Global childhood vaccination remains resilient, but equity cracks are widening

In 2024, immunisation data from WHO and UNICEF show that while 115 million infants (89%) received at least one dose of DTP vaccine and 109 million (85%) completed the series, nearly 20 million missed doses. Among these, 14.3 million infants were “zero-dose”, exceeding the IA2030 target by 4 million and the 2019 baseline by 1.4 million. The slight gains — 171,000 additional first doses and one million extra completed series — offer cautious optimism, but the underlying disparities remain troubling.

Conflicts compound these inequities. Fragile and conflict-afflicted countries account for just a quarter of the world’s infants, yet they harbour half of all zero-dose children, whose numbers have increased from 3.6 million in 2019 to 5.4 million in 2024. In Sudan, vaccination coverage collapsed — from 85% pre-war to as low as 8% in conflict zones — while Yemen’s zero-dose figures climbed significantly, driven by instability, health service disruptions, and misinformation.

Conversely, Gavi-supported, low-income countries saw marked improvements, reducing un- and under-vaccinated cohorts by around 650,000 in 2024. Yet even high- and upper-middle-income economies are experiencing slippage, with measles coverage hovering at 84% (first dose) and 76% (second), below the 95% threshold needed for herd immunity. Consequently, measles outbreaks surged, with 60 countries reporting significant incidents in 2024, doubling since 2022.

Country case snapshots powerfully illustrate these trends. In Bosnia and Herzegovina, measles vaccination rates are at just 55%, compared to Croatia’s 90%, contributing to over 7,000 cases and two adolescent deaths, prompting WHO and UNICEF to urge intensified immunisation campaigns. In Pakistan, polio resurgence has occurred amid militant threats and disrupted campaigns, with over one million children missing doses in 2024. The government’s response includes large-scale vaccination drives and policy enforcement, such as arrest warrants, signalling both the challenge and political recognition of routine immunisation’s fragility. Meanwhile, Bangladesh has steadily expanded its vaccine schedule — adding Hib, rubella, PCV, IPV and MR2 — achieving DTP3 coverage around 93% and fully vaccinated rates near 84% by 2019.

These illustrations reveal both progress and vulnerability. Countries with strong political will, robust systems, and community trust — like Bangladesh — are managing gains. Others, like Pakistan and Bosnia, highlight how instability, mistrust, and misinformation can swiftly unravel public health gains.

The 2024 immunisation data reiterates an urgent message. Global coverage has stabilised and broadened, but millions of children remain vulnerable in conflict zones and complacent high-income settings. Measles outbreaks, polio flare-ups, diphtheria spikes, and new threats like RSV underscore that the progress we’ve made is neither permanent nor evenly shared. Unless we decisively fill funding gaps, fortify health delivery in emergencies, ensure vaccine equity, and strengthen trust, these vulnerabilities will deepen — and outbreaks will follow.