Stalling Progress in Childhood Vaccination Coverage Threatens Global Health Goals

Since the World Health Organization (WHO) launched its Expanded Program on Immunization (EPI) in 1974, remarkable strides have been made worldwide in protecting children against deadly diseases through vaccination. Over this nearly five-decade period, immunization efforts have prevented approximately 154 million childhood deaths and added more than 10 billion years of full health across the globe. The initial focus was on six key preventable diseases: tuberculosis, diphtheria, pertussis, tetanus, polio, and measles. As vaccine technology advanced, the program expanded to include additional vaccines targeting illnesses like Haemophilus influenzae type B, hepatitis B, rubella, pneumococcal disease, rotavirus, and human papillomavirus (HPV). Over 4 billion children have received vaccines through this initiative, reflecting its massive reach and impact.

However, despite these successes, recent data reveals a concerning slowdown in vaccination rates over the past two decades, with significant disparities across different regions and countries. The COVID-19 pandemic further intensified these service disruptions, leading to millions of children missing essential vaccines, especially in low- and middle-income nations. Between 2020 and 2023, approximately 15.6 million children missed their full diphtheria-tetanus-pertussis vaccination doses, while 15.9 million did not receive any dose of polio vaccine, and over 9 million missed tuberculosis immunization.

Disruptions from the pandemic disproportionately affected sub-Saharan Africa, where an estimated 6.96 million children missed rotavirus vaccines, and deficiencies in vaccine coverage have resulted in recent outbreaks of measles, polio, and diphtheria. In Europe and the United States, measles cases surged again—almost 10 times higher in the EU by 2024 and over 1,000 cases reported across 30 U.S. states by May 2025.

Global vaccination coverage for the original EPI vaccines has improved since 1980; for instance, the coverage for the diphtheria-tetanus-pertussis (DTP) vaccine rose from 49% to 89%, and measles vaccination from 37% to 83%. Despite this progress, recent fluctuations show declines in some high-income countries and uneven coverage worldwide. Notably, the proportion of children receiving the measles vaccine decreased in 100 countries, particularly in Latin America and the Caribbean.

The study highlights the urgent need for targeted strategies to overcome barriers like vaccine misinformation, hesitancy, logistical challenges, and geopolitical conflicts. Efforts to build trust in vaccines through community engagement and culturally sensitive approaches are essential to improve coverage. Achieving the WHO’s 2030 goals, including halving the number of unvaccinated children, will require accelerating efforts, especially in regions with persistent low coverage like sub-Saharan Africa and South Asia. Rising birth cohorts and strained health systems will pose additional challenges, emphasizing the importance of sustained investment and innovative solutions.

Experts stress that reducing vaccine hesitancy and addressing disparities are critical to preventing outbreaks of preventable diseases, which could reverse decades of progress. Continued global cooperation and tailored interventions are vital to ensure every child has access to lifesaving vaccines and to meet international health targets.