Global childhood immunization coverage inches forward despite conflict and hesitancy – UNICEF, WHO

Global childhood immunization coverage rose slightly in 2025, with 90% of infants receiving at least one dose of the diphtheria, tetanus and pertussis (DTP) vaccine, according to the annual WHO-UNICEF Estimates of National Immunization Coverage (WUENIC). While this represents a one percentage point increase from the previous year, global progress remains stalled, hovering one point below 2019 levels and failing to regain the momentum lost during the COVID-19 pandemic. Despite these gains, approximately 13.5 million infants—often referred to as “zero-dose” children—did not receive a single vaccine in their first year of life.

The WUENIC dataset, which aggregates information from 185 countries, highlights a widening divide between regions that have fully recovered and those where vaccination rates remain in decline.

Regional Disparities and the Impact of Conflict

The path to recovery is not uniform. According to the latest UNICEF immunization data, the Americas and South-East Asia have managed to reach or exceed their 2019 baseline coverage levels. In contrast, the Western Pacific region has seen a notable decline, leaving it the furthest behind compared to its pre-pandemic performance. Africa, the Eastern Mediterranean, and Europe have reported modest gains, yet they continue to struggle to return to their 2019 status.

Data indicates that more than half of all zero-dose children reside in fragile, conflict-affected, or vulnerable (FCV) settings, even though these areas account for only about one-third of the global child population. The volatility in these regions is stark: while Syria experienced a significant loss in coverage—dropping 6 percentage points in DTP1—Sudan achieved the largest single-country gain globally, increasing DTP1 coverage by 35 percentage points. This contrast demonstrates that, even in active conflict zones, targeted efforts to maintain access to health services can yield measurable results.

The Challenge of Incomplete Series and Measles Outbreaks

Reaching a child for the first dose is only the beginning of the immunization journey. A growing concern for public health officials is the rising number of children who start their vaccination schedule but drop out before completion. Globally, an estimated 7.3 million infants received their first DTP dose but failed to receive their first measles dose (MCV1).

This drop-out rate has direct consequences for community immunity. Measles coverage reached 84% for the first dose (MCV1) and 77% for the second dose (MCV2) in 2025. Both figures remain well below the 95% threshold required to prevent community transmission of the virus. Consequently, 57 countries reported large or disruptive measles outbreaks during the year.

Shifting Barriers in High-Income Nations

While conflict and poverty are primary drivers in many nations, middle- and high-income countries face different, yet equally damaging, hurdles. In these settings, the issue is less about the physical availability of vaccines and more about shifting political commitment and rising vaccine hesitancy. For instance, South Africa has seen its DTP1 coverage fall by 20 percentage points since 2019. Similarly, Bosnia and Herzegovina recorded a 23-point drop in MCV1 coverage over the past year, despite a temporary increase in 2024.

Data Systems Under Strain

The ability to monitor these trends is currently under threat. The Vaccine Alliance (Gavi) and its partners have noted that the data systems used to track immunization coverage are showing signs of exhaustion. In 2025, only 18 national immunization surveys were completed and submitted, a significant decrease from the 50 submitted in 2024 and the annual average of 33 observed between 2015 and 2019.

The global community is currently off track to meet the targets set by the Immunization Agenda 2030 (IA2030). To bridge this gap, agencies are calling for a multi-pronged approach: strengthening health services in fragile settings, countering misinformation, sustaining domestic and international funding, and investing in modernized disease surveillance.

As the global health community moves into this new cycle, the focus remains on ensuring that no child is excluded from the protection of basic, life-saving vaccines.