WHO/H. Dicko
A child is being vaccinated orally in Borno state, Nigeria
© Credits

Immunization coverage

15 July 2024

Key facts

  • Globally in 2023, there were 14.5 million children missing out on any vaccination – so-called zero-dose children.
  • Coverage of a third dose of vaccine protecting against diphtheria, tetanus, and pertussis (DTP3) was 84% in 2023.
  • The proportion of children receiving a first dose of measles vaccine was 83% in 2023, well below the 2019 level of 86%.
  • Global coverage for the first dose of HPV vaccine in girls grew from 20% in 2022 to 27% in 2023.
  • Coverage of yellow fever vaccine in the countries at risk of it is 50%, well below the recommended 80%.

Overview

While immunization is one of the most successful public health interventions, coverage plateaued in the decade prior to COVID-19. The COVID-19 pandemic, associated disruptions, and vaccination efforts strained health systems in 2020 and 2021, resulting in dramatic setbacks. Data from 2023 show that performance has not yet returned to 2019 levels.

During 2023, about 84% of infants worldwide (108 million) received 3 doses of diphtheria-tetanus-pertussis (DTP3) vaccine, protecting them against infectious diseases that can cause serious illness and disability or be fatal. However, these global figures hide significant disparity among countries of different income strata, with low-income countries lagging behind.

Measles, because of its high transmissibility, acts as an early warning system, quickly exposing immunity gaps in the population. Still, 22.2 million children missed their routine first dose of measles, far from the 2019 level of 19.3 million.

Global immunization coverage 2023

A summary of global vaccination coverage in 2023 follows.

Haemophilus influenzae type b (Hib) causes meningitis and pneumonia. The Hib vaccine had been introduced in 193 Member States by the end of 2023. Global coverage with 3 doses of Hib vaccine is estimated at 77%. There is great variation between regions. The WHO European Region is estimated to have 94% coverage, while it is only 33% in the WHO Western Pacific Region.

Hepatitis B is a viral infection that attacks the liver. Hepatitis B vaccine for infants had been introduced nationwide in 190 Member States by the end of 2023. Global coverage with 3 doses of hepatitis B vaccine is estimated at 83%. In addition, 117 Member States introduced 1 dose of hepatitis B vaccine nationwide to newborns within the first 24 hours of life. Global coverage is 45% and is as high as 79% in the WHO Western Pacific Region, while it is estimated at only 17% in the WHO African Region.

Human papillomavirus (HPV) is the most common viral infection of the reproductive tract and can cause cervical cancer in women, other types of cancer, and genital warts in both men and women. One hundred forty-three Member States provided the HPV vaccine in their national immunization schedule and services by the end of 2023, including 13 new introductions. In 2023, 37 countries – representing more than 45% of girls aged 9–14 years old vaccinated in that year – used a 1-dose schedule. Global coverage with the first dose of HPV among girls is now estimated at 27%. While far from the 90% target by 2030, it represents a large increase from 20% in 2022 and was driven by new introductions in several large countries and further improvements in existing programmes, including in countries using the 1-dose schedule.

Bacterial meningitis is an infection that is often deadly and leaves 1 in 5 individuals with long-term devastating sequelae after the acute infection. Before the introduction of MenAfriVac in 2010 – a revolutionary vaccine – Neisseria meningitidis serogroup A (NmA) accounted for 80–85% of meningitis epidemics in the African meningitis belt. By the end of 2023, more than 350 million people in 24 out of the 26 countries in the meningitis belt had been vaccinated with MenAfriVac through campaigns and 15 countries had included MenAfriVac in their routine immunization schedule. In the 26 countries of the meningitis belt, coverage is estimated at 29% in 2023. No case of NmA meningitis has been confirmed since 2017 in the meningitis belt.

Measles is a highly contagious disease caused by a virus, which usually results in a high fever and rash, and can lead to blindness, encephalitis or death. By the end of 2023, 83% of children had received 1 dose of measles-containing vaccine by their second birthday, and 74% of children received 2 doses of measles vaccine. By the end of 2023, 190 Member States had included a second dose of measles vaccine in their national immunization schedules.

Mumps is a highly contagious virus that causes painful swelling at the side of the face under the ears (the parotid glands), fever, headache and muscle aches. It can lead to viral meningitis. Mumps vaccine had been introduced nationwide in 124 Member States by the end of 2023.

Pneumococcal diseases include pneumonia, meningitis and febrile bacteraemia, as well as otitis media, sinusitis and bronchitis. Pneumococcal vaccine had been introduced in 159 Member States by the end of 2023 and global third dose coverage was estimated at 65%. There is great variation between regions. The WHO European Region is estimated to have 86% coverage, while it is only 26% in the WHO Western Pacific Region.

Polio is a highly infectious viral disease that can cause irreversible paralysis. In 2023, 83% of infants around the world received 3 doses of polio vaccine. In 2023, the coverage of infants receiving their first dose of inactivated polio vaccine (IPV) in countries that are still using oral polio vaccine (OPV) is estimated at 83% as well. In these same countries, the coverage of infants receiving their second dose of IPV is estimated at 42%. There is great variation between regions. The WHO European Region is estimated to have 89% coverage, while it is only 6% in the WHO South-East Asia Region. Targeted for global eradication, polio has been stopped in all countries except for Afghanistan and Pakistan. Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries.

Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. Rotavirus vaccine was introduced in 123 countries by the end of 2023. Global coverage was estimated at 55%.

Rubella is a viral disease which is usually mild in children, but infection during early pregnancy may cause fetal death or congenital rubella syndrome, which can lead to defects of the brain, heart, eyes and ears. Rubella vaccine was introduced nationwide in 175 Member States by the end of 2023, and global coverage was estimated at 71%.

Tetanus is caused by a bacterium which grows in the absence of oxygen, for example in dirty wounds or the umbilical cord if it is not kept clean. The spores of C. tetani are present in the environment irrespective of geographical location. It produces a toxin which can cause serious complications or death. Maternal and neonatal tetanus persist as public health problems in 10 countries, mainly in Africa and Asia.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. As of 2023, yellow fever vaccine had been introduced in routine infant immunization programmes in 37 of the 42 countries and territories at risk for yellow fever in Africa and the Americas. In these 42 countries and territories, coverage is estimated at 50%.

Key challenges

In 2023, 14.5 million infants did not receive an initial dose of DTP vaccine, pointing to a lack of access to immunization and other health services, and an additional 6.5 million are partially vaccinated. Of the 21 million, just under 60% of these children live in 10 countries: Afghanistan, Angola, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Sudan and Yemen.

Monitoring data at subnational levels is critical to helping countries prioritize and tailor vaccination strategies and operational plans to address immunization gaps and reach every person with life-saving vaccines.

WHO response

WHO is working with countries and partners to improve global vaccination coverage, including through these initiatives adopted by the World Health Assembly in August 2020.

Immunization Agenda 2030

IA2030 sets an ambitious, overarching global vision and strategy for vaccines and immunization for the decade 2021–2030. It was co-created with thousands of contributions from countries and organizations around the world. It draws on lessons from the past decade and acknowledges continuing and new challenges posed by infectious diseases (e.g. Ebola, COVID-19).

The strategy has been designed to respond to the interests of every country and intends to inspire and align the activities of community, national, regional and global stakeholders towards achieving a world where everyone, everywhere fully benefits from vaccines for good health and well-being. IA2030 is operationalized through regional and national strategies and mechanisms to ensure ownership and accountability and a monitoring and evaluation framework to guide country implementation.

In 2020, the World Health Assembly adopted the global strategy towards eliminating cervical cancer. In this strategy, the first of the 3 pillars require the introduction of the HPV vaccine in all countries and has set a target of reaching 90% coverage. With introduction currently in 74% of Member States, large investments towards introduction in low- and middle-income countries will be required in the next 10 years as well as programme improvements to reach the 90% coverage targets in low- and high-income settings alike will be required to reach the 2030 targets.