Global childhood vaccination coverage plateaued between 2010 and 2023, according to a new analysis published in The Lancet by the Global Burden of Disease (GBD) Study vaccination research consortium. Between 2010 and 2019, 100 of the 204 countries monitored saw a decline in measles vaccine coverage. Notably, 21 of the 36 high-income countries experienced a drop in coverage for at least one vaccine dose of diphtheria, tetanus, and pertussis (DTP); measles; or polio.
“These types of study will always be limited by the lack of high quality national data from most countries in the world which means there has to be extrapolation and assumption,” said Andrew Pollard, director of the Oxford Vaccine Group and professor of Infection and Immunity at the Pandemic Sciences Institute, University of Oxford, Oxford, England, in a press statement. “Nevertheless, these are important data providing a concerning picture of recent declines in vaccine coverage and an increase in the number of zero dose children which risks the future health and lives of millions of children.”
Between 1980 and 2023, global coverage of vaccines against DTP, measles, polio, and tuberculosis nearly doubled. These gains reflect the success of the World Health Organization’s (WHO) Expanded Program on Immunization, launched in 1974 to ensure universal access to essential vaccines. Between 1980 and 2019, the number of children who received no doses of DTP in their first year of life dropped from 58.8 million to 14.7 million — figures recorded just before the COVID-19 pandemic disrupted immunization programs worldwide.
To support the WHO’s 2019 goal of improving global vaccination coverage by 2030, the GBD consortium conducted an in-depth analysis of routine childhood immunization trends in 204 countries and territories from 1980 to 2023, with projections through 2030. The findings are intended to inform global and regional strategies for closing coverage gaps over the next 5 years.
Progress Slowed After 2010
The study found that global progress in childhood immunization stalled around 2010 and has since reversed in several regions. Coverage rates for DTP, measles, and polio declined notably in many countries. Polio remains endemic in parts of the world, including Pakistan and Afghanistan, which continue to report outbreaks caused by wild poliovirus. In Papua New Guinea, less than half of the population is vaccinated against the disease.
The COVID-19 pandemic further disrupted global vaccination efforts. Between 2020 and 2023, approximately 15.6 million children missed all three doses of DTP, another 15.6 million missed their first dose of the measles vaccine, 15.9 million went without all three polio vaccine doses, and 9.2 million were not immunized with the BCG vaccine.
In 2023 alone, an estimated 15.7 million children worldwide did not receive any dose of the DTP vaccine in their first year of life. Brazil ranked eighth globally, with roughly 452,000 unvaccinated children. The countries with the highest numbers of zero-dose children included Nigeria (2.48 million), India (1.44 million), the Democratic Republic of Congo (882,000), Ethiopia (782,000), Somalia (710,000), Sudan (627,000), and Indonesia (538,000).
Mixed Forecasts for 2030 Goals
Looking ahead, projections for 2030 suggest that only DTP coverage is on track to reach 90% globally. Coverage for measles and other routine vaccines is expected to remain highly variable by region. Among the 204 countries and territories analyzed, only 85 are currently estimated to have achieved 90% coverage for the full three-dose DTP series, 56 for pneumococcal vaccine, and 57 for the two-dose measles schedule.
In the baseline scenario, those numbers are projected to rise by 2030 to 108 countries achieving 90% DTP coverage, 83 for pneumococcal, and 91 for measles. Only high-income regions are expected to maintain ≥ 90% coverage for all three vaccines. In the most optimistic scenario, 186 countries could meet the DTP target, 171 for pneumococcal, and 161 for measles. In contrast, a worst-case scenario would see even high-performing countries fall below the 90% threshold by 2030.
Call for Change
To achieve the Immunization Agenda 2030 goal of halving the number of zero-dose children and reaching 90% coverage across all vaccines throughout the life course, the study highlights the urgent need for “transformational improvements in equity.” These include targeted immunization strategies, strengthening of primary care, and efforts to counter vaccine hesitancy.
Emily Haeuser, PhD, lead author of the study, emphasized the challenge of improving vaccine delivery and uptake in underserved areas. “The diversity of challenges and barriers to immunization varies widely across countries and within communities,” she said, pointing to factors such as displacement, armed conflict, political instability, economic uncertainty, climate crises, misinformation, and vaccine hesitancy. “This underscores the need for new, locally tailored solutions.”
Helen Bedford, PhD, professor of child health at University College London, London, England, who was not involved in the study, added that the decline in vaccine uptake stems from a complex set of issues. “Addressing these challenges requires commitment and resources to tackle growing social inequalities, misinformation about vaccine safety, and the need to rebuild public trust in immunization programs,” she said.
“Vaccination remains our most powerful tool to protect child health, but its success depends on sustained investment, equity, and public confidence.”
This story was translated from Medscape’s Portuguese edition.