An estimated 14.3 million children globally remain completely unvaccinated, according to a new report, and public health experts point to conflict zones as threatening childhood vaccination efforts worldwide.
Each year, the World Health Organization and the United Nations Children’s Fund publish a comprehensive report on estimates of national immunization coverage, based on data from 195 countries. This year’s report, released Monday, says there have been some improvements in protecting children against certain diseases through routine vaccinations.
Globally, 171,000 fewer children remained unvaccinated last year than in 2023, according to the report. But that still leaves more than 14 million children vulnerable to vaccine-preventable diseases and an additional 5.7 million with only partial protection because they may not have gotten all the recommended doses of certain vaccine series.
“The latest estimates highlight a really concerning trajectory,” Dr. Kate O’Brien, director of WHO’s Department of Immunization, Vaccines and Biologicals, said in a news briefing.
“The global vision is for everyone everywhere to benefit from lifesaving vaccines,” she said. “But we’ve hit this very stubborn glass ceiling, and breaking through that glass to protect more children against vaccine-preventable diseases is becoming more difficult.”
Rising conflicts and war zones emerging around the world have eroded some of the progress in providing children with immunizations, she added, leading to many children remaining unvaccinated, especially in low- or middle-income countries.
“Children living in one of 26 countries affected by fragility, conflict or humanitarian emergencies are three times more likely to be unvaccinated compared to children who live in stable countries,” O’Brien said. “In fact, half of all children unvaccinated in the world live in these fragile, vulnerable and conflict countries.”
The new report says that last year, nine countries – Nigeria, India, Sudan, the Democratic Republic of Congo, Ethiopia, Indonesia, Yemen, Afghanistan and Angola – accounted for 52% of all children who have never received a dose of vaccine.
Meanwhile, mostly in high-income countries, vaccine coverage has been affected by vaccine hesitancy and distrust in institutions, leading to a resurgence of vaccine-preventable diseases including measles and polio, said Dr. Ephrem Lemango, UNICEF’s associate director for health and global chief of immunization.
“Based on all we know, over the past 50 years, over 150 million lives were saved through vaccination, and this has been able to protect children from any forms of vaccine-preventable diseases,” Lemango said at the briefing.
“But misinformation and any forms of vaccine hesitance is a reflection of a broader lack of trust or mistrust in the systems that deliver the vaccines, in the health workers that provide the vaccines and in the manufacturing facilities or the ecosystems that manufacture the vaccines,” he said. “So it is important to see misinformation or lack of information as part of a broader ecosystem to be able to address.”
Misinformation appears to be driving outbreaks of disease in pockets of countries that tend to have high vaccination rates, O’Brien said.
“There are communities sort of hidden under that national number that have very low vaccination coverage, and that’s where outbreaks are happening, and those children are the ones who are suffering,” she said.
In the United States, a measles outbreak that originated in a part of West Texas that has a low vaccination rate continues to spread, and there have been more measles cases reported in the US this year than any other since the disease was declared eliminated a quarter-century ago.
But O’Brien added that while the effects of misinformation remain concerning, they are not the main reason millions of children remain unvaccinated globally.
“The main reason, when you look worldwide, why children aren’t vaccinated is because of access to vaccines and access to vaccination services – and this is where it’s particularly important,” O’Brien said.
“They’re not being vaccinated because they don’t have access,” she said. “They’re in dangerous settings, it’s hard to gain access to them, and in some situations, the government does not have access to those environments.”
The new report comes amid growing concern about funding for global vaccination efforts. The Trump administration has dismantled the US Agency for International Development, or USAID, which has partnered with organizations like Gavi, the Vaccine Alliance to provide vaccines. And the US has announced plans to reduce funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria.
“We still have a lot of work to do,” WHO Director-General Dr. Tedros Adhanom Ghebreyesus said in a news release. “Drastic cuts in aid, coupled with misinformation about the safety of vaccines, threaten to unwind decades of progress. WHO remains committed to working with our partners to support countries to develop local solutions and increase domestic investment to reach all children with the lifesaving power of vaccines.”
The new report says that in 2024, protection against diphtheria, tetanus and pertussis remained constant, as an estimated 89% of infants globally received at least one dose of the DTP vaccine, the same share as in 2023 and 2022. Roughly 85% completed all three recommended doses of vaccine last year, compared to 84% in 2023 and 85% in 2022.
The percentage of children receiving their first dose of measles vaccine remained relatively constant last year, at 84%, compared to 83% in 2023 and 2022. But that share is lower than in 2019, when coverage was 86%, according to the new report. Overall, the report says, 20.6 million children missed their routine first dose of measles vaccine last year.
Meanwhile, the global percentage of children receiving their second dose of measles vaccine increased from 73% in 2022 and 74% in 2023 to 76% in 2024, according to the new report.
In the United States, childhood vaccine coverage has been declining, and the vast majority of measles cases this year – more than 90% – have been in people who were unvaccinated or whose vaccination status was unknown, according to the US Centers for Disease Control and Prevention.
“The good news is that we have managed to reach more children with life-saving vaccines. But millions of children remain without protection against preventable diseases, and that should worry us all,” UNICEF Executive Director Catherine Russell said in the news release. “We must act now with determination to overcome barriers like shrinking health budgets, fragile health systems along with misinformation and access constraints because of conflicts. No child should die from a disease we know how to prevent.”
O’Brien said there has been “incredible improvement” in global coverage of the HPV vaccine, which helps protect against the human papillomavirus, which can cause cervical cancer and other related diseases.
The percentage of girls receiving a first dose increased to 31% in 2024, from 27% in 2023 and 20% in 2022. The percentage receiving all the doses of vaccine recommended in their country increased to 28% in 2024, from 21% in 2023 and 14% in 2022, according to the new report.
HPV vaccine coverage was somewhat stable among boys, with 8% receiving a first dose in 2024 and 2023.
“This is a real bright spot in the data that, again, year on year now, we’re seeing increases in HPV vaccine coverage,” O’Brien said, adding that recent increases are largely attributable to the introduction of the vaccine in Nigeria, Bangladesh and four other countries.
Overall, the new report shows that although there hasn’t been a significant retreat in childhood vaccine coverage globally, there hasn’t been significant improvement either, said Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, who was not involved in the report.
“Fourteen million children who have received no vaccines is 14 million too many. Childhood vaccination is one of the most cost-effective medical interventions that’s ever been developed,” Barouch said. “I would hope that global health authorities prioritize childhood vaccination programs and that funding mechanisms are developed to ensure the continuation of these programs.”
