Data from WHO and UNICEF, shared in July 2023, suggest that fewer children missed routine vaccinations in 2022 than in the previous year. Although higher than the 18.4 million children who missed out in 2019, 20.5 million children represent an improvement on the 24.4 million who missed out in 2021. This demonstrates that collective efforts to catch up on immunisation goals are heading in the right direction.  

The vaccine against diphtheria, tetanus, and pertussis (DTP) is the “global marker” for immunisation coverage. Of the 20.5 million children who missed one or more doses of DTP vaccines in 2022, 14.3 are “zero-dose children” who did not receive a single dose.  

Children pay the price 

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, is encouraged by the data, which are a “tribute to those who have worked so hard to restore life-saving immunisation services”. However, he emphasised the need to sustain this hard work.  

“Global and regional averages don’t tell the whole story and mask severe and persistent inequities. When countries and regions lag, children pay the price.” 

Although progress has been made in the early stages of global recovery, the improvement has been “concentrated in a few countries”. For “well-resourced” countries with large infant populations, like India and Indonesia, progress “masks slower recovery” or the possibility of continuing declines in low-income countries, particularly for measles vaccines.  


WHO states that vaccination against measles, a “most infectious pathogen”, has not seen the necessary recovery. This puts an additional 35.2 million children at risk of infection. Although there has been an increase in first dose measles coverage from 81% in 2021 to 83% in 2022, this is still lower than the 86% in 2019. This places children in under-vaccinated communities at risk of outbreaks. 

Catherine Russell, UNICEF Executive Director, identifies a “grave warning” in the data.  

“Until more countries mend the gaps in routine immunisation coverage, children everywhere will remain at risk of contracting and dying from diseases we can prevent. Viruses like measles do not recognise borders.” 

Calling for “strengthened efforts”, she hopes to reach children who have missed vaccinations alongside wider restoration and improvement of immunisation services.  

Local examples 

WHO suggests that countries or regions that had steady pre-pandemic coverage have been able to “stabilise” immunisation services. For example, South Asia reported “gradual, ongoing increases” in coverage in the decade before the pandemic has been able to recovery rapidly and robustly in comparison with Latin America and the Caribbean.  

However, the African region is “lagging behind” in recovery. With a growing child population, specific countries will need to continue scaling up routine immunisation services every year to maintain coverage.  

DTP3 coverage in the 57 lower-income countries supported by Gavi increased to 81% in 2022, from 78% in 2021. However, this was concentrated in lower-middle income countries, with low-income countries “not yet” increasing coverage. Dr Seth Berkley, CEO of Gavi, commented that “after the massive disruption wrought by the pandemic” it is “incredibly reassuring” to see Gavi-supported countries making “such a strong recovery”.  

“However, it is also clear from this important study that we need to find ways of helping every country protect their people, otherwise we run the risk of two tracks emerging, with lower, lower middle-income countries outpacing the rest.”  

Thanks to renewed HPV vaccination efforts, coverage surpassed pre-pandemic levels. However, this remains below the 90% target. With a newly launched HPV revitalisation led by Gavi, existing programmes will be strengthened, and new introductions facilitated.  

For more like this, don’t forget to subscribe to our weekly newsletter here.