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Global childhood vaccination coverage: where we are and where we’re headed

Strengthening primary health care and combating misinformation and vaccine hesitancy are the first steps toward meeting global targets, study suggests

 22/08/2025 - Publicado há 11 meses

By: Yasmin Constante*

Art by: Daniela Gonçalves**

Criança olha para uma enfermeira que se prepara para aplicar uma vacina
According to the 2025 VacinaBR Yearbook, Brazil has faced a continuous decline in childhood vaccination coverage since 2015 – Photo: Fabio Rodrigues-Pozzebom/ Agência Brasil

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A recently published article in The Lancet analyzes global trends in childhood vaccination between 1980 and 2023. The study, which involved researchers from around the world, makes projections for 2030 and assesses what is needed for the goals of the World Health Organization’s (WHO) Immunization Agenda to be achieved.

The publication provides updated global, regional, and national estimates of routine childhood vaccination coverage over 43 years for 204 countries and territories, and for 11 combinations of vaccine doses recommended by WHO for all children globally.

The research was developed based on the 2023 Global Burden of Disease (GBD) Study, conducted under the coordination of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Leonardo Roever is a PhD professor in the graduate program in neuroscience and behavior at USP’s Ribeirão Preto Medical School (FMRP) and has been a member of the Global Burden of Disease (GBD) Study for eight years. As a senior collaborator, his participation in the article included data analysis, scientific writing, approval, and review.

Roever explains in an interview with Jornal da USP that the Global Burden of Disease, Injuries, and Risk Factors Study evaluates health-related databases and articles, such as premature deaths and years lived with disability, with the aim of developing research. According to GBD, its network of researchers includes more than 7,000 collaborators in 156 countries worldwide.

Goals for 2030

The WHO’s Immunization Agenda 2030 (IA2030) seeks, through specific goals, to guide immunization programs and, consequently, increase global vaccination coverage. The agenda was developed through a collaborative approach that encompasses the needs of countries with greater vulnerabilities in the health sector.

The goals include reaching 90% coverage for essential childhood and adolescent vaccines; halving the number of zero-dose children; and completing 500 introductions of new or underused vaccines, such as those for COVID-19, rotavirus, or human papillomavirus (HPV).

The article points out that, for the goals to be successfully achieved, new immunization strategies must be created that are adaptable to the contexts of each locality for accelerated progress. Misinformation and vaccine hesitancy can be identified among the causes of negative trends.

Sub-Saharan Africa and South Asia are considered the regions most in need of progress. Latin America and the Caribbean are also highlighted, in this case with the goal of restoring previously reported figures.

Developed by WHO with the aim of ensuring universal access to vaccines, the essential programme on immunization (EPI) has been active for over 50 years. Initially, its focus was on universalizing six vaccines for children. Currently, the programme has expanded and includes 13 antigens: Bacillus Calmette-Guérin (BCG), diphtheria, pertussis, tetanus, Haemophilus influenzae type b (Hib), hepatitis B (HepB), poliomyelitis, measles, rubella, pneumococcal disease (PCV), rotavirus (Rota), human papillomavirus (HPV), and COVID-19 – intended for adults.

According to the research, among three vaccines – the third dose of the diphtheria-tetanus-pertussis vaccine (DTP3); the third dose of the pneumococcal conjugate vaccine (PCV3); and the second dose of the meningococcal type C vaccine (MCV2) – the trend is that only the first will meet the 90% target.

Imagem da bandeira da Organização Mundial da Saúde.
The WHO’s Essential Programme on Immunization has been active since 1974 – Photo: United States Mission Geneva /Wikimedia Commons

Regarding forecasts for improvement, Roever points out that he hopes changes will be made but emphasizes that this depends on various factors, such as each country’s financial capacity to expand vaccination coverage.

Children under 1 year of age who have completed the routine childhood vaccination – measured by those who have not received the first dose of the diphtheria-tetanus-pertussis vaccine (DTP1) – are considered zero-dose children.

During the analyzed period, Brazil was among the eight countries with the highest concentration of children in this condition, along with Nigeria, India, the Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, and Indonesia. Currently, despite some improvement, the country ranks 17th on the list.

According to Roever, this can be explained by the vulnerability conditions of these countries, which likely have inefficient immunization systems due to a lack of financial resources. Additionally, he highlights factors such as lack of access and lack of trust in health and information systems as contributors to these numbers.

The research also highlights that, when comparing data over more than four decades, long-term trends mask more recent challenges. This is because coverage of the original vaccines from the essential programme on immunization nearly doubled during the analyzed period, but coverage gains declined between 2010 and 2019 in several locations.

The covid-19 pandemic intensified these challenges. Vaccination coverage rates that fell in 2020 had not returned to previous levels by 2023. According to the article, the count of zero-dose children peaked during the covid-19 pandemic.

The largest reductions between 2019 – the last pre-pandemic year – and 2023 were estimated for coverage of the type 3 poliovirus vaccine, and the smallest reductions for the first dose of the diphtheria-tetanus-pertussis vaccine.

The full article is available at this link.

More information is available in the report Immunization Agenda 2030: A Global Strategy to Leave No One Behind, by WHO.

*Intern under the supervision of Luiza Caires

**Intern under the supervision of Moisés Dorado

English version: Nexus Traduções, edited by Denis Pacheco

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