Childhood vaccinations are stalling, and experts warn: "We can't rest easy."

Millions of children are at risk of contracting deadly diseases , and the reason is that vaccination rates have stagnated. This is reflected in new research published Wednesday in The Lancet and compiled by members of the Global Burden of Disease Study (GBD) vaccination program.

The paper states that the world has made unprecedented progress in childhood vaccination against life-threatening diseases since the WHO established the Expanded Programme on Immunization (EPI) in 1974. However, the authors note that the past two decades have also been marked by stagnant childhood vaccination rates and wide variations in vaccination coverage. "These challenges have been compounded by the COVID-19 pandemic, which has left millions of children vulnerable to preventable diseases and death," they explain.

They add that these estimates should be interpreted as a "clear warning" that the global immunization targets for 2030 "will not be met without transformative improvements in equity." "Progress has been far from universal. Large numbers of children remain unvaccinated or undervaccinated," says Jonathan Mosser , lead author of the study, from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The doctor goes on to say that "persistent" global inequalities , challenges stemming from the pandemic, rising misinformation, and vaccine hesitancy have all contributed to "slowing down" immunization progress . "These trends increase the risk of outbreaks of vaccine-preventable diseases, such as measles , polio, and diphtheria , underscoring the crucial need for targeted improvements to ensure all children can benefit from life-saving vaccines," he describes.

Regarding vaccinations, the EPI initially focused on six diseases: tuberculosis, diphtheria , whooping cough, tetanus, polio, and measles. The program was later expanded to include additional vaccines , both in childhood and throughout life, protecting against Haemophilus influenzae type B, hepatitis B, rubella, pneumococcal disease, rotavirus, and human papillomavirus .

Thus, over the past 50 years, the EPI has vaccinated more than 4,000,000,000 children , preventing the deaths of an estimated 154 million children worldwide. In 2019, the WHO set ambitious targets to improve vaccination coverage globally through the 2030 Immunization Agenda , including halving the number of “zero-dose” children – children under one year of age who have not received any doses of the diphtheria, tetanus, and pertussis vaccine . To increase vaccine uptake and use, the authors urge “intensified efforts” to combat misinformation and vaccine hesitancy.

However, they note that outbreaks of vaccine-preventable diseases persist , reflecting inequalities in coverage. "Increasing numbers of wild-type polio cases have been reported in Pakistan and Afghanistan , and there is an ongoing polio outbreak in Papua New Guinea, where less than half the population is immunized. In 2024, nearly ten times as many measles infections were reported in the European Union and the European Economic Area. The ongoing measles outbreak in the US reached more than 1,000 confirmed cases in 30 states by May 2025, surpassing the total number of cases in 2024," the research explains.

This new analysis provides updated and expanded global, regional, and national estimates of annual routine childhood vaccination coverage between 1980 and 2023 in 204 countries and territories, for 11 vaccine combinations and doses recommended by WHO for all children worldwide.

From diphtheria to tetanus

The success of the past 50 years is partly a result of a doubling of global coverage for the original diphtheria, tetanus and pertussis vaccines (first dose from 49% to 89%; and all three doses from 40% to 81%), measles (from 37% to 83%), polio (from 42% to 80%) and tuberculosis (from 38% to 83%) between 1980 and 2023. In addition, there has been a 75% drop in the number of unvaccinated zero-dose children worldwide , from 58.8 million in 1980 to 14.7 million in 2019, as well as the introduction and scale-up of critical new life-saving vaccines against pneumococcal disease, rotavirus and a second dose of measles vaccine.

However, this long-term progress masks recent challenges and substantial disparities . Between 2010 and 2019, progress in coverage slowed and, in some parts of the world, reversed. For example , 21 of 36 high-income countries experienced declines in coverage for at least one of the vaccine doses originally recommended by the EPI (excluding tuberculosis vaccine , which is no longer included in routine immunization schedules in some countries), including a 12% decline in the first dose of measles vaccination in Argentina , and declines of 8% and 6% in the third dose of diphtheria, tetanus, and pertussis vaccination in Finland and Austria, respectively.

They also stress that “large discrepancies” persist, with considerably lower coverage and higher rates of unvaccinated or undervaccinated children in low- and middle-income countries . In 2023, more than half of the world’s 15.7 million unvaccinated children lived in just eight countries, mostly in sub-Saharan Africa (53%) and South Asia (13%): Nigeria (2.48 million), India (1.44 million), the Democratic Republic of the Congo (DRC, 882,000), Ethiopia (782,000), Somalia (710,000), Sudan (627,000), Indonesia (538,000) and Brazil (452,000).

Opinions on the study

For his part, Ed Parker, associate professor and co-director of the Vaccine Centre at the London School of Hygiene & Tropical Medicine (LSHTM), commented on the publication: "It gives a clear picture of the challenges that need to be addressed following the interruption of vaccination during the pandemic and the stagnation that preceded it." "The study team estimated coverage trends with careful consideration of the biases , gaps, and inconsistencies inherent in such data, which provides a solid basis for the study's conclusions," he told SMC.

Helen Bedford , Professor of Child Health at University College London, insists that "we cannot rest on our laurels." She analyzes the possible reasons for this decline in vaccine acceptance : "They are numerous and complex , but they require resources to address the challenges posed by increasing social inequality, the easy availability of misinformation about the safety and necessity of vaccines, and improving public confidence in vaccination programs. Vaccination remains one of our most powerful tools for protecting children's health, but its continued success depends on sustained investment, equity, and public confidence."