2024 GLOBAL IMMUNISATION COVERAGE ESTIMATES: Understanding the picture in lower-income countries

Each year WHO and UNICEF release global and national routine immunisation coverage estimates (WUENIC).

Gavi, the Vaccine Alliance analyses what the 2024 WUENIC data says about the state of immunisation in the 57 low- and lower-middle income countries it supports. This note will be available online hereonce the embargo lifts. 

KEY TAKEAWAYS

Lower-income countries are protecting more people, against more diseases than ever before in history – and coverage rates are steadily on the rise following declines during the COVID-19 pandemic.

• With Gavi routine immunisation support, lower-income countries protected more than 72 million children against a range of infectious diseases in 2024, more than any previous year on record. They are more committed to financing immunisation than ever before – contributing record amounts to co-finance vaccine programmes – US$ 255 million in 2024 alone.
• This means Gavi’s target to protect 1.1 billion children by 2025 has been surpassed – with 1.2 billion children protected in lower-income countries since 2000.
• In 2024, coverage rates improved across all the vaccines Gavi supports, by 8 percentage pointson average, with large gains in routine coverage with vaccines against polio, cervical cancer, measles, pneumonia, rotavirus and yellow fever.
• In 2024, 70% of lower-income countries maintained or improved coverage with three doses of the diphtheria-tetanus-pertussis vaccine (DTP3) – which is often used as a proxy to measure a countries’ ability to consistently reach children with essential vaccinations.
• Thanks to these efforts, DTP3 coverage increased 1 percentage point in 2024 in lower-income countries, to 82%. This is still one percentage point below pre-pandemic levels (2019).
• The number of zero-dose children who are yet to receive a single vaccine went down by 500,000.

However, population growth, fragility, and conflict still present major barriers to achieving true equity, leaving millions of the most vulnerable – and the world – at risk.

• Thanks to population growth, countries are having to reach more children each year to maintain coverage levels. In 2024, there were 2.5 million (3%) more births in 2024 as compared to 2019 in the 57 lower-income countries Gavi supports.
• Despite a decline of half a million, there are still 10.2 million zero-dose children in lower-income countries.
• DTP3 coverage rates in the twelve countries Gavi classifies as experiencing fragility and conflict held steady at 61%, following a major decline from 68% in 2022 to 61% in 2023, with large declines  in Sudan (down 12 percentage points) and Yemen (down 4 percentage points counteracting  significant improvements other fragile and conflict-impacted countries in 2024 – including large 6-7 percentage point gains in countries such as Mali, Syria and Haiti.s ).

Targeted efforts to reach missed children are yielding improvements, but face challenges.

• Coverage with the first dose of the DTP vaccine, or DTP1, is an important measure that helps the world understand how many zero-dose children still don’t have access to life-saving vaccines. DTP1 coverage stood at 87% in 2024 – nearly recovered from a 4 percentage point decrease during the COVID-19 pandemic.
• This means there are half a millionfewer zero-dose children in lower-income countries in 2024, thanks mainly to targeted efforts in populous countries like India, DR Congo and Ethiopia.
• However, this means millions of children are still at risk. Nearly half (4.9 million) of all the 10.2 million zero-dose children in lower-income countries live in five populous countries – Nigeria, DR Congo, India, Pakistan and Ethiopia. These countries also account for nearly 60% of the birth cohort in Gavi-supported countries.
• Another nearly 30% (2.9 million) of zero-dose children in lower-income countries live in fragile and conflict-affected settings.
• Gavi works closely with these countries on targeted work to reach missed children and communities, and with new partners that can help reach communities in fragile settings. For example, Gavi’s innovative Zero-dose Immunisation Programme (ZIP) implemented in partnership with NGOs and humanitarian actors, has administered 9 million vaccine doses in conflict-impacted regions in Africa, leading to an estimated 1 millionpreviously missed children who are now fully immunised.
• However, progress is still far behind Gavi’s target of achieving a 25% reduction in the number of zero-dose children (to 6.9 million) by 2025. Achieving this goal will require a 32% reduction compared to 2024 figures. The COVID-19 pandemic, rising birth cohort, and fragility have all played factors in slowing down progress.

Africa has now recovered immunisation coverage to pre-pandemic levels, even with an increasing birth cohort.

• The majority of the countries that Gavi supports are in Africa, a region where DTP3 coverage has fully recovered to pre-pandemic levels despite an increasing population requiring countries to reach more and more children to achieve gains.
• The WHO AFRO region saw declines in DTP3 from 76% in 2019 to 72% in 2022, but has now fully recovered in 2024 – with DTP3 coverage back up to 76%.
• The largest gains in DTP3 in 2024 in the African region were in Mali (+7pp), DR Congo (+5pp), Rwanda (+4pp), and Ethiopia (+3pp).

Immunisation rates in Eastern-Mediterranean region drop due to conflict in Sudan and Yemen despite strong gains in other countries.

• DTP3 coverage in the Eastern-Mediterranean region dropped to 79% due to large conflict-related declines in Sudan and Yemen, and despite gains in many Gavi-supported countries including Pakistan, Syria, and Somalia.
  • Within the 57 countries Gavi supports, lower-middle income countries have fully recovered DTP3 to pre-pandemic levels.

Lower-middle income countries have recovered immunisation coverage to pre-pandemic levels, while low-income countries continue to be impacted – underscoring the importance of building resilient health systems.

• However, 26 low-income countries are still at 70% DTP3 coverage in 2024 relative to 75% in 2019.

More girls are being protected against cervical cancer than ever before in history, with efforts well on track to achieve ambitious targets.

• At the end of 2022, Gavi revitalized its efforts to protect girls with the HPV vaccine which protects against cervical cancer – one of the leading killers of women and girls in lower-income countries.
• Thanks to these efforts, more girls in lower-income countries have been protected with the HPV vaccine in 2024 than the previous decade combined.
• HPV vaccine coverage in lower-income countries has risen from 3% in 2019 to 7% in 2022, doubling to 16% in 2023, before increasing again to 25% in 2024.
• More than twice as many girls were vaccinated with Gavi support in 2024 (32.6 million) than in 2023.
• As of 2024, nearly 60 million girls have been fully immunised with HPV vaccine with Gavi support, well on track towards the target of reaching 86 million girls by the end of 2025.

Immunisation rates against measles continue to improve after pandemic-related declines, but are still well below levels needed to prevent outbreaks.

• Measles immunity gaps are a significant concern, given the high transmissibility of the virus and risk for serious outbreaks.
• Measles coverage rates fell during the pandemic, with many countries delayed in carrying out planned introductions and large-scale preventive vaccination campaigns.
• For the past few years, Gavi and countries have accelerated measles efforts – reaching hundreds of millions of children through routine, preventive and outbreak vaccination. These efforts have translated into rising measles vaccination rates and increasing protection.
• Coverage with the first dose of measles vaccine (MCV1) was at 81% in 2019, dropping down to 77% in 2021 before reaching 78% in 2023. In 2024, MCV1 coverage increased again, by 2 percentage points to 80%. This gain is largely driven by improvements in coverage in highly populous countries.
• Coverage with the second dose of measles vaccine (MCV2) has seen significant gains, with persistent efforts to introduce this vaccine into routine immunisation yielding results – starting at just 59% in 2019 and climbing steadily to 70% in 2024.
• However, coverage remains well below the 95% threshold considered necessary to prevent outbreaks. In 2024, 15.5 million children in lower income countries were missing the first dose of measles vaccine, accounting for 75% of the 20.6 million global total.

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