Global Immunization Coverage Nears Pre-Pandemic Levels in 2025, Yet Millions Remain Vulnerable to Preventable Diseases

Global immunization efforts in 2025 achieved significant strides towards recovering from the disruptions of recent years, with 90% of infants worldwide – approximately 116 million – receiving at least one dose of the diphtheria, tetanus, and pertussis (DTP) vaccine. The latest annual WHO-UNICEF Estimates of National Immunization Coverage (WUENIC) reveal that 85% of infants, equating to 110 million children, successfully completed the full three-dose DTP series. While these figures represent a crucial one-percentage-point increase from the previous year, global coverage still hovers one point below 2019 levels, indicating a persistent challenge to fully regain lost ground and expand reach beyond a narrow range observed since 2009.

Despite the positive momentum in overall DTP vaccination, the report highlights a critical and growing concern: the increasing number of children who initiate their vaccination schedule but fail to complete it. An estimated 13.5 million "zero-dose" children did not receive any vaccine in their first year during 2025, a reduction of nearly 750,000 from the prior year. However, this progress is tempered by the alarming rise in drop-out rates, particularly evident in the context of measles vaccination. Approximately 7.3 million infants received their first DTP dose but subsequently missed their initial measles dose, contributing to stagnant measles coverage. Only 84% of children received the first measles dose (MCV1) and a mere 77% received the second dose (MCV2). These figures fall critically short of the 95% threshold universally recognized as necessary to prevent outbreaks of this highly contagious virus, leading to 57 countries reporting large or disruptive measles outbreaks in 2025.

A Decade of Stagnation and the Shadow of COVID-19

For over a decade leading up to the COVID-19 pandemic, global immunization coverage for routine childhood vaccines had largely stagnated. Despite concerted efforts, the world struggled to make substantial progress beyond the 85-90% mark for the DTP vaccine, a crucial indicator of immunization system strength. The onset of the COVID-19 pandemic in early 2020 exacerbated this pre-existing challenge, triggering unprecedented disruptions to health services worldwide. Supply chains were fractured, healthcare workers were redeployed to manage the pandemic response, and public health campaigns were curtailed. Lockdowns and movement restrictions further hindered access to clinics, leading to a significant and immediate decline in routine immunization rates globally. The years 2020-2022 saw some of the largest sustained drops in childhood vaccination coverage in decades, pushing millions of children into vulnerability.

The data for 2025 reflects a period of intensive recovery efforts by governments, health organizations, and partners like Gavi, the Vaccine Alliance. The one-percentage-point increase in DTP coverage signifies a determined push to re-engage communities, restore services, and catch up on missed vaccinations. This bounce-back is a testament to the resilience of global health systems and the dedication of frontline health workers. However, the fact that coverage remains below 2019 levels underscores the profound and lingering impact of the pandemic and the systemic issues that continue to impede universal access. The narrow range of coverage since 2009 suggests that while emergency recovery is underway, fundamental barriers to sustained progress persist.

Disparities Across Regions and Vulnerable Populations

The global averages mask significant disparities in immunization coverage across different regions and country contexts. Of the 195 countries providing data, 100 have commendably maintained at least 90% coverage with three doses of the DTP vaccine since 2019. However, the report indicates little progress in expanding this group. While 30 countries that were below 90% coverage in 2019 have since improved their rates, a concerning 65 countries are either stagnating or falling further behind. This latter group includes 13 fragile, conflict-affected, or vulnerable (FCV) countries, where the challenges to delivering essential health services are often compounded by political instability, insecurity, and chronic underfunding.

Regional performance offers a mixed picture. The Americas and South-East Asia have not only fully recovered but have also improved their performance compared to their 2019 baselines, with South-East Asia now leading as the highest-performing region. This achievement highlights successful strategies in these regions to rebuild and strengthen their immunization programmes. In contrast, Africa, the Eastern Mediterranean, and Europe regions, while showing gains last year, still have coverage rates below their pre-COVID-19 pandemic levels, indicating ongoing recovery efforts are needed. The Western Pacific region experienced a decline, making it the region furthest below its 2019 baseline, signaling a need for urgent interventions to understand and address the factors contributing to this backslide.

The plight of "zero-dose" children remains a critical concern, with more than half of these children residing in FCV settings, even though these settings account for only about a third of the world’s child population. In such environments, immunization programmes are frequently strained to breaking point by political upheaval, active conflicts, and severe underfunding. For instance, Syria tragically lost 6 percentage points on DTP1 coverage and 12 points on MCV1 in a single year, reflecting the devastating impact of prolonged conflict on essential health services. Conversely, Sudan recorded the largest single-country gain globally last year, increasing DTP1 coverage by an impressive 35 percentage points and lifting MCV1 coverage by 22 points. This remarkable turnaround, even amidst ongoing conflict, serves as a powerful demonstration of what is possible when access to services improves through dedicated efforts and humanitarian corridors.

Beyond FCV settings, even middle- and high-income countries face their own set of challenges. In these nations, where vaccines are generally accessible, coverage is slipping due to factors such as shifting political commitment, structural issues within health systems, or a worrying rise in vaccine hesitancy. South Africa, for example, has seen its DTP1 coverage fall by 20 percentage points since 2019 and continued to decline in 2025. Similarly, Bosnia and Herzegovina, after experiencing the largest increase in MCV1 coverage in its region in 2024, witnessed a sharp 23-point drop in the past year, underscoring the volatility and fragility of immunization gains even in more stable contexts.

The Measles Menace: A Global Outbreak Warning

The persistent low coverage for measles vaccination poses a severe and immediate threat to global health security. Measles, caused by a highly contagious virus, can lead to serious complications, including pneumonia, encephalitis, and even death, especially in malnourished children and those with compromised immune systems. The fact that 7.3 million infants received their first DTP dose but dropped out before receiving their first measles dose is particularly alarming. This significant drop-out rate contributes directly to the stalled measles coverage rates of 84% for MCV1 and 77% for MCV2. The 95% threshold for herd immunity is essential to prevent outbreaks, making the current figures a global emergency.

The consequences are stark: 57 countries reported large or disruptive measles outbreaks in 2025. These outbreaks not only place immense strain on healthcare systems but also disrupt education, economic activity, and further erode public trust in health services. The economic cost of managing measles outbreaks far outweighs the cost of preventative vaccination. Each outbreak represents a failure to protect children and a setback for broader public health goals. The resurgence of measles serves as a vivid reminder of the critical importance of completing vaccination schedules and the devastating impact of even small gaps in coverage.

Voices from the Frontlines: A Call for Renewed Commitment

Leaders from the global health community have consistently emphasized the urgency of addressing these immunization gaps. Catherine Russell, UNICEF Executive Director, acknowledged the significant efforts made: "Governments and health workers have helped global vaccination rates bounce back after dropping significantly during the COVID-19 pandemic." However, she quickly pivoted to the continuing challenges, stating, "But millions of vulnerable children are still being left unprotected due to conflict, displacement, and poverty. We must reach every child, and we must rebuild trust where it is fraying. No child should suffer from a disease that a simple vaccine can prevent." Her words underscore the multifaceted nature of the problem, extending beyond mere vaccine availability to encompass socio-economic and geopolitical factors.

Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, reiterated the fundamental importance of vaccination: "Every child, whether born into wealth or poverty, peace or conflict, deserves the lifegiving protection that vaccines provide. Immunization is one of the most cost-effective, most equitable, and most reliable interventions for protecting children’s health and well-being." He further articulated the broader implications for global security: "Our greatest security begins with ensuring that everyone, wherever they may live, is protected from deadly diseases that vaccines have the power to prevent." This perspective elevates immunization from a purely health issue to a cornerstone of national and international stability.

Dr. Sania Nishtar, CEO of Gavi, the Vaccine Alliance, highlighted the positive impact of collaboration: "The historic levels of immunization that we are seeing across lower income countries shows what can be achieved when all stakeholders work together towards a shared objective." She also acknowledged the formidable challenges ahead: "As Gavi heads into a new five-year period, our great challenge now will be to maintain this momentum in the face of funding constraints, geopolitical uncertainty, and increasing outbreaks – while working harder to reach those children that still do not have access to immunization." Gavi’s sustained investments, alongside governments and communities over the past 25 years, have significantly reduced the annual number of zero-dose children by 40%, demonstrating the power of collective action. In Gavi-supported countries, children are now protected against more diseases than ever before, with an average of 74% coverage across a full course of WHO-recommended vaccines.

Strains on the System: Funding Cuts and Data Gaps

Despite these successes and the unwavering commitment of global health partners, the very foundations that enabled this progress are now under significant strain. The full impact of international health financing cuts announced over the past two years is not yet reflected in the 2025 WUENIC estimates. However, the data systems crucial for tracking this impact and preventing backsliding are themselves showing signs of weakening. A worrying indicator is the drastic reduction in national immunization surveys: only 18 were undertaken and submitted in this round, a sharp decline from 50 in 2024 and an average of 33 per year between 2015 and 2019. This reduction in robust, country-level data collection directly impedes the ability of health agencies to accurately identify zero-dose children, understand the reasons for non-vaccination, and tailor effective outreach strategies. Weakening investments in these essential data systems will inevitably lead to outbreaks and preventable deaths, warn WHO and UNICEF.

The global Immunization Agenda 2030 (IA2030), a comprehensive strategy developed by WHO, UNICEF, Gavi, and other partners, aims to ensure vaccines reach everyone, everywhere, at every age. However, current trends indicate that the world is further off track to reach the IA2030 goal of significantly reducing the number of zero-dose children. This trajectory demands a sharp course correction and a bridging of critical gaps.

A Path Forward: Urgent Calls to Action

To address the immediate challenges and secure long-term gains in global immunization, WHO and UNICEF, in collaboration with Gavi and other partners, are calling on governments and relevant stakeholders to implement a multi-pronged approach:

1. Increase Investment and Sustainable Financing: Governments and international donors must prioritize and significantly increase financial commitments to immunization programs. This includes not only vaccine procurement but also strengthening cold chains, training health workers, and ensuring robust surveillance and data systems. Sustainable financing is paramount to insulate programs from geopolitical uncertainties and economic downturns.
2. Strengthen Primary Healthcare and Outreach: Immunization services must be fully integrated into resilient primary healthcare systems. This requires investing in frontline health workers, improving infrastructure in remote and underserved areas, and developing innovative outreach strategies to reach every child, particularly those in FCV settings and marginalized communities.
3. Address Vaccine Hesitancy and Build Trust: Targeted, culturally sensitive communication campaigns are essential to counter misinformation, build public trust in vaccines, and address specific community concerns. Engaging local leaders, healthcare professionals, and trusted community members can help rebuild confidence where it has frayed.
4. Enhance Data Systems and Monitoring: Robust and timely data collection, analysis, and utilization are crucial for identifying immunization gaps, tracking progress, and adapting strategies. Renewed investment in national immunization surveys and real-time monitoring systems is vital to ensure no child is left behind.
5. Prioritize Catch-Up Campaigns: Aggressive and well-resourced catch-up campaigns are needed to reach the millions of children who missed out on routine vaccinations during and after the pandemic, especially for measles. These campaigns must be carefully planned to avoid overwhelming health systems and to ensure equitable access.
6. Focus on Fragile and Conflict-Affected Settings: Specialized approaches are required for FCV countries, involving flexible delivery mechanisms, partnerships with humanitarian organizations, and sustained diplomatic efforts to ensure safe access for vaccinators. Learning from successful interventions, like Sudan’s gains, can inform future strategies.

The journey towards universal immunization coverage is a testament to collective human endeavor and the power of preventive medicine. While 2025 saw commendable progress in recovering from pandemic-induced setbacks, the persistent challenges of zero-dose children, high drop-out rates, and the alarming resurgence of measles outbreaks underscore the fragile nature of these gains. The calls from global health leaders serve as a powerful reminder: ensuring every child’s right to life-saving vaccines is not just a health imperative, but a cornerstone of a more equitable, secure, and prosperous future for all.