In 2025, 90% of infants globally received at least one dose of a diphtheria, tetanus, and pertussis (DTP) vaccine, and 85% completed the full three-dose series, according to the latest WHO-UNICEF Estimates of National Immunization Coverage (WUENIC) released today. This represents a modest one-percentage-point increase for both indicators from the previous year. However, these figures remain one percentage point below 2019 levels, indicating a prolonged period of stagnation in global vaccination rates since 2009.
The WUENIC report, a cornerstone of global public health data, provides an annual assessment of immunization coverage across 185 countries. The data, collected through country-reported statistics and meticulously analyzed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), offer a critical snapshot of progress and persistent challenges in protecting the world’s youngest populations from preventable diseases.
The Persistent Challenge of "Zero-Dose" Children
Despite the slight uptick in overall vaccination rates, the report highlights a significant and concerning cohort: an estimated 13.5 million infants in 2025 did not receive a single vaccine dose within their first year of life. While this figure represents a decrease of nearly 750,000 "zero-dose" children compared to the previous year, this hard-won progress is being undermined by a growing number of children who begin their vaccination schedules but fail to complete them. The majority of these vulnerable children reside in countries that receive support from Gavi, the Vaccine Alliance, underscoring the critical role of this partnership in global immunization efforts.
The implications of being "zero-dose" are profound. These children are left entirely unprotected against a spectrum of potentially deadly diseases for which safe and effective vaccines exist. This gap in protection not only jeopardizes individual child survival but also increases the risk of disease outbreaks within communities, straining already fragile healthcare systems.
Measles Coverage Stalls Amidst Drop-Out Crisis
A particularly alarming trend identified in the WUENIC report is the stalled coverage for the measles vaccine. Globally, 7.3 million infants are estimated to have received their first DTP dose but did not proceed to receive their first measles dose. This drop-out rate directly contributes to the insufficient coverage needed to prevent measles outbreaks. Currently, only 84% of children receive the first dose of the measles-containing vaccine (MCV1), and a mere 77% receive the second dose (MCV2). Both figures fall significantly short of the 95% coverage threshold deemed essential by health experts to achieve and maintain herd immunity, thereby preventing widespread transmission of this highly contagious virus.
The consequences of this deficit are starkly evident: in 2025, a staggering 57 countries reported large or disruptive measles outbreaks. These outbreaks represent not only a public health crisis, leading to increased morbidity and mortality, particularly among young children, but also a significant drain on healthcare resources that could otherwise be directed towards essential services.
Global Leaders Sound the Alarm on Vulnerable Children
UNICEF Executive Director Catherine Russell emphasized the hard-fought gains made in global vaccination rates following the significant disruptions caused by the COVID-19 pandemic. "Governments and health workers have helped global vaccination rates bounce back after dropping significantly during the COVID-19 pandemic," Russell stated. "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 challenges facing immunization programs. While the pandemic undoubtedly impacted routine health services, the ongoing impact of geopolitical instability, humanitarian crises, and socioeconomic disparities continues to leave millions of children on the fringes of essential healthcare.
Regional Disparities and Persistent Gaps
The WUENIC data reveals a complex global picture with significant regional variations. While 100 countries have managed to maintain at least 90% coverage for the DTP vaccine series since 2019, progress in expanding this group has been slow. Of the countries that were below 90% coverage in 2019, only 30 have improved their rates over the past six years. Alarmingly, 65 countries are either stagnating or experiencing a decline in coverage, with 13 of these categorized as fragile, conflict-affected, or vulnerable (FCV) settings.
Regional Performance Analysis:
- Asia Sees Strong Recovery: The Americas and South-East Asia regions have fully recovered and even surpassed their pre-COVID-19 pandemic immunization performance levels. South-East Asia, in particular, has emerged as the highest-performing region.
- Africa, Eastern Mediterranean, and Europe Show Gains: These regions have witnessed an increase in coverage rates over the past year. However, their overall immunization coverage still lags behind the levels recorded before the pandemic.
- Western Pacific Region Declines: In contrast, the Western Pacific region experienced a decline in immunization coverage, leaving it the furthest below its 2019 baseline.
The Critical Impact of Fragile and Conflict-Affected Settings
The report places a significant spotlight on the disproportionate burden of "zero-dose" children in fragile, conflict-affected, or vulnerable (FCV) settings. More than half of all "zero-dose" children globally reside in these areas, despite FCV settings accounting for only about a third of the world’s child population. In these contexts, immunization programs are frequently hampered by political instability, ongoing insecurity, and chronic underfunding.
The data provides a stark illustration of this impact: Syria, in a single year, experienced a substantial decline of 6 percentage points in DTP1 coverage and a significant 12-point drop in MCV1 coverage. These figures highlight the rapid erosion of immunization gains that can occur when conflict disrupts health services.
However, the report also offers a beacon of hope, showcasing what is achievable even amidst adversity. Sudan recorded the largest single-country gain globally in the past year, with a remarkable 35-percentage-point increase in DTP1 coverage and a 22-point rise in MCV1 coverage. This substantial improvement demonstrates the profound impact that improved access to essential health services can have, even in regions experiencing ongoing conflict.
Challenges Beyond Conflict: Hesitancy and Structural Issues
The immunization landscape is not solely challenged by conflict and displacement. Middle- and high-income countries, where vaccines are generally accessible, are also experiencing declining coverage rates. This trend is attributed to a confluence of factors, including shifting political commitment, structural challenges within healthcare systems, and a rise in vaccine hesitancy.
South Africa, for instance, has seen its DTP1 coverage fall by 20 percentage points since 2019, with a continued decline observed in 2025. Similarly, Bosnia and Herzegovina, after achieving the largest increase in MCV1 coverage in its region in 2024, experienced a significant 23-point drop in the past year. These examples underscore the fact that maintaining high immunization coverage requires sustained effort, consistent political will, and effective strategies to address public concerns and system inefficiencies.
A Call for Universal Protection and Renewed Commitment
Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, underscored the fundamental right of every child to protection from preventable diseases. "Every child, whether born into wealth or poverty, peace or conflict, deserves the lifegiving protection that vaccines provide," he stated. "Immunization is one of the most cost-effective, most equitable, and most reliable interventions for protecting children’s health and well-being. Our greatest security begins with ensuring that everyone, wherever they may live, is protected from deadly diseases that vaccines have the power to prevent."
His statement reaffirms the foundational principle that immunization is a cornerstone of global health security and a critical tool for achieving equitable health outcomes.
Historical Progress and Future Challenges
Over the past 25 years, a sustained period of investment from governments and partners, coupled with strong community engagement and robust program development, has led to a remarkable 40% reduction in the annual number of "zero-dose" children. Gavi-supported countries, for example, now offer protection against a wider range of diseases, with average coverage across a full course of WHO-recommended vaccines reaching 74%.
Dr. Sania Nishtar, CEO of Gavi, the Vaccine Alliance, acknowledged these achievements: "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. 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."
Strained Data Systems Threaten Future Progress
A critical concern highlighted by the WUENIC report is the strain on the very data systems needed to monitor and protect immunization progress. The full impact of international health financing cuts announced over the past two years is not yet fully reflected in these estimates. However, the data reveals a concerning decline in the number of national immunization surveys conducted and submitted. Only 18 such surveys were completed and submitted for this reporting round, a significant drop from 50 in 2024 and the average of 33 per year between 2015 and 2019.
WHO and UNICEF warn that weakening investments in these vital data systems will inevitably lead to an increased risk of preventable outbreaks and deaths. Robust data is essential for identifying vulnerable populations, tracking progress, and allocating resources effectively.
The Immunization Agenda 2030: A Path Forward
WHO and UNICEF, in collaboration with Gavi and other partners, are actively working to advance the global Immunization Agenda 2030 (IA2030). This comprehensive strategy aims to ensure that vaccines reach everyone, everywhere, at every age. However, the current trajectory indicates that the world is falling further off track from achieving the IA2030 target of significantly reducing the number of "zero-dose" children.
To address this critical gap and effect a necessary course correction, WHO and UNICEF are issuing a strong call to action for governments and relevant partners to:
- Increase and sustain domestic and international financing for immunization programs. This includes dedicated funding for routine immunization services, outbreak response, and the development of new vaccines.
- Strengthen primary healthcare systems to ensure equitable access to immunization services. This involves investing in infrastructure, training healthcare workers, and improving supply chain management.
- Prioritize immunization in humanitarian and fragile contexts. This requires tailored strategies to reach marginalized and displaced populations with life-saving vaccines.
- Address vaccine hesitancy and build trust through transparent communication and community engagement. This involves working with local leaders, healthcare providers, and communities to address concerns and promote vaccine confidence.
- Invest in robust data collection and monitoring systems to track immunization coverage and identify gaps. This will enable evidence-based decision-making and targeted interventions.
The WUENIC report serves as a critical reminder that while progress has been made, the fight against preventable diseases through vaccination is far from over. The commitment of global leaders, national governments, and healthcare professionals, coupled with sustained investment and innovative approaches, will be crucial in ensuring that no child is left behind and that the world can achieve the ambitious goals set forth by the Immunization Agenda 2030.
