Global childhood vaccination stalls as 13.5 million children remain 'zero-dose'

The world is making slow, uneven progress in vaccinating children. But for 13.5 million children, that progress has not come at all. They are known as 'zero-dose' children — those who have never received a single routine vaccine.

New data from UNICEF and the World Health Organization (WHO) shows that while global childhood immunization coverage has inched forward in recent years, it still has not returned to pre-pandemic levels. The agencies warn that the gains are fragile and uneven, leaving millions of children vulnerable to preventable diseases like measles, polio, and diphtheria.

Slow recovery, persistent gaps

The latest estimates reveal that in 2025, about 84% of the world's children received three doses of the diphtheria-tetanus-pertussis (DTP) vaccine, a key marker of immunization system performance. This is an improvement from the pandemic-era low of 81% in 2021, but still below the 86% recorded in 2019.

Before the pandemic, the world had been making steady progress toward the goal of 90% coverage. That target now seems distant. The WHO and UNICEF describe the current trajectory as a 'slow crawl' rather than a strong rebound.

The 13.5 million 'zero-dose' crisis

Of particular concern are the 13.5 million children who have not received a single dose of the DTP vaccine. These children, many living in conflict zones, remote areas, or marginalized communities, are completely unprotected against a range of deadly diseases.

Nearly half of all zero-dose children live in just five countries: Nigeria, India, Pakistan, Ethiopia, and the Democratic Republic of the Congo. Conflict and insecurity are major drivers. In countries like Sudan, Myanmar, and Yemen, ongoing violence has disrupted health services and displaced families, making routine immunization nearly impossible.

Vaccine hesitancy also plays a role. The WHO notes that misinformation and distrust, amplified during the pandemic, have led some parents to delay or refuse vaccines for their children. Even in countries with strong health systems, pockets of low coverage persist.

Measles outbreaks a warning sign

The consequences of these gaps are already visible. Measles, one of the most contagious diseases, is surging. In 2025, there were an estimated 300,000 measles cases globally, a sharp increase from the previous year. Outbreaks have been reported in over 30 countries, including India, Pakistan, and parts of Africa.

Measles is often the first disease to reappear when vaccination coverage drops, because it requires at least 95% coverage with two doses to prevent outbreaks. Many countries are far below that threshold. The WHO has called the rise in measles cases a 'canary in the coal mine' for broader immunization system weaknesses.

What needs to change

UNICEF and the WHO are calling for urgent action to reach zero-dose children. Their recommendations include strengthening primary health care, investing in community health workers, and improving vaccine supply chains in fragile settings. They also emphasize the need to build trust through community engagement and to counter misinformation with accurate, accessible information.

India, which has one of the largest immunization programs in the world, has made significant strides through its Mission Indradhanush initiative, targeting districts with low coverage. But even here, gaps remain, particularly in urban slums and among migrant populations.

The global health agencies stress that the goal is not just to recover lost ground, but to accelerate progress. Every child missed is a risk — not only to that child, but to the community. As long as the virus circulates, the threat of outbreaks remains.

What happens next depends on political will and funding. The next round of global immunization targets is set for 2030. Without a significant push, that deadline may be as elusive as the pre-pandemic goals.