Global childhood vaccination coverage increased slightly in 2024, but pre-pandemic levels were not restored

The data provided by WHO and UNICEF are highly valuable for several reasons. Firstly, because they are new data for a comprehensive historical series, with a reliable methodology that has remained stable over time. Secondly, because they paint an accurate picture of the situation regarding childhood immunisation and also accurately identify weaknesses and challenges to be addressed.

A quick conclusion could be that in 2024 there has been an improvement in some of the key indicators compared to 2023, but this improvement is slight and insufficient, as pre-pandemic status has not been restored and it is estimated that if the current pace continues, the targets set for 2030 will not be achieved (such as halving the number of children with zero doses compared to 2019 and achieving 90% global coverage for DTP (3 doses), pneumococcal conjugate (3 doses) and measles (2 doses) vaccines throughout life).

To highlight some positive aspects highlighted in this WHO/UNICEF publication, the most notable improvements have been observed in coverage for: the inactivated polio vaccine in countries with outbreaks of polio caused by vaccine-derived polioviruses; the pneumococcal conjugate vaccine; rotavirus vaccination; and human papillomavirus vaccination. On the other hand, there is still a long way to go for these vaccinations in the countries that need them most.

Another important aspect is the role of Gavi [the Vaccine Alliance, an international public-private partnership], which currently reaches 57 countries. A new indicator shown in this WHO/UNICEF study is the Breadth of Protection, which combines the coverage of 11 priority vaccinations into a single value and shows that countries under Gavi's protection, as a whole, achieve similar values to those of all other countries outside Gavi's scope. The data also show the difficulties faced by countries that leave Gavi's umbrella in the years following their departure.

As various studies have repeatedly pointed out for many years, inequalities persist and are overwhelming.

And they could get worse in the coming years: Africa is the only WHO region that, even today, continues to experience continuous increases in the annual birth cohort; every year for as long as this trend continues, more children will need to be vaccinated. This links to the difficulties and challenges that will need to be addressed in the coming years if we are to get closer to the 2030 targets.

Strengthening vaccination in countries with a certain degree of social and economic stability in order to at least maintain (and ideally improve) current coverage levels (as is happening with measles) requires explicit, broad and sustained social, academic, economic and political commitment. However, the greatest challenges come from the need to achieve widespread and equitable vaccination in countries suffering from mass displacement due to political instability, armed conflict, economic uncertainty and climate crises. The effects of misinformation and vaccine hesitancy threaten all countries, whether highly developed or less so. In short, as we know, stable political and financial commitment over time is needed to maintain a primary care system that brings equity to health programmes, including immunisation.

The need for stable funding affects different countries around the world in different ways. Those with greater capacity will have to contribute more, as they have done for decades, albeit with enormous difficulties. Unfortunately, the new US administration has decided to go ahead with plans to drastically cut its contribution to global health programmes, such as vaccinations. This will have a huge impact, as the US has been the largest donor to these programmes (and this must be recognised), and its withdrawal from the WHO, Gavi and other entities will have to be made up by the rest of the international community until rationality returns to the US.

The data published by the WHO/UNICEF are not far from those shown by another recent study, carried out using a different methodology. With an extra dose of optimism, we could highlight the need for the international community to assume its shared responsibility to improve child health protection equitably around the world, confident that this can be achieved with tools such as vaccinations, which have already brought about extraordinary achievements such as the eradication of smallpox and the drastic reduction of terrible diseases such as polio, diphtheria and others.

The report comes from a reliable institution, the World Health Organisation (WHO), which analyses the coverage of various paediatric vaccines in 2024 (such as diphtheria-tetanus-pertussis, measles, yellow fever, polio, etc.) and compares it with previous years. It is based on data obtained from the various member states of the World Health Organisation and UNICEF, up to June 2025. The data provided for 2024 is compared with that of previous years (up to 2000), thus covering a total of 24 years of study (page 25).

This provides a snapshot of the evolution of vaccination coverage worldwide and identifies whether there have been improvements or setbacks in ensuring that all children are protected against the most serious infections. It also analyses data in relation to income factors in different countries and conflicts, which may influence the higher prevalence of unvaccinated children.

Furthermore, it helps to highlight whether the targets set for the coming years (specifically 2030) are achievable or what problems have arisen in reducing the number of unvaccinated children.

It is interesting to see how all the progress made between 2000 and 2019 was reversed during the pandemic in 2020.

Even four years after the pandemic, the good vaccination coverage figures achieved in 2019 have not been reached.

How does this fit in with previous work? What new information does it provide?

"It is a study from 2024, but it compares with previous data from 2000, providing interesting information on the evolution of vaccination worldwide.

It also shows the efforts made by institutions such as Gavi to enable certain countries to vaccinate children who were not vaccinated at the recommended ages, so that they can do so and increase protection for as many children as possible.

The data on measles is very interesting. In the last five years, 80 countries have experienced measles outbreaks, which are associated with low vaccination coverage (page 20).

New vaccines have been introduced, such as conjugate vaccines for pneumococcus, rotavirus and papilloma. With regard to the human papilloma virus vaccine, a global increase has been observed, mainly due to the large number of countries (64) that introduced vaccination in 2024 (page 29).

Are there any important limitations to bear in mind?

‘This is a very well-conducted study of vaccination coverage, from the most reliable institution, which we should take as a reference.

It would be good to include the decline in infections covered by these vaccines in different countries, as it only includes countries with measles outbreaks. This would be another much more complex study, especially to obtain data from countries with poor health coverage and monitoring of children.’

How relevant is it for practice/clinical practice in Spain?

"Spain is one of the leading countries in childhood vaccination and also has good figures for older adults. It is essential to know the global vaccination coverage, as many pathogens require very high levels (such as measles) to avoid the risk of outbreaks.

We must understand that we are talking about global health and that what happens in other countries can ultimately affect us. It is also essential to know what possible pathogens we may encounter if we travel to certain countries for work or leisure, and that we should be vaccinated against prevalent diseases (such as yellow fever, dengue, hepatitis A, etc.).

People who want to travel should find out which vaccinations they need depending on their trip, their health, age, pregnancy, etc., and go to foreign health vaccination centres to get vaccinated in advance (2-3 months) before travelling. I recommend that travellers consult the website of the Ministry of Health and that of the international vaccination centres of the Foreign Health Service.

The annual WHO and UNICEF report on global vaccination coverage in children offers some glimmer of hope after several years of darkness and bad news, caused mainly by disruptions resulting from the COVID-19 pandemic. Compared to 2023, global vaccination coverage indicators have improved modestly, with fewer children globally receiving no vaccines (‘zero doses’) and some modest improvement in global coverage for the main vaccines routinely administered in early childhood.

However, progress is modest and largely does not demonstrate a recovery to pre-pandemic levels. It is precisely the poorest countries that are showing the fewest signs of recovery and are still furthest from regaining pre-pandemic vaccination coverage, a further sign of the significant health inequalities that exist. Add to this the fact that population growth in these countries is faster than in the rest of the world, and we should be concerned about the growing number of children who will be born and exposed to the risk of not receiving vaccines that could protect them against potentially fatal diseases. At this time of significant uncertainty regarding international development aid, and when multilateral organisations such as Gavi are seeing their funding and sustainability threatened, it is important to redouble our efforts to highlight that their work saves lives, and that countries that continue to receive special support from Gavi are improving their vaccination coverage indicators, leaving their children better protected by the vaccines they receive. Without a concerted effort to secure funding for the vaccination of all children born today in the poorest countries, including those in conflict, we risk losing decades of progress achieved through many years of collective effort.