Abstract
Background: Since its inception in 1974, the Essential Programme on Immunization (EPI) has achieved remarkable success, averting the deaths of an estimated 154 million children worldwide through routine childhood vaccination. However, more recent decades have seen persistent coverage inequities and stagnating progress, which have been further amplified by the COVID-19 pandemic. In 2019, WHO set ambitious goals for improving vaccine coverage globally through the Immunization Agenda 2030 (IA2030). Now halfway through the decade, understanding past and recent coverage trends can help inform and reorient strategies for approaching these aims in the next 5 years. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, this study provides updated global, regional, and national estimates of routine childhood vaccine coverage from 1980 to 2023 for 204 countries and territories for 11 vaccine-dose combinations recommended by WHO for all children globally. Employing advanced modelling techniques, this analysis accounts for data biases and heterogeneity and integrates new methodologies to model vaccine scale-up and COVID-19 pandemic-related disruptions. To contextualise historic coverage trends and gains still needed to achieve the IA2030 coverage targets, we supplement these results with several secondary analyses: (1) we assess the effect of the COVID-19 pandemic on vaccine coverage; (2) we forecast coverage of select life-course vaccines up to 2030; and (3) we analyse progress needed to reduce the number of zero-dose children by half between 2023 and 2030. Findings: Overall, global coverage for the original EPI vaccines against diphtheria, tetanus, and pertussis (first dose [DTP1] and third dose [DTP3]), measles (MCV1), polio (Pol3), and tuberculosis (BCG) nearly doubled from 1980 to 2023. However, this long-term trend masks recent challenges. 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 these vaccine doses (excluding BCG, which has been removed from routine immunisation schedules in some countries and territories). The COVID-19 pandemic exacerbated these challenges, with global rates for these vaccines declining sharply since 2020, and still not returning to pre-COVID-19 pandemic levels as of 2023. Coverage for newer vaccines developed and introduced in more recent years, such as immunisations against pneumococcal disease (PCV3) and rotavirus (complete series; RotaC) and a second dose of the measles vaccine (MCV2), saw continued increases globally during the COVID-19 pandemic due to ongoing introductions and scale-ups, but at slower rates than expected in the absence of the pandemic. Forecasts to 2030 for DTP3, PCV3, and MCV2 suggest that only DTP3 would reach the IA2030 target of 90% global coverage, and only under an optimistic scenario. The number of zero-dose children, proxied as children younger than 1 year who do not receive DTP1, decreased by 74·9% (95% uncertainty interval 72·1–77·3) globally between 1980 and 2019, with most of those declines reached during the 1980s and the 2000s. After 2019, counts of zero-dose children rose to a COVID 19-era peak of 18·6 million (17·6–20·0) in 2021. Most zero-dose children remain concentrated in conflict-affected regions and those with various constraints on resources available to put towards vaccination services, particularly sub-Saharan Africa. As of 2023, more than 50% of the 15·7 million (14·6–17·0) global zero-dose children resided in just eight countries (Nigeria, India, Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia, and Brazil), emphasising persistent inequities. Interpretation: Our estimates of current vaccine coverage and forecasts to 2030 suggest that achieving IA2030 targets, such as halving zero-dose children compared with 2019 levels and reaching 90% global coverage for life-course vaccines DTP3, PCV3, and MCV2, will require accelerated progress. Substantial increases in coverage are necessary in many countries and territories, with those in sub-Saharan Africa and south Asia facing the greatest challenges. Recent declines will need to be reversed to restore previous coverage levels in Latin America and the Caribbean, especially for DTP1, DTP3, and Pol3. These findings underscore the crucial need for targeted, equitable immunisation strategies. Strengthening primary health-care systems, addressing vaccine misinformation and hesitancy, and adapting to local contexts are essential to advancing coverage. COVID-19 pandemic recovery efforts, such as WHO's Big Catch-Up, as well as efforts to bolster routine services must prioritise reaching marginalised populations and target subnational geographies to regain lost ground and achieve global immunisation goals. Funding: The Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 235-260 |
| Number of pages | 26 |
| Journal | The Lancet |
| Volume | 406 |
| Issue number | 10500 |
| DOIs | |
| Publication status | Published - 19 Jul 2025 |
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In: The Lancet, Vol. 406, No. 10500, 19.07.2025, p. 235-260.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030
T2 - a systematic analysis for the Global Burden of Disease Study 2023
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AU - Kamath, Rajesh
AU - Kamorudeen, Ramat T.
AU - Kamyari, Naser
AU - Kamyshnyi, Oleksandr
AU - Kanaan, Mona
AU - Kanaan, Saddam Fuad
AU - Kang, Jiseung
AU - Kankam, Samuel Berchi
AU - Kanmodi, Kehinde Kazeem
AU - Kannan S, Suthanthira
AU - Kantar, Rami S.
AU - Kapoor, Neeti
AU - Karami, Jafar
AU - Karasneh, Reema A.
AU - Karaye, Ibraheem M.
AU - Karch, André
AU - Karobari, Mohmed Isaqali
AU - Karpiński, Tomasz M.
AU - Kashyap, Manoj Kumar
AU - Khajuria, Himanshu
AU - Khaksar, Mohammad Ali
AU - Khalid, Nauman
AU - Khalil, Anees Ahmed
AU - Khamesipour, Faham
AU - Khan, Abdul Arif
AU - Khan, Ajmal
AU - Khan, Faiz Ullah
AU - Khan, Gulfaraz
AU - Khan, Maseer
AU - Khan, Md Abdullah Saeed
AU - Khan, Moien AB
AU - Khan, Muhammad Umer
AU - Khan, Ramsha Mushtaq
AU - Khan, Sumaiya Khan
AU - Khan, Ubaid
AU - Khan, Yusuf Saleem
AU - Khan, Zahid
AU - Khanal, Vishnu
AU - Khasbage, Sameer Uttamaro
AU - Khatab, Khaled
AU - Khatatbeh, Haitham
AU - Khatatbeh, Moawiah Mohammad
AU - Khazaei, Afshin
AU - Kheirallah, Khalid A.
AU - Khosravi, Farbod
AU - Kim, Grace
AU - Kim, Jinho
AU - Kim, Kwanghyun
AU - Kim, Min Seo
AU - Kimokoti, Ruth W.
AU - Kinfu, Yohannes
AU - Kisa, Adnan
AU - Kisa, Sezer
AU - KM, Shivakumar
AU - Kochhar, Sonali
AU - Kokkorakis, Michail
AU - Kolahi, Ali Asghar
AU - Kompani, Farzad
AU - Korshunov, Vladimir Andreevich
AU - Korzh, Oleksii
AU - Kostev, Karel
AU - Koul, Parvaiz A.
AU - Kretchy, Irene Akwo
AU - Kretchy, James Paul
AU - Krishan, Kewal
AU - Kuate Defo, Barthelemy
AU - Kuchay, Raja Amir Hassan
AU - Kuddus, Mohammed
AU - Kuitunen, Ilari
AU - Kulimbet, Mukhtar
AU - Kumah, Emmanuel
AU - Kumar, Dewesh
AU - Kumar, G. Anil
AU - Kumar, Jogender
AU - Kumar, Kamal
AU - Kumar, Narendar
AU - Kumar, Rakesh
AU - Kundu, Satyajit
AU - Kunutsor, Setor K.
AU - Kurniasari, Maria Dyah
AU - Kushawaha, Pramod Kumar
AU - Kusnali, Asep
AU - Kusuma, Dian
AU - Kuttybayev, Assylkhan
AU - Kwong, Wai Hang Patrick
AU - Kyei-Arthur, Frank
AU - Kytö, Ville
AU - L C, Dr Pallavi
AU - La Vecchia, Carlo
AU - Ladan, Muhammad Awwal
AU - Lahariya, Chandrakant
AU - Lakanova, Balzhan
AU - Landires, Iván
AU - Lasrado, Savita
AU - Lau, Colleen L.
AU - Le, Huu Hoai
AU - Le, Minh Huu Nhat
AU - Le, Nhi Huu Hanh
AU - Le, Trang Diep Thanh
AU - Ledda, Caterina
AU - Lee, Sergey Vadimovich
AU - Lee, Seung Won
AU - Lee, Wei Chen
AU - Legesse, Awol Yemane
AU - Leong, Elvynna
AU - Li, Ming Chieh
AU - Li, Peng
AU - Li, Wei
AU - Ligade, Virendra S.
AU - Lin, Jialing
AU - Lin, John C.
AU - Lin, Queran
AU - Liu, Gang
AU - Liu, Haipeng
AU - Liu, Jue
AU - Liu, Patrick Y.
AU - Liu, Xuefeng
AU - Liu, Zhe
AU - Llanaj, Erand
AU - López-Gil, José Francisco
AU - Lopukhov, Platon D.
AU - Lucchetti, Giancarlo
AU - Ludhiadch, Abhilash
AU - Luo, Peng
AU - Lutambi, Angelina M.
AU - Lv, Lei
AU - Lwin, Kaung Suu
AU - Lytras, Miltiadis D.
AU - Lytvyak, Ellina
AU - M. Afifi, Ahmed
AU - Ma, Kevin Sheng Kai
AU - Ma, Zheng Feei
AU - Ma'aruf, Shamsuddeen Yusuf Yusuf
AU - Mabrok, Mahmoud
AU - Machoy, Monika
AU - Madadi, Firoozeh
AU - Madadizadeh, Farzan
AU - Madinezad, Seyed Ataollah
AU - Madureira-Carvalho, Aurea Marilia
AU - Mahalingam, Sasikumar
AU - Mahamed, Samatar Abshir
AU - Mahmood, Nozad H.
AU - Mahmoud, Mansour Adam
AU - Mahmoudi, Farhad
AU - Malhotra, Hardeep Singh
AU - Malik, Ahmad Azam
AU - Malik, Shahid
AU - Malik, Tabarak
AU - Malta, Deborah Carvalho
AU - Mamo, Biniyam Tedla Tedla
AU - Manjani, Lokesh
AU - Mannethodi, Kamaruddeen
AU - Mansoor, Farheen
AU - Mansournia, Mohammad Ali
AU - Manzoor, Shaista
AU - Maqbool, Tahir
AU - Marasini, Bishnu P.
AU - Marateb, Hamid Reza
AU - Margetis, Konstantinos
AU - Marks-Hultström, Michael
AU - Martinez-Valle, Adolfo
AU - Martins-Melo, Francisco Rogerlândio
AU - Martorell, Miquel
AU - Marzo, Roy Rillera
AU - Marzouk, Sammer
AU - Masi, Stefano
AU - Matei, Clara N.
AU - Mathangasinghe, Yasith
AU - Mathur, Medha
AU - Mathur, Neeta
AU - Matozinhos, Fernanda Penido
AU - Maude, Richard James
AU - Mbachu, Chioma Ngozichukwu Pauline
AU - Mbachu, Ikechukwu Innocent
AU - McPhail, Steven M.
AU - Medel Salas, María Paz
AU - Mediratta, Rishi P.
AU - Mehta, Vini
AU - Mehto, Subhash
AU - Meiring, James
AU - Mekene Meto, Tesfahun
AU - Mekonnen, Tesfaye Hambisa
AU - Meles, Hadush Negash
AU - Melese, Endalkachew Belayneh
AU - Memish, Ziad Ahmed
AU - Mendoza, Walter
AU - Menezes, Godfred Antony
AU - Menezes, Ritesh G.
AU - Mengistie, Emiru Ayalew
AU - Mengstie, Leweyehu Alemaw
AU - Mentis, Alexios Fotios A.
AU - Meo, Sultan Ayoub Ayoub
AU - Meretoja, Atte
AU - Mestrovic, Tomislav
AU - Mettananda, Sachith
AU - Metwally, Mohamed M.M.
AU - Michalek, Irmina Maria
AU - Minervini, Giuseppe
AU - Ming, Wai kit
AU - Mirica, Andreea
AU - Mirkheshti, Alireza
AU - Mishra, Vinaytosh
AU - Mohamed, Heba M.
AU - Mohamed, Hebatalla
AU - Mohamed, Jama
AU - Mohamed, Mona Gamal
AU - Mohamed, Nouh Saad
AU - Mohamed Ahmed, Khabab Abbasher Hussien Abbasher Hussien
AU - Mohammad, Taj
AU - Mohammadi, Abdolreza
AU - Mohammed, Shafiu
AU - Mohammed, Yahaya
AU - Mohan, Syam
AU - Mohseni, Mohammad
AU - Mohsenzadeh, Amin
AU - Mokdad, Ali H.
AU - Mokhtarzadehazar, Peyman
AU - Monasta, Lorenzo
AU - Moni, Mohammad Ali
AU - Moradi, Maryam
AU - Moradi, Yousef
AU - Moraga, Paula
AU - Morgan, Anthony Kwame
AU - Morrison, Shane Douglas
AU - Morsy, Mahmoud M.
AU - Mousavi, Seyed Ahmad
AU - Mousavi Kiasary, Seyed Mohamad Sadegh
AU - Mowafy, Hagar
AU - Mozahheb Yousefi, Kimia
AU - Mubarak, Rabia
AU - Mubarik, Sumaira
AU - Mueller, Ulrich Otto
AU - Mukherjee, Sumoni
AU - Mulita, Francesk
AU - Mulyadi, Mulyadi
AU - Munjal, Kavita
AU - Munshi, Anjana
AU - Murray, Christopher J.L.
AU - Musaigwa, Fungai
AU - Mustafa, Sherzad Ibrahim
AU - Mustapha, Mubarak Taiwo
AU - Muthupandian, Saravanan
AU - Muvunyi, Claude Mambo Mambo
AU - Muzaffar, Muhammad
AU - Myung, Woojae
AU - Nafei, Ayoub
AU - Naghavi, Pirouz
AU - Naghibzadeh, Amirhossein
AU - Naghshbandi, Mobin
AU - Naik, Ganesh R.
AU - Naik, Gurudatta
AU - Nainu, Firzan
AU - Nair, Tapas Sadasivan
AU - Najdaghi, Soroush
AU - Najmuldeen, Hastyar Hama Rashid
AU - Nandi, Arindam
AU - Narasimha Swamy, Sreenivas
AU - Nargus, Shumaila
AU - Nashwan, Abdulqadir J.
AU - Nassar, Mahmoud
AU - Natto, Zuhair S.
AU - Naureen, Zakira
AU - Navaratna, Samidi Nirasha Kumari
AU - Nayak, Biswa Prakash
AU - Nayak, Shalini Ganesh Ganesh
AU - Nayon, Md Fahad Shahariar
AU - Nazri-Panjaki, Athare
AU - Ndishimye, Pacifique
AU - Negoi, Ionut
AU - Nepal, Samata
AU - Netsere, Henok Biresaw
AU - Nguyen, Kieu Viet Nhi
AU - Nguyen, Nhan
AU - Nguyen, Nhien Ngoc Y.
AU - Nguyen Khoi, Quan
AU - Nhi, Nguyen Ngoc Yen
AU - Niazi, Robina Khan
AU - Nieddu, Luciano
AU - Nigusse, Afewerki Tesfahunegn Tesfahunegn
AU - Nikoobar, Ali
AU - Niroomand, Behnaz
AU - Nnaji, Chukwudi A.
AU - Nomura, Shuhei
AU - Noor, Syed Toukir Ahmed
AU - Noroozi, Masoud
AU - Nriagu, Valentine C.
AU - Nri-Ezedi, Chisom Adaobi
AU - Nshimiyimana, Jean Claude
AU - Nugen, Fred
AU - Nunemo, Mengistu H.
AU - Nyande, Felix Kwasi
AU - Oancea, Bogdan
AU - Oboh, Mary Aigbiremo
AU - Odat, Ramez M.
AU - Odetokun, Ismail A.
AU - Oduro, Michael Safo
AU - Ogundare, Tunde Emmanuel
AU - Ogundeko-Olugbami, Oluwafunmilayo Tosin
AU - Ojedoyin, Olusegun Olatunji
AU - Okekunle, Akinkunmi Paul
AU - Okoli, Onyedika A.
AU - Okonji, Osaretin Christabel
AU - Okunlola, John Olayemi
AU - Okunlola, Oluyemi Adewole
AU - Olabisi, Oluwaseyi Isaiah
AU - Olivas-Martinez, Antonio
AU - Oliveira, Gláucia Maria Moraes
AU - Olorukooba, Abdulhakeem Abayomi
AU - Olorunju, Samson Bamidele
AU - Olorunsaiye, Comfort Z.Z.
AU - Olusanya, Bolajoko Olubukunola
AU - Oluwole, Oluwafemi G.Gabriel
AU - Omage, Folorunsho Bright
AU - Onwujekwe, Obinna E.
AU - Onyeaghala, Chizaram A.
AU - Opitz, Marcel
AU - Ordak, Michal
AU - Orish, Verner N.
AU - Orscelik, Atakan
AU - Ortiz, Alberto
AU - Ortiz-Brizuela, Edgar
AU - Ortiz-Prado, Esteban
AU - Osborne, Augustus
AU - Osei, Eric
AU - Othman, Elham H.
AU - Otorkpa, Oche Joseph
AU - Ouyahia, Amel
AU - Owolabi, Mayowa O.
AU - Oyebola, Kolapo
AU - Oyelade, Tope
AU - Oyeyemi, Oyetunde T.
AU - Ozsahin, Ilker
AU - Padubidri, Jagadish Rao
AU - Pakbaz, Yeganeh
AU - Palicz, Tamás
AU - Panda, Sujogya Kumar
AU - Panos, Georgios D.
AU - Panos, Leonidas D.D.
AU - Papa, Mario Virgilio
AU - Papadimopoulos, Ilias
AU - Pardhan, Shahina
AU - Parekh, Utsav
AU - Parikh, Romil R.
AU - Park, Chulwoo
AU - Passera, Roberto
AU - Patel, Mitesh
AU - Patel, Neel Navinkumar
AU - Patil, Shankargouda
AU - Patoulias, Dimitrios
AU - Pawar, Shrikant
AU - Pawar, Shubhadarshini
AU - Pazoki Toroudi, Hamidreza
AU - Pekarcikova, Jarmila
AU - Pepito, Veincent Christian Filipino
AU - Peprah, Prince
AU - Pereira, Gavin
AU - Perez Chacon, Gladymar
AU - Perna, Simone
AU - Petakh, Pavlo
AU - Peter, Olumuyiwa James
AU - Pham, Nhat Truong
AU - Pham, Tung Thanh
AU - Piracha, Zahra Zahid
AU - Pirera, Edoardo
AU - Poddighe, Dimitri
AU - Polibin, Roman V.
AU - Poluru, Ramesh
AU - Pourasghary, Sajjad
AU - Pourbabaki, Reza
AU - Pourghazi, Farzad
AU - Pourtaheri, Naeimeh
AU - Prakash, Ashwathi
AU - Prates, Elton Junio Sady
AU - Purohit, Jyotirekha
AU - Puvvula, Jagadeesh
AU - Qanash, Husam
AU - Qasim, Nameer Hashim
AU - Qazi, Asma Saleem
AU - Qi, Xiang
AU - Qi, Zhipeng
AU - Qian, Gangzhen
AU - Rabiee, Navid
AU - Rachmat, Basuki
AU - Radhakrishnan, Venkatraman
AU - Rahim, Fakher
AU - Rahimi, Sajjad
AU - Rahimi-Movaghar, Vafa
AU - Rahman, Fryad Majeed
AU - Rahman, Md Mosfequr
AU - Rahman, Md Obaidur
AU - Rahman, Mosiur
AU - Rahman, Muhammad Aziz
AU - Rahmani, Saeed
AU - Rahmoune, Hakim
AU - Raina, Sunil Kumar
AU - Raj, Jeffrey Pradeep
AU - Raja, Adarsh
AU - Rajendran, Gunaseelan
AU - Rajendran, Judah
AU - Rajizadeh, Mohammad Amin
AU - Rajpurohit, Siddheesh
AU - Ramadan, Mahmoud Mohammed
AU - Ramasamy, Chitra
AU - Ramasamy, Shakthi Kumaran
AU - Ramphul, Kamleshun
AU - Rana, Kirtan
AU - Rana, Rishabh Kumar
AU - Ranabhat, Chhabi Lal
AU - Rancic, Nemanja
AU - Rani, Smitha
AU - Rao, Chythra R.
AU - Rao, Sowmya J.
AU - Rashid, Md Abdur
AU - Rashidi, Mohammad Mahdi
AU - Rasul, Azad
AU - Rathish, Devarajan
AU - Rauf, Abdur
AU - Rauniyar, Santosh Kumar
AU - Rawaf, David Laith
AU - Rawaf, Salman
AU - Redwan, Elrashdy
AU - Rehman, Wajiha
AU - Reyes, Luis Felipe
AU - Rezaei, Mina
AU - Rezaei, Nazila
AU - Rezaeian, Mohsen
AU - Riad, Abanoub
AU - Rizvi, Moattar Raza
AU - Robinson-Oden, Hannah Elizabeth
AU - Rocha, Hermano Alexandre Lima
AU - Rodrigues da Silva, Thales Philipe
AU - Roever, Leonardo
AU - Roshanshad, Amirhossein
AU - Rout, Himanshu Sekhar
AU - Rouzbahani, Shiva
AU - Roy, Adrija
AU - Roy, Nitai
AU - Roy, Sharmistha
AU - Roy, Shubhanjali
AU - Ruela, Guilherme de Andrade
AU - Rwegerera, Godfrey M.
AU - Saad, Aly M.A.
AU - Saber-Ayad, Maha Mohamed
AU - Sadat Rafiei, Seyed Kiarash
AU - Saddik, Basema Ahmad
AU - Sadegh, Tarannom
AU - Sadeghi-Ghyassi, Fatemeh
AU - Saeed, Mohd
AU - Saeed, Umar
AU - Safari, Mehdi
AU - Sagharichi, Mastooreh
AU - Sagoe, Dominic
AU - Saheb Sharif-Askari, Narjes
AU - Sajadi, S. Mohammad
AU - Sajib, Md Refat Uz Zaman
AU - Sajid, Mirza Rizwan
AU - Saki, Morteza
AU - Salabat, Dorsa
AU - Salam, Nasir
AU - Salami, Afeez Abolarinwa
AU - Saleh, Mohamed A.
AU - Salehi, Mahdi
AU - Salemcity, Aanuoluwa James
AU - Salihu, Dauda
AU - Salimi, Sohrab
AU - Salimi Pormehr, Pegah
AU - Sallam, Malik
AU - Samadi Kafil, Hossein
AU - Samargandy, Saad
AU - Samodra, Yoseph Leonardo
AU - Samuel, Nahom Samuel
AU - Samy, Abdallah M.
AU - Sankar, Sathish
AU - Sanyaolu, Adekunle
AU - Sarfo, Jacob Owusu
AU - Sarma, Hemen
AU - Sarmadi, Mohammad
AU - Sarode, Sachin C.
AU - Sathian, Brijesh
AU - Satpathy, Maheswar
AU - Savabi Far, Mehrdad
AU - Sawhney, Monika
AU - Saya, Ganesh Kumar
AU - Schinckus, Christophe
AU - Schneider, Ione Jayce Ceola
AU - Schuermans, Art
AU - Sedigh, Amin
AU - Semreen, Mohammad H.
AU - Senapati, Sabyasachi
AU - Sendekie, Ashenafi Kibret
AU - Sengupta, Pallav
AU - Senol, Yigit Can
AU - Senthilkumaran, Subramanian
AU - Serban, Dragos
AU - Sethi, Yashendra
AU - Seyed Alshohadaei, Seyed Mohammad
AU - Sha'aban, Abubakar
AU - Shahab, Muhammad
AU - Shahid, Samiah
AU - Shahid, Syed Ahsan Ahsan
AU - Shahid, Wajeehah
AU - Shahkarami, Farshad
AU - Shahrahmani, Fatemeh
AU - Shahwan, Moyad Jamal
AU - Shaikh, Ahmed
AU - Shaikh, Masood Ali
AU - Shaikh, Nafhat
AU - Shakeri, Alireza
AU - Shams-Beyranvand, Mehran
AU - Shamshirgaran, Mohammad Ali
AU - Shamsi, Anas
AU - Shamsutdinova, Alfiya
AU - Shan, Dan
AU - Shannawaz, Mohammed
AU - Sharifan, Amin
AU - Sharma, Bunty
AU - Sharma, Manoj
AU - Sharma, Vishal
AU - Shawahna, Ramzi
AU - Shayan, Maryam
AU - Shenoy, Suchitra M.
AU - Sherchan, Samendra P.
AU - Shetty, Shiran
AU - Shimul, Md Monir Hossain
AU - Shittu, Aminu
AU - Shokati Eshkiki, Zahra
AU - Shokri, Azad
AU - Shool, Sina
AU - Shorofi, Seyed Afshin
AU - Shuval, Kerem
AU - Siavashpour, Zahra
AU - Siddig, Emmanuel Edwar
AU - Siddiqua, Ayesha
AU - Silva, Gustavo Correia Basto da
AU - Silva, Luís Manuel Lopes Rodrigues
AU - Singh, Amit
AU - Singh, Baljinder
AU - Singh, Bhim Pratap
AU - Singh, Harmanjit
AU - Singh, Jasvinder A.
AU - Singh, Kalpana
AU - Singh, Poornima Suryanath
AU - Singh, Samer
AU - Singh, Satwinder
AU - Sinha, Mukesh Kumar
AU - Siraj, Ebrahim Abdela
AU - Skhvitaridze, Natia
AU - Skryabin, Valentin Yurievich
AU - Sohel, Md Salman
AU - Sokhan, Anton
AU - Soliman, Ahmed M.
AU - Soliman, May Mohamed Sherif
AU - Soliman, Noha Salah
AU - Soliman, Sameh S.M.
AU - Song, Weiyi
AU - Sood, Aayushi
AU - Sood, Prashant
AU - Soraneh, Soroush
AU - Sorensen, Reed J.D.
AU - Sorrentino, Michele
AU - Spartalis, Michael
AU - Sra, Manraj Singh
AU - Sreeramareddy, Chandrashekhar T.
AU - Srichawla, Bahadar S.
AU - Srinivasalu, Vignes Anand
AU - Srinivasan, Manikandan
AU - Srivastava, Devin Bailey
AU - Stergachis, Andy
AU - Stevanović, Aleksandar
AU - Subasi, Omer
AU - Sulaiman, Surajo Kamilu Kamilu
AU - Suleiman Odidi, Muritala Odidi
AU - Suleman, Muhammad
AU - Sullman, Mark J.M.
AU - Sultan Meo, Anusha
AU - Sun, Zhong
AU - Sundaram, Thanigaivel
AU - Sunkersing, David
AU - Suvvari, Tarun Kumar
AU - Swain, Chandan Kumar
AU - Szarpak, Lukasz
AU - Tabarés-Seisdedos, Rafael
AU - Tabatabaeizadeh, Seyed Amir
AU - Tabche, Celine
AU - Tabibi, Ramin
AU - Tabuchi, Takahiro
AU - Tadesse, Lidia S.Seifu
AU - Taghizadeh-Hesary, Farzad
AU - Taheri Soodejani, Moslem
AU - Tajabadi, Shima
AU - Talaat, Iman M.
AU - Talukder, Byomkesh
AU - Tampa, Mircea
AU - Tamuzi, Jacques Lukenze
AU - Tan, Ker Kan
AU - Tariq, Saba
AU - Tasnim, Anika
AU - Tat, Nathan Y.
AU - Tat, Vivian Y.
AU - Taye, Birhan Tsegaw
AU - Tefera, Yibekal Manaye
AU - Teferi, Gizaw Hailiye
AU - Teklehaimanot, Wegayehu Zeneb
AU - Temsah, Mohamad Hani
AU - Temsah, Reem Mohamad Hani
AU - Tesfamariam, Wegen Beyene
AU - Tewari, Jay
AU - Thankappan, Kavumpurathu Raman
AU - Tharwat, Samar
AU - Thiruvengadam, Muthu
AU - Ticoalu, Jansje Henny Vera
AU - Tincho, Marius Belmondo
AU - Tomo, Sojit
AU - Tovani-Palone, Marcos Roberto
AU - Trabelsi, Khaled
AU - Tran, Quynh Thuy Huong
AU - Tran, Tam Quoc Minh
AU - Tran, Thang Huu
AU - Tran Minh Duc, Nguyen
AU - Trihandini, Indang
AU - Tripathi, Tulika
AU - Tromans, Samuel Joseph
AU - Truppa, Claudia
AU - Tsai, Daniel Hsiang Te
AU - Tsatsakis, Aristidis
AU - Tsedalu Amare, Abraham Tsedalu
AU - Tumurkhuu, Munkhtuya
AU - Tusa, Biruk Shalmeno
AU - Tzivian, Lilian
AU - Ullah, Atta
AU - Ullah, Riaz
AU - Ullah, Saeed
AU - Umar, Lawan
AU - Umar, Muhammad
AU - Unim, Brigid
AU - Upadhyay, Era
AU - Urmey, Jeba Mahiad
AU - Usman, Jibrin Sammani
AU - Uzunçıbuk, Hande
AU - Uzzaman, Nazim
AU - Vadagam, Pratyusha
AU - Vaithinathan, Asokan Govindaraj
AU - Van den Eynde, Jef
AU - Varghese, Joe
AU - Vasankari, Tommi Juhani
AU - Vasudevan, Srivatsa Surya
AU - Venkidasamy, Baskar
AU - Villa, Simone
AU - Villafañe, Jorge Hugo
AU - Villani, Leonardo
AU - Vinayak, Manish
AU - Violante, Francesco S.
AU - Visaga Ambi, Senthil
AU - Waheed, Yasir
AU - Walia, Megha
AU - Wang, Cong
AU - Wang, Qingzhi
AU - Wang, Ruixuan
AU - Wang, Wei
AU - Wang, Xing
AU - Waqar, Ahmed Bilal
AU - Waqas, Muhammad
AU - Ward, Joseph L.
AU - Wassie, Yilkal Abebaw
AU - Weerasekara, Ishanka
AU - Wickramasinghe, Nuwan Darshana Darshana
AU - Wilandika, Angga
AU - Willeit, Peter
AU - Wojewodzic, Marcin W.
AU - Wondmeneh, Yohannes Chemere
AU - Wondyifraw, Haileyesus Gedamu
AU - Wongnaah, Florence Gyembuzie
AU - Worku, Minichil Chanie Chanie
AU - Wu, Felicia
AU - Wu, James Fan
AU - Xia, Qing
AU - Xiao, Guangqin
AU - Xiao, Lishun
AU - Xie, Wanqing
AU - Xu, Site
AU - Xue, Mingyang
AU - Yadav, Mukesh Kumar
AU - Yaghoubi, Sajad
AU - Yahoo (Syed), Saba
AU - Yahya, Galal
AU - YANG, Hanwen
AU - Yang, Xinxin
AU - Yao, Laiang
AU - Yassin, Mohamed A.
AU - Yasufuku, Yuichi
AU - Yaya, Sanni
AU - Yeganeh, Meghdad
AU - Yesuf, Subah Abderehim
AU - Yezli, Saber
AU - Yismaw, Yazachew Engida Engida
AU - Yon, Dong Keon
AU - Yonemoto, Naohiro
AU - Yu, Chuanhua
AU - Yuan, Chun Wei
AU - Yunus, Ghazala
AU - Yunusa, Umar
AU - Zaghampour, Manijeh
AU - Zakham, Fathiah
AU - Zamagni, Giulia
AU - Zastrozhin, Michael
AU - Zawiah, Mohammed
AU - Zeariya, Mohammed G.M.
AU - Zemariam, Alemu Birara Birara
AU - Zhan, Tiansong
AU - Zhang, Casper J.P.
AU - Zhang, Jinpeng
AU - Zhang, Xiyu
AU - Zhong, Anthony
AU - Zhou, Jiayan
AU - Zhu, Bin
AU - Zhumagaliuly, Abzal
AU - Zia, Hafsa
AU - Zielińska, Magdalena
AU - Zoghi, Ghazal
AU - Zrieq, Rafat Mohammad
AU - Zyoud, Ahed H.
AU - Zyoud, Sa'ed H.
AU - Zyoud, Shaher H.
AU - Vollset, Stein Emil
AU - Hay, Simon I.
AU - Lim, Stephen S.
AU - Mosser, Jonathan F.
N1 - Publisher Copyright: © 2025 Elsevier Ltd
PY - 2025/7/19
Y1 - 2025/7/19
N2 - Background: Since its inception in 1974, the Essential Programme on Immunization (EPI) has achieved remarkable success, averting the deaths of an estimated 154 million children worldwide through routine childhood vaccination. However, more recent decades have seen persistent coverage inequities and stagnating progress, which have been further amplified by the COVID-19 pandemic. In 2019, WHO set ambitious goals for improving vaccine coverage globally through the Immunization Agenda 2030 (IA2030). Now halfway through the decade, understanding past and recent coverage trends can help inform and reorient strategies for approaching these aims in the next 5 years. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, this study provides updated global, regional, and national estimates of routine childhood vaccine coverage from 1980 to 2023 for 204 countries and territories for 11 vaccine-dose combinations recommended by WHO for all children globally. Employing advanced modelling techniques, this analysis accounts for data biases and heterogeneity and integrates new methodologies to model vaccine scale-up and COVID-19 pandemic-related disruptions. To contextualise historic coverage trends and gains still needed to achieve the IA2030 coverage targets, we supplement these results with several secondary analyses: (1) we assess the effect of the COVID-19 pandemic on vaccine coverage; (2) we forecast coverage of select life-course vaccines up to 2030; and (3) we analyse progress needed to reduce the number of zero-dose children by half between 2023 and 2030. Findings: Overall, global coverage for the original EPI vaccines against diphtheria, tetanus, and pertussis (first dose [DTP1] and third dose [DTP3]), measles (MCV1), polio (Pol3), and tuberculosis (BCG) nearly doubled from 1980 to 2023. However, this long-term trend masks recent challenges. 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 these vaccine doses (excluding BCG, which has been removed from routine immunisation schedules in some countries and territories). The COVID-19 pandemic exacerbated these challenges, with global rates for these vaccines declining sharply since 2020, and still not returning to pre-COVID-19 pandemic levels as of 2023. Coverage for newer vaccines developed and introduced in more recent years, such as immunisations against pneumococcal disease (PCV3) and rotavirus (complete series; RotaC) and a second dose of the measles vaccine (MCV2), saw continued increases globally during the COVID-19 pandemic due to ongoing introductions and scale-ups, but at slower rates than expected in the absence of the pandemic. Forecasts to 2030 for DTP3, PCV3, and MCV2 suggest that only DTP3 would reach the IA2030 target of 90% global coverage, and only under an optimistic scenario. The number of zero-dose children, proxied as children younger than 1 year who do not receive DTP1, decreased by 74·9% (95% uncertainty interval 72·1–77·3) globally between 1980 and 2019, with most of those declines reached during the 1980s and the 2000s. After 2019, counts of zero-dose children rose to a COVID 19-era peak of 18·6 million (17·6–20·0) in 2021. Most zero-dose children remain concentrated in conflict-affected regions and those with various constraints on resources available to put towards vaccination services, particularly sub-Saharan Africa. As of 2023, more than 50% of the 15·7 million (14·6–17·0) global zero-dose children resided in just eight countries (Nigeria, India, Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia, and Brazil), emphasising persistent inequities. Interpretation: Our estimates of current vaccine coverage and forecasts to 2030 suggest that achieving IA2030 targets, such as halving zero-dose children compared with 2019 levels and reaching 90% global coverage for life-course vaccines DTP3, PCV3, and MCV2, will require accelerated progress. Substantial increases in coverage are necessary in many countries and territories, with those in sub-Saharan Africa and south Asia facing the greatest challenges. Recent declines will need to be reversed to restore previous coverage levels in Latin America and the Caribbean, especially for DTP1, DTP3, and Pol3. These findings underscore the crucial need for targeted, equitable immunisation strategies. Strengthening primary health-care systems, addressing vaccine misinformation and hesitancy, and adapting to local contexts are essential to advancing coverage. COVID-19 pandemic recovery efforts, such as WHO's Big Catch-Up, as well as efforts to bolster routine services must prioritise reaching marginalised populations and target subnational geographies to regain lost ground and achieve global immunisation goals. Funding: The Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.
AB - Background: Since its inception in 1974, the Essential Programme on Immunization (EPI) has achieved remarkable success, averting the deaths of an estimated 154 million children worldwide through routine childhood vaccination. However, more recent decades have seen persistent coverage inequities and stagnating progress, which have been further amplified by the COVID-19 pandemic. In 2019, WHO set ambitious goals for improving vaccine coverage globally through the Immunization Agenda 2030 (IA2030). Now halfway through the decade, understanding past and recent coverage trends can help inform and reorient strategies for approaching these aims in the next 5 years. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, this study provides updated global, regional, and national estimates of routine childhood vaccine coverage from 1980 to 2023 for 204 countries and territories for 11 vaccine-dose combinations recommended by WHO for all children globally. Employing advanced modelling techniques, this analysis accounts for data biases and heterogeneity and integrates new methodologies to model vaccine scale-up and COVID-19 pandemic-related disruptions. To contextualise historic coverage trends and gains still needed to achieve the IA2030 coverage targets, we supplement these results with several secondary analyses: (1) we assess the effect of the COVID-19 pandemic on vaccine coverage; (2) we forecast coverage of select life-course vaccines up to 2030; and (3) we analyse progress needed to reduce the number of zero-dose children by half between 2023 and 2030. Findings: Overall, global coverage for the original EPI vaccines against diphtheria, tetanus, and pertussis (first dose [DTP1] and third dose [DTP3]), measles (MCV1), polio (Pol3), and tuberculosis (BCG) nearly doubled from 1980 to 2023. However, this long-term trend masks recent challenges. 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 these vaccine doses (excluding BCG, which has been removed from routine immunisation schedules in some countries and territories). The COVID-19 pandemic exacerbated these challenges, with global rates for these vaccines declining sharply since 2020, and still not returning to pre-COVID-19 pandemic levels as of 2023. Coverage for newer vaccines developed and introduced in more recent years, such as immunisations against pneumococcal disease (PCV3) and rotavirus (complete series; RotaC) and a second dose of the measles vaccine (MCV2), saw continued increases globally during the COVID-19 pandemic due to ongoing introductions and scale-ups, but at slower rates than expected in the absence of the pandemic. Forecasts to 2030 for DTP3, PCV3, and MCV2 suggest that only DTP3 would reach the IA2030 target of 90% global coverage, and only under an optimistic scenario. The number of zero-dose children, proxied as children younger than 1 year who do not receive DTP1, decreased by 74·9% (95% uncertainty interval 72·1–77·3) globally between 1980 and 2019, with most of those declines reached during the 1980s and the 2000s. After 2019, counts of zero-dose children rose to a COVID 19-era peak of 18·6 million (17·6–20·0) in 2021. Most zero-dose children remain concentrated in conflict-affected regions and those with various constraints on resources available to put towards vaccination services, particularly sub-Saharan Africa. As of 2023, more than 50% of the 15·7 million (14·6–17·0) global zero-dose children resided in just eight countries (Nigeria, India, Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia, and Brazil), emphasising persistent inequities. Interpretation: Our estimates of current vaccine coverage and forecasts to 2030 suggest that achieving IA2030 targets, such as halving zero-dose children compared with 2019 levels and reaching 90% global coverage for life-course vaccines DTP3, PCV3, and MCV2, will require accelerated progress. Substantial increases in coverage are necessary in many countries and territories, with those in sub-Saharan Africa and south Asia facing the greatest challenges. Recent declines will need to be reversed to restore previous coverage levels in Latin America and the Caribbean, especially for DTP1, DTP3, and Pol3. These findings underscore the crucial need for targeted, equitable immunisation strategies. Strengthening primary health-care systems, addressing vaccine misinformation and hesitancy, and adapting to local contexts are essential to advancing coverage. COVID-19 pandemic recovery efforts, such as WHO's Big Catch-Up, as well as efforts to bolster routine services must prioritise reaching marginalised populations and target subnational geographies to regain lost ground and achieve global immunisation goals. Funding: The Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.
UR - https://www.scopus.com/pages/publications/105010687738
U2 - 10.1016/S0140-6736(25)01037-2
DO - 10.1016/S0140-6736(25)01037-2
M3 - Article
C2 - 40578370
AN - SCOPUS:105010687738
SN - 0140-6736
VL - 406
SP - 235
EP - 260
JO - The Lancet
JF - The Lancet
IS - 10500
ER -