Global, regional, and national trends in routine childhood vaccination coverage from
1980 to 2023 with forecasts to 2030: a systematic analysis for the Global Burden of
Disease Study 2023
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.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.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.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.The Bill & Melinda Gates Foundation and Gavi,
the Vaccine Alliance.
