Childhood vaccination coverage nearly doubled since 1980 — and has stalled since 2010

The headline number in a Global Burden of Disease analysis published in The Lancet on 24 June is a success: global coverage for the original Expanded Programme on Immunization vaccines — against diphtheria, tetanus and pertussis (first and third doses), measles (first dose), polio (third dose) and tuberculosis — nearly doubled between 1980 and 2023 [s1].

Almost every other number in the paper is a warning.

What was estimated, and how

The analysis produces global, regional and national estimates of routine childhood vaccine coverage from 1980 to 2023 for 204 countries and territories, covering 11 vaccine-dose combinations that WHO recommends for all children globally [s1]. It sits within the Global Burden of Diseases, Injuries, and Risk Factors Study 2023 and uses modelling designed to account for data biases and heterogeneity, and to model both vaccine scale-up and pandemic-related disruption [s1].

Three secondary analyses follow: the effect of the COVID-19 pandemic on coverage; forecasts of selected life-course vaccines to 2030; and the progress needed to halve the number of zero-dose children between 2023 and 2030 [s1]. Those targets come from the Immunization Agenda 2030, the coverage goals WHO set in 2019 [s1]. The work was funded by the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance [s1].

Where the stall shows up

The long upward trend since 1980 conceals a reversal that began before the pandemic. Coverage gains slowed between 2010 and 2019 in many countries and territories, including declines in 21 of 36 high-income countries and territories for at least one of the original EPI vaccine doses — excluding BCG, which some countries have removed from routine schedules [s1].

The pandemic made it worse. Global rates for those vaccines declined sharply from 2020 and, as of 2023, had still not returned to pre-pandemic levels [s1].

Newer vaccines behaved differently. Coverage for pneumococcal conjugate vaccine (third dose), the complete rotavirus series and a second dose of measles vaccine continued to increase globally through the pandemic, because introductions and scale-ups were still under way — but at slower rates than would have been expected without it [s1].

Zero-dose children

The paper's most concrete metric is the count of zero-dose children, proxied as children under one year who do not receive a first dose of DTP.

That number fell by 74.9% (95% uncertainty interval 72.1-77.3) globally between 1980 and 2019, with most of the decline achieved during the 1980s and the 2000s [s1]. After 2019 it rose again, to a pandemic-era peak of 18.6 million (17.6-20.0) in 2021 [s1].

As of 2023, the global figure stood at 15.7 million (14.6-17.0), and more than half of those children lived in just eight countries: Nigeria, India, the Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia and Brazil [s1]. Zero-dose children remain concentrated in conflict-affected regions and in places with constrained resources for vaccination services, particularly sub-Saharan Africa [s1].

The forecast

Forecasts to 2030 for three life-course vaccines — DTP3, PCV3 and MCV2 — suggest that only DTP3 would reach the Immunization Agenda 2030 target of 90% global coverage, and only under an optimistic scenario [s1].

That is a forecast, not an observation, and forecasts of vaccination coverage have to model political stability, financing and health-system capacity a decade out. The authors present it as an indication of the gap between current trajectory and stated target rather than as a prediction of what will happen.

The regional detail matters more than the global average. Substantial increases would be needed in many countries, with sub-Saharan Africa and south Asia facing the greatest challenges, while Latin America and the Caribbean would need to reverse recent declines simply to restore previous coverage levels — especially for DTP1, DTP3 and Pol3 [s1].

What the study cannot tell you

This is a modelling study built on administrative and survey data of varying quality across 204 countries and 43 years. Its uncertainty intervals are wide where data are sparse, which tends to be exactly where coverage is lowest. It estimates coverage, not disease: it does not report outbreaks, cases or deaths averted in 2023, and the frequently cited figure of 154 million child deaths averted since 1974 appears in the paper as background rather than as a new result of this analysis [s1].

The authors' own framing of what would change the trajectory is unglamorous: strengthening primary health care, addressing vaccine misinformation and hesitancy, adapting to local contexts, and targeting subnational geographies and marginalised populations through pandemic-recovery efforts such as WHO's Big Catch-Up [s1]. The Lancet published a linked comment, "Strengthening global routine childhood vaccination", alongside the analysis on the same day [s2].

What to watch

Whether the zero-dose count for 2024 and 2025, when it is estimated, continues to fall from the 2021 peak or settles at a plateau above the 2019 level. The paper establishes that the pandemic-era peak has passed; it does not establish that the pre-2019 downward trend has resumed [s1].

Sources

• [s1] Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet, 24 June 2025. https://doi.org/10.1016/S0140-6736(25)01037-2
• [s2] Strengthening global routine childhood vaccination. The Lancet, 24 June 2025. https://doi.org/10.1016/S0140-6736(25)01278-4