Global levels of childhood vaccinations have stalled in 2023, leaving many without life-saving protection

Global childhood vaccination coverage stalled in 2023, leaving 2.7 million additional children unvaccinated and undervaccinated compared to pre-pandemic levels in 2019, according to data released today by the World Health Organization (WHO) and UNICEF.

The latest World Health Organization and UNICEF Estimates of National Immunization Coverage (WUENIC) – which provide the largest and most comprehensive set of data on immunization trends for vaccination against 14 diseases in the world – highlight the need for continued efforts to catch up, recover and strengthen systems.

“The latest trends show that many countries are still missing 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 that every child is immunized and that overall health care is strengthened.”

According to the findings, the number of children who received three doses of the diphtheria, tetanus and pertussis (DTP) vaccine in 2023 – a key indicator of global immunization coverage – stopped 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 environments, where children are particularly vulnerable to preventable diseases due to disruption and lack of access to safety, nutrition and health services.

Additionally, 6.5 million children have not completed their third dose of the 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 largely unchanged since 2022 and – more alarmingly – has still not returned to 2019 levels, reflect ongoing challenges with disruptions in health services, logistical challenges, vaccine hesitancy and inequalities in access to services.

Low vaccination coverage is already leading to measles outbreaks

The data further show that vaccination rates against the deadly measles disease have stalled, leaving nearly 35 million children with no or only partial protection.

In 2023, only 83% of children worldwide received the first dose of measles vaccine through routine health services, while the number of children who received the second dose increased modestly compared to the previous year, reaching 74% of children. These figures are insufficient to achieve the 95% coverage required to prevent outbreaks, prevent unnecessary illness and death, and achieve measles elimination goals.

In the past five years, measles outbreaks have affected 103 countries – home to approximately three quarters of the world's infants. Low vaccination coverage (80% or less) was a major factor. In contrast, 91 countries with high measles vaccination coverage experienced no outbreaks.

“Measles outbreaks are the canary in the coal mine, detecting 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 applied even in the most difficult places. WHO is committed to working with all our partners to support countries in closing these gaps and protecting the children most at risk as soon as possible.”

Global HPV vaccine coverage among girls has increased significantly

The new data also highlight some bright spots in immunization coverage. The continued introduction of new and underutilized vaccines, including vaccines against human papillomavirus (HPV), meningitis, pneumococcal, poliomyelitis and rotavirus diseases, continues to expand coverage, particularly in the 57 countries supported by Gavi, the Vaccine Alliance.

For example, the proportion of adolescent girls globally who received at least 1 dose of the HPV vaccine, which protects against cervical cancer, increased from 20% in 2022 to 27% in 2023. This was largely driven by strong vaccine uptake. supported by Gavi countries such as Bangladesh, Indonesia and Nigeria. The use of a single-dose HPV vaccine schedule has also helped increase vaccination coverage.

“The HPV vaccine is one of the most impactful vaccines in Gavi's portfolio and it is incredibly encouraging that it is now reaching more girls than ever before,” said Dr Sania Nishtar, Gavi CEO, Vaccine Alliance. “With vaccines now available to more than 50% of eligible girls in African countries, we still have a lot of 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 target of 90%. 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 youth platform, U-report, found that more than 75% were unaware or unsure of what HPV was, highlighting the need for better vaccine availability and public awareness. When they received information about the virus, its association with cancers and the existence of a vaccine, 52% of respondents indicated that they wanted to receive the HPV vaccine, but were prevented by financial constraints (41%) and lack of availability (34%).

Strong local action is needed to get vaccines to everyone, everywhere

Although modest progress has been made 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 doses' of children in the world by 2030.

The IA2030 Partnership Council calls for increased investment in innovation and ongoing collaboration. The Council also recommends that partners increase their support to country leadership to improve routine immunization as part of their integrated primary health care programs, with strong political support, community leadership and sustainable funding.

Notes to editors

About data

Based on data from reporting countries, the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) provide the largest and most comprehensive set of data on immunization trends in the world for vaccinations against 14 diseases given through regular health systems – typically in clinics, community centers, assistance services, or visits by a health worker. For the year 2023, data were submitted from 185 countries.

About the 2030 Immunization Plan (IA2030)

IA2030 is a global strategy endorsed by the World Health Assembly to ensure that everyone, everywhere, at every age benefits from vaccines for improved health and well-being by 2030. It focuses on increasing vaccine coverage, equity, sustainability and pandemic preparedness while promoting lifelong immunization and integration of immunization with other health services.

ABOUT WHO

Committed to the health and well-being of all people and guided by science, the World Health Organization leads and advocates global efforts to give everyone, everywhere, an equal chance for a safe and healthy life. We are the UN health agency that connects nations, partners and people on the front lines in more than 150 locations – leading the world's response to health emergencies, preventing disease, addressing the root causes of health problems and expanding access to medicines and healthcare. Our mission is to promote health, keep the world safe and serve the vulnerable.

About UNICEF UNICEF works in some of the most difficult places in the world to reach the most disadvantaged children. In more than 190 countries and territories, we work for every child, everywhere, to build a better world for all.

For more information about UNICEF and its work, visit: www.unicef.org Follow UNICEF at Twitter, Facebook, Instagram and YouTube.