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
Catherine Bisignano
Ashley A. Harris
Amanda E. Smith
Paulina A. Lindstedt
Simeon Okechukwu Ajakwe
Olivia D. Nesbit
Taylor Noyes
Noga Shalev
Latera Tesfaye Olana
Catherine M. Antony
Nancy Fullman
Sharareh Eskandarieh
Mushood Ahmed
Naveed Ahmed
Rana Kamal Abu Farha
Kamoru Ademola Adedokun
Nurudeen A. Adegoke
Aanuoluwapo Adeyimika Afolabi
Giuseppina Affinito
Dolapo Emmanuel Ajala
Eman Abu-Gharbieh
Reed J.D. Sorensen
Chun Wei Yuan
Stein Emil Vollset
Stephen S. Lim
Jonathan F. Mosser
Andy Stergachis
Farbod Khosravi
Sonali Kochhar
Armita Abedi
Usha Adiga
Mitra Abbasifard
Mohammad Amin Aalipour
Faezeh Abbaspour
Tomislav Mestrovic
Dariush Abtahi
Ripon Kumar Adhikary
Mohd Adnan
Aqeel Ahmad
Simon I. Hay
Abdollah Jafarzadeh
Williams Agyemang-Duah
Hana J. Abukhadijah
Danish Ahmad
Amin Sharifan
Rotimi Felix Afolabi
Saira Afzal
Emad M. Abdallah
Samar Abd Elhafeez
Meqdad Saleh Ahmed
Muktar Beshir Ahmed
Syed Anees Ahmed
Suneth Buddhika Agampodi
Khurshid Ahmad
Tauseef Ahmad
Sepehr Aghajanian
Ayman Ahmed
Ramy Mohamed Ghazy
Meriem Abdoun
Salahdein Aburuz
Lucas Guimarães Abreu
Alireza Shakeri
Qorinah Estiningtyas Sakilah Adnani
Emily Haeuser
Sam Byrne
Jason Nguyen
Catalina Raggi
Susan A. McLaughlin
Hedayat Abbastabar
Rana Kamal Abu Farha
Sherief Abd-Elsalam
Dmitry Abramov
Adam Abdullahi
Faezeh Abbaspour
Reda Abdel-Hameed
Samar Abd ElHafeez
Atef Abdelkader
Deldar Morad Abdulah
Haroon Ahmed
Lisa C. Adams
Toufik Abdul-Rahman
Constanza Elizabeth Aguilera Arriagada
Mahsa Ahadi
Rabbiya Ahmad
Shoaib Ahmad
Asrat Agalu Abejew
Abdu A. Adamu
Juliana Bunmi Adetunji
Kulmira Abdykerimova
Rahim Abo Kasem
Nagah M. Abourashed
Mohamed Abouzid
Roberto Ariel Abeldaño Zuñiga
Juan Manuel Acuna
Anirudh Balakrishna Acharya
Meshack Achore
Ousman Adal
Habeeb Abiodun Afolabi
Hasan Aalruz
Arman Abdous
Auwal Abdullahi
Bilyaminu Abubakar
David Adedia
Syed Hani Abidi
Olumide Abiodun
Hassan Abolhassani
Richard Gyan Aboagye
Ulric Sena Abonie
Abdullahi Tunde Aborode
Wakgari Mosisa Abdisa
Oyelola A. Adegboye
Mohammad Mahdi Bastan
Dhiraj Motilal Agarwal
Tajudeen Adesanmi Adebisi
Oluwatobi E. Adegbile
Olumide Thomas Adeleke
Mache Tsadik Adhana
Molalegne Bitew
Feven Sahle Gebre
Leticia Akua Adzigbli
Alireza Mirkheshti
Sohrab Salimi
Seyed Mohammad Seyed Alshohadaei
Hafsa Zia
Gizachew Taddesse Akalu
Jiawei He
Prince Owusu Adoma
Dorsa Salabat
Mohamed Jalloh
Vafa Rahimi-Movaghar
Sina Shool
Melika Jameie
Jafar Karami
Farzad Kompani
Mohammad Ali Mansournia
Abdolreza Mohammadi
Amin Mohsenzadeh
Aleksandr Y. Aravkin
Omid Dadras
Iman M. Talaat
Ali H. Mokdad
Xiaochen Dai
Lalit Dandona
Rakhi Dandona
Sara Bagheri
Fereshteh Baghizadeh
Mahdis Bayat
Minoo Heidari Almasi
Ali Asghar Kolahi
Ali Nikoobar
Mohammad Mahdi Rashidi
Firoozeh Madadi
Mehdi Safari
Mastooreh Sagharichi
Maryam Shayan
Georgia Smith
Samuel James Herold
Annie Haakenstad
Christopher J.L. Murray
Zahra Siavashpour
Mohsen Rezaeian
Shakiba Ghasemi Assl
Atakan Orscelik
Yigit Can Senol
Michael Zastrozhin
Hannah Elizabeth Robinson-Oden
Amin Azizan
Nazila Rezaei
Pegah Salimi Pormehr
Amin Sedigh
Farshad Shahkarami
Kazem Ghaffari
Ghazal Arjmand
Mahsa Asadi Anar
Rasoul Ebrahimi
Seyed Ataollah Madinezad
Behnaz Niroomand
Seyed Kiarash Sadat Rafiei
Antonio Olivas-Martinez
Publication Name: Lancet
Publication Date: 2025-07-19
Volume: 406
Issue: 10500
Page Range: 235-260
Description:
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.
Open Access: Yes
Authors - 179
Catherine Bisignano
57211140934
Ashley A. Harris
59408873000
Amanda E. Smith
56128141700
Paulina A. Lindstedt
57211558396
Simeon Okechukwu Ajakwe
57414321100
Olivia D. Nesbit
58198382900
Taylor Noyes
58514585700
Noga Shalev
59740283100
Latera Tesfaye Olana
57460330300
Catherine M. Antony
57218881089
Nancy Fullman
57211064970
Sharareh Eskandarieh
57211720158
Mushood Ahmed
59998578800
Naveed Ahmed
57650122100
Rana Kamal Abu Farha
56283149600
Kamoru Ademola Adedokun
57207983240
Nurudeen A. Adegoke
57196007299
Aanuoluwapo Adeyimika Afolabi
57219351723
Giuseppina Affinito
57220067141
Dolapo Emmanuel Ajala
58746442600
Eman Abu-Gharbieh
24586714800
Reed J.D. Sorensen
57196918748
Chun Wei Yuan
57205704701
Stein Emil Vollset
57196315778
Stephen S. Lim
60390993200
Jonathan F. Mosser
56111776300
Andy Stergachis
7006802396
Farbod Khosravi
57220082222
Sonali Kochhar
57214107714
Armita Abedi
57204607249
Usha Adiga
14057674100
Mitra Abbasifard
37053407900
Mohammad Amin Aalipour
57221831253
Faezeh Abbaspour
60317983600
Tomislav Mestrovic
6507240107
Dariush Abtahi
18036750600
Ripon Kumar Adhikary
55847469100
Mohd Adnan
36022136700
Aqeel Ahmad
57210400531
Simon I. Hay
7101875313
Abdollah Jafarzadeh
32667811600
Williams Agyemang-Duah
57190228903
Hana J. Abukhadijah
57865346000
Danish Ahmad
57202805842
Amin Sharifan
57224116591
Rotimi Felix Afolabi
57190673952
Saira Afzal
7004381116
Emad M. Abdallah
16644652400
Samar Abd Elhafeez
55551273300
Meqdad Saleh Ahmed
59039407300
Muktar Beshir Ahmed
57207802317
Syed Anees Ahmed
59706359000
Suneth Buddhika Agampodi
23017863100
Khurshid Ahmad
59998147800
Tauseef Ahmad
57214283386
Sepehr Aghajanian
57221371799
Ayman Ahmed
57199492030
Ramy Mohamed Ghazy
57212085342
Meriem Abdoun
20336514800
Salahdein Aburuz
59755057900
Lucas Guimarães Abreu
55937631400
Alireza Shakeri
57218867854
Qorinah Estiningtyas Sakilah Adnani
57211604149
Emily Haeuser
57221852630
Sam Byrne
59823144800
Jason Nguyen
57207723790
Catalina Raggi
58961180400
Susan A. McLaughlin
57923882000
Hedayat Abbastabar
57212441848
Rana Kamal Abu Farha
60033327900
Sherief Abd-Elsalam
57189845325
Dmitry Abramov
57193731047
Adam Abdullahi
59545619100
Faezeh Abbaspour
58779719600
Reda Abdel-Hameed
59998433900
Samar Abd ElHafeez
59158131500
Atef Abdelkader
57203858681
Deldar Morad Abdulah
57200190808
Haroon Ahmed
57222316680
Lisa C. Adams
59884095500
Toufik Abdul-Rahman
57576497300
Constanza Elizabeth Aguilera Arriagada
58651413400
Mahsa Ahadi
59997847900
Rabbiya Ahmad
59997703400
Shoaib Ahmad
59998578700
Asrat Agalu Abejew
55204820500
Abdu A. Adamu
57202024381
Juliana Bunmi Adetunji
57192177427
Kulmira Abdykerimova
59998147700
Rahim Abo Kasem
57221750031
Nagah M. Abourashed
57450956800
Mohamed Abouzid
57204445082
Roberto Ariel Abeldaño Zuñiga
57737618600
Juan Manuel Acuna
56473433400
Anirudh Balakrishna Acharya
35751874500
Meshack Achore
57204045088
Ousman Adal
57766218500
Habeeb Abiodun Afolabi
58174110900
Hasan Aalruz
57216547615
Arman Abdous
57263159900
Auwal Abdullahi
56102934500
Bilyaminu Abubakar
56389502700
David Adedia
57207309355
Syed Hani Abidi
59663694600
Olumide Abiodun
7003859089
Hassan Abolhassani
58597704600
Richard Gyan Aboagye
57221438826
Ulric Sena Abonie
57214797230
Abdullahi Tunde Aborode
57916532700
Wakgari Mosisa Abdisa
59998578600
Oyelola A. Adegboye
55270465600
Mohammad Mahdi Bastan
58798063200
Dhiraj Motilal Agarwal
54398213500
Tajudeen Adesanmi Adebisi
59997997500
Oluwatobi E. Adegbile
58998875200
Olumide Thomas Adeleke
57204237787
Mache Tsadik Adhana
57219360973
Molalegne Bitew
36661865700
Feven Sahle Gebre
59293898300
Leticia Akua Adzigbli
57899326600
Alireza Mirkheshti
36624096900
Sohrab Salimi
57214885114
Seyed Mohammad Seyed Alshohadaei
57214890774
Hafsa Zia
59628039200
Gizachew Taddesse Akalu
56905441600
Jiawei He
57201492225
Prince Owusu Adoma
57777244400
Dorsa Salabat
58872095600
Mohamed Jalloh
56835467800
Vafa Rahimi-Movaghar
6507646446
Sina Shool
57221702987
Melika Jameie
57411116400
Jafar Karami
56717737700
Farzad Kompani
56071483000
Mohammad Ali Mansournia
34570618600
Abdolreza Mohammadi
57572569600
Amin Mohsenzadeh
56038765700
Aleksandr Y. Aravkin
35386103000
Omid Dadras
57205721978
Iman M. Talaat
7801465176
Ali H. Mokdad
7004813962
Xiaochen Dai
57221591169
Lalit Dandona
7007017243
Rakhi Dandona
57203043697
Sara Bagheri
57211190313
Fereshteh Baghizadeh
57207301893
Mahdis Bayat
59998149400
Minoo Heidari Almasi
57222035540
Ali Asghar Kolahi
24331775400
Ali Nikoobar
57580752700
Mohammad Mahdi Rashidi
57324471900
Firoozeh Madadi
35795920300
Mehdi Safari
57208576562
Mastooreh Sagharichi
57221835086
Maryam Shayan
57209496707
Georgia Smith
58960344900
Samuel James Herold
59997997300
Annie Haakenstad
56079498000
Christopher J.L. Murray
55481130700
Zahra Siavashpour
36599228600
Mohsen Rezaeian
15053682700
Shakiba Ghasemi Assl
58248121400
Atakan Orscelik
59998297100
Yigit Can Senol
57798703100
Michael Zastrozhin
56728932200
Hannah Elizabeth Robinson-Oden
58955995600
Amin Azizan
59238777000
Nazila Rezaei
36700192900
Pegah Salimi Pormehr
57224049909
Amin Sedigh
57211192863
Farshad Shahkarami
59307452900
Kazem Ghaffari
56725625500
Ghazal Arjmand
58859915100
Mahsa Asadi Anar
58018735600
Rasoul Ebrahimi
58945477800
Seyed Ataollah Madinezad
59997707400
Behnaz Niroomand
57738297000
Seyed Kiarash Sadat Rafiei
58001619500
Antonio Olivas-Martinez
57205108486
