Global Immunization: A Stalled Promise

By Darius Spearman (africanelements)

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Immunization Goals: A Global Challenge

The world is currently off track to meet the ambitious targets set by the Immunization Agenda 2030 (IA2030) (IPS News). This global strategy, developed by the World Health Organization (WHO) and partners, aims to guide immunization efforts from 2021 to 2030 (who.int). Its core purpose is to reduce illness and death from vaccine-preventable diseases, ensure fair access to vaccines, and strengthen immunization within primary healthcare to support universal health coverage (who.int). The IA2030 sets ambitious goals, including achieving 90 percent global immunization coverage for essential childhood vaccines and halving the number of unvaccinated children by 2030 (IPS News).

However, recent data from the 2024 Estimates of National Immunization Coverage (WUENIC) paints a concerning picture (IPS News). In 2024, 20 million children did not receive at least one dose of the diphtheria, tetanus, and pertussis (DTP) vaccine, which is a key indicator for global immunization coverage (IPS News). The DTP vaccine protects against three serious bacterial diseases: diphtheria, which can cause breathing difficulties and heart problems; tetanus, leading to painful muscle spasms; and pertussis, or whooping cough, which is especially dangerous for infants (who.int). The completion of three doses of the DTP vaccine (DTP3) is used as a global marker because it is widely available and part of a basic childhood vaccination series, reflecting the strength of a country’s immunization program (healthpolicy-watch.news).

The Unvaccinated: A Growing Concern

Of the 20 million children who missed at least one DTP dose in 2024, a staggering 14.3 million received no vaccines at all (IPS News). These are known as “zero-dose” children, meaning they have not received any routine vaccinations (who.int). This number is 4 million more than the 2024 target and 1.4 million more than in 2019, the baseline year for IA2030 (IPS News). In 2023, there were 14.5 million zero-dose children globally, which was 33% more than the target set for that year, indicating a worsening trend (who.int). These children are entirely unprotected against common vaccine-preventable diseases, making them highly vulnerable to illness, disability, and even death (who.int).

Understanding “Zero-Dose” Children

“Zero-dose” children are those who have not received any routine vaccinations. This group is a critical focus because they are entirely unprotected against common vaccine-preventable diseases, making them highly vulnerable to illness, disability, and death. Reaching zero-dose children is essential for achieving equitable immunization coverage and preventing outbreaks, as they often reside in underserved communities, fragile settings, or areas affected by conflict, indicating systemic barriers to healthcare access. (who.int)

The global childhood immunization levels stalled in 2023 and have not returned to 2019 levels (unicef.org). This stagnation reflects ongoing challenges such as disruptions in healthcare services, logistical hurdles, and vaccine hesitancy (news-medical.net). The number of children who did not receive a single dose of the DTP vaccine increased from 13.9 million in 2022 to 14.5 million in 2023 (unicef.org). This trend highlights the urgent need for ongoing catch-up efforts, recovery strategies, and strengthening of health systems to ensure every child receives life-saving protection (unicef.org).

Conflict and Crisis: Barriers to Vaccination

Conflict and humanitarian crises are major obstacles to vaccination efforts. Children living in the 26 countries affected by fragility, conflict, or humanitarian emergencies are three times more likely to be unvaccinated than those in stable countries (IPS News). Half of all unvaccinated children globally reside in these 26 countries (IPS News). In half of these nations, the number of unvaccinated children rapidly increased from 3.6 million in 2019 to 5.4 million in 2024 (unicef.org). These crises severely disrupt immunization efforts by leading to the breakdown of health systems, displacement of populations, and insecurity (who.int). This makes it difficult for health workers to reach affected communities, destroys infrastructure, and diverts resources away from essential health services, including vaccination (who.int).

Despite these challenges, there has been some progress. Immunization coverage in the 57 low-income countries supported by Gavi, the Vaccine Alliance, improved in the past year (unicef.org). This resulted in a reduction of roughly 600,000 un- and under-vaccinated children, even with ongoing conflicts and population growth (unicef.org). However, inadequate immunization coverage and delayed or low-coverage supplementary immunization campaigns have created significant immunity gaps in these vulnerable populations, making them susceptible to outbreaks (who.int). Supplementary immunization campaigns are mass vaccination drives conducted in addition to routine services, often targeting specific age groups or populations in response to outbreaks or to boost immunity in areas with low routine coverage (who.int). They are crucial for closing immunity gaps, especially in hard-to-reach populations or during disease outbreaks (who.int).

Measles: A Persistent Threat

Measles remains a significant concern due to insufficient vaccination coverage. In 2024, 20 million children missed their first dose of the measles vaccine, and 12 million did not complete their second dose, leaving 30 million children at risk (IPS News). This has led to a surge in cases, with 360,000 measles cases confirmed globally in 2024, the highest number since 2019 (IPS News). The number of countries experiencing large and disruptive measles outbreaks rose to 60, almost double the number in 2022 (IPS News).

In 2023, only 83% of children worldwide received their first dose of the measles vaccine through routine health services (unicef.org). While the number of children receiving their second dose modestly increased from the previous year, reaching 74% of children, this is still not enough to prevent outbreaks (unicef.org). Global outbreaks of vaccine-preventable diseases are increasing, with 109 large or disruptive outbreaks of measles, circulating vaccine-derived poliovirus (cVDPV), cholera, and meningococcal disease in 2023 (who.int). This represents a 43% increase over the 2021 baseline (who.int). These increasing outbreaks signify significant immunity gaps within populations, leading to increased illness and death, especially among vulnerable groups (who.int).

Challenges to Immunization: Beyond the Vaccine

Immunization efforts face numerous challenges beyond simply having vaccines available. These include fewer health facilities, shortages of healthcare workers, vaccine stockouts, and difficulties reaching remote communities, especially in areas affected by conflict or displacement (IPS News). In high-income countries, immunization is challenged by decreased acceptance and vaccine hesitancy, often fueled by misinformation and distrust in institutions (IPS News). Vaccine hesitancy refers to the delay in acceptance or refusal of vaccination despite the availability of vaccination services, while misinformation involves the spread of inaccurate or misleading information about vaccines (who.int). Both significantly affect immunization uptake by eroding public trust in vaccines and health authorities, leading to lower vaccination rates (who.int).

The COVID-19 pandemic continues to affect routine immunization efforts by causing disruptions that led to a backslide in childhood immunization coverage (who.int). While some recovery has begun, the pandemic created a cohort of children who missed routine vaccinations, necessitating new policies to reach them (who.int). The focus on COVID-19 vaccination efforts also strained healthcare systems and diverted resources, impacting the delivery of other essential health services (who.int). Furthermore, a persistent funding gap hinders progress. Of the USD 11.9 billion needed to achieve immunization goals, only USD 9 billion has been raised (IPS News). This shortfall can lead to delays in vaccine procurement, insufficient staffing, and limited outreach activities, ultimately hindering progress towards global immunization targets (IPS News).

Progress and Hope: A Glimmer of Light

Despite the significant challenges, there has been some encouraging progress in immunization efforts. The number of zero-dose children, those who have not received any routine vaccinations, saw a slight reduction from 14.4 million in 2023 to 14.3 million in 2024 (IPS News). Additionally, 85% of infants worldwide received three doses of the DTP vaccine in 2024, an increase of 1 million from 2023 (IPS News). This modest growth means more children are protected against diphtheria, tetanus, and pertussis, diseases that can be deadly, especially for young children (who.int).

UNICEF and its partners have made significant strides through their Zero-Dose Immunization Program (ZIP), which has vaccinated over 1 million children in conflict-affected regions of the Sahel and the Horn of Africa since 2023 (IPS News). Gavi, the Vaccine Alliance, has also played a crucial role, supporting more children against more diseases than ever before in 2024 (IPS News). Gavi has allocated nearly 200 million routine vaccine doses to 35 lower-income countries to reach millions of children who missed vaccinations during the COVID-19 pandemic (gavi.org). These efforts demonstrate the resilience and determination of countries and organizations working to close the immunization gap.

HPV Vaccination: A Success Story

An area of notable progress is Human Papillomavirus (HPV) vaccination. In 2024, 43 million girls were vaccinated against HPV, putting the world on track to reach 86 million adolescents by the end of 2025 (IPS News). This means 60 million girls are now protected against cervical cancer, more than in any previous decade (IPS News). The progress in HPV vaccination is significant because it represents a successful expansion of vaccine programs beyond traditional childhood diseases to include cancer prevention (who.int). HPV vaccination targets the viruses that cause most cervical cancers and other HPV-related cancers, offering a crucial public health intervention (who.int). Its rising global coverage, driven by recent rollouts in low- and middle-income countries, demonstrates the feasibility of introducing new vaccines and reaching adolescents, contributing to overall immunization goals and long-term health outcomes (who.int).

This success highlights the importance of continued commitment and investment in immunization programs. While the world faces a stubborn “glass ceiling” in reaching every child, the progress in HPV vaccination and the efforts to reduce zero-dose children offer hope (IPS News). The path forward requires addressing systemic challenges, strengthening primary healthcare, and building trust within communities to ensure that every child, regardless of their circumstances, receives the life-saving protection of vaccines.

Strategies for the Future: Getting Back on Track

To get back on track to meet the IA2030 targets, several key strategies are being implemented and proposed. One crucial approach involves developing new policies to reach children who missed vaccinations during the pandemic, especially those who are now past the routine vaccination age (who.int). This includes targeted catch-up campaigns and innovative delivery methods to ensure these children receive the protection they need. Furthermore, strengthening immunization and primary healthcare services, including community health systems, is a fundamental strategy (who.int). This involves investing in healthcare infrastructure, training more health workers, and ensuring a consistent supply of vaccines, especially in remote and underserved areas.

Addressing systemic immunization challenges is also a major focus to correct longer-term stagnation in vaccination rates and reach the most marginalized children (who.int). This includes tackling issues like inadequate cold chain infrastructure, logistical hurdles in vaccine delivery, and workforce shortages. Additionally, building and sustaining vaccine confidence and acceptance through engagement with communities and health providers is essential (who.int). This involves open communication, addressing concerns about vaccine safety and efficacy, and countering misinformation. Social determinants such as poverty, education, and gender also play a significant role in immunization gaps by creating barriers to vaccine access and uptake, disproportionately affecting marginalized communities (who.int). Therefore, efforts must also consider these underlying social factors to ensure equitable access to vaccines for all children.

Regional Disparities and Global Efforts

Immunization challenges and coverage vary significantly by region and country income level. Lower-income countries, particularly those in fragile, vulnerable, and conflict-affected settings, often face greater challenges due to weaker health systems, limited resources, and higher numbers of zero-dose children (who.int). This leads to substantial immunity gaps and a higher incidence of outbreaks. While global figures provide an overview, regional and country-specific data reveal disparities, with some regions making progress while others struggle with stagnated or even reversed immunization achievements (who.int).

The global community, including organizations like WHO, UNICEF, and Gavi, the Vaccine Alliance, are working together to deliver the global Immunization Agenda 2030 (IA2030) (unicef.org). This strategy aims for all countries and relevant global partners to achieve set goals on preventing diseases through immunization and delivering vaccines to everyone, everywhere, at every age (unicef.org). The IA2030 framework includes a Monitoring and Evaluation (M&E) Framework with tailored indicators to continuously improve immunization programs at all levels (who.int). These efforts are crucial to ensure that the promise of immunization, one of the most effective public health interventions, can be realized for every child, especially in communities that have historically been underserved and overlooked.

ABOUT THE AUTHOR

Darius Spearman has been a professor of Black Studies at San Diego City College since 2007. He is the author of several books, including Between The Color Lines: A History of African Americans on the California Frontier Through 1890. You can visit Darius online at africanelements.org.