries are still lagging behind. Continued efforts are needed to “again achieve the vaccination coverage that historically placed us at the top of the world ranking.”
In the Americas, the number of children under one year of age who have never received a dose of vaccine was reduced to 1.1 million. Compared to 2022, coverage for the first dose of DTP-containing vaccines increased from 90% to 91% in 2023, while coverage for the third dose increased from 83% to 86%. While encouraging, these results still leave 1 in 10 children under one year of age in the Americas unprotected. The first dose of measles-containing vaccine reached a coverage rate of 85%, compared to 83% in 2022, and the risk of outbreaks of vaccine-preventable diseases in many communities remains high.
PAHO remains committed to strengthening National Immunization Programs, said Dr. Barbosa, reminding Member States that investment in immunization saves lives and is a gain for society, “with savings in health costs, improved productivity, education, tourism and other development indicators.”
Global HPV vaccine coverage among girls increased substantially
The new data also highlight some bright spots in vaccination coverage. The proportion of adolescent girls globally who received at least one dose of the human papillomavirus (HPV) vaccine, which provides protection against cervical cancer, increased from 20% in 2022 to 27% in 2023. This was largely due to strong vaccine rollouts in Gavi-supported countries such as Bangladesh, Indonesia and Nigeria. The use of the single-dose HPV vaccination schedule also helped boost vaccination coverage.
“The HPV vaccine is one of the most effective vaccines in Gavi’s portfolio and it is incredibly encouraging 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 more than 50% of eligible girls in African countries, we have much work to do, but today we can see that we have a clear path to eliminating this terrible disease.”
However, HPV vaccine coverage is well below the 90% target. eliminate cervical cancer as a public health problem, affecting only 56% of adolescent girls in high-income countries and 23% in low- and middle-income countries.
A recent survey of more than 400,000 users of UNICEF’s digital platform for youth, U ReportThe study revealed that over 75% are unaware or unsure of what HPV is, underscoring the need for improved 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 hampered by financial constraints (41%) and lack of availability (34%).
Strong local action is needed to reach everyone, everywhere with vaccines
While there has 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 worldwide by 2030.
The IA2030 Alliance Council calls for increased investment in innovation and continued collaboration. The Council also recommends that partners step up their support to national leaders to improve routine immunization as part of their integrated primary health care programs, backed by strong political support, community leadership and sustainable financing.
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Notes for editors
About the data
The WHO/UNICEF estimates of national immunization coverage (WUENIC) based on country-reported data provide the world’s largest and most comprehensive dataset on vaccination trends against 14 diseases delivered through routine health systems, typically in clinics, community centres, outreach services or visits by health workers. For 2023, data were provided for 185 countries.
About the Immunization Agenda 2030 (IA2030)
IA2030 is a global strategy endorsed by the World Health Assembly that aims to ensure that all people, everywhere, at every age, benefit from vaccines for improved health and well-being by 2030. It focuses on increasing vaccination coverage, equity, sustainability and pandemic preparedness, while promoting lifelong immunization and the integration of immunization with other health services.
