Strong progress in lower-income countries underscores need for sustained investment in immunisation

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

Immunisation in the lowest-income countries is supported by Gavi, the Vaccine Alliance – a partnership that helps vaccinate more than half the world’s children, and includes WHO and UNICEF as core members. 

Below, Gavi analyses what the 2025 WUENIC data says about the state of immunisation in the 57 low- and lower-middle income countries it supports.

Continued progress in lower-income countries

2025 was a record-setting year for the number of children protected: Lower-income countries immunised 73 million children with Gavi-supported vaccines – more than any other year in history.

Importantly, protection with a critical first vaccine has recovered to pre-pandemic levels: Average coverage with the first dose of a diphtheria-tetanus-pertussis vaccine (DTP1) increased 1 percentage point to 88% in 2025, the same level as 2019. 

For the majority of countries, immunisation coverage is improving:Three-fourths of all countries maintained or improved coverage with the third dose of DTP vaccine (DTP3) in 2025 – the highest proportion in more than two decades. Two-thirds of countries have a DTP3 coverage rate of 80% or higher.

A lot less children are missing out: The number of “zero-dose children”, or children that have never received a single dose of vaccine, decreased in lower-income countries by 640,000 in 2025. This decline represents 85% of the global reduction and pushes the overall number of zero-dose children back down nearly to pre-pandemic (2019) levels. 

Children in lower-income countries are now, on average, as protected against a range of diseases as those in the rest of the world: Average coverage across a range of Gavi-supported vaccines – called the “breadth of protection” – is at 65%, for the first time equal to the rest of the world. This number has risen by 16 percentage points since 2019, thanks in large part to new vaccine introductions and scale-ups.

The biggest improvements were made in some of the most difficult contexts: On average DTP3 coverage in 12 countries* categorised as experiencing fragility and conflict rose by 5 percentage points in 2025 – and now stands at 66%. Sudan was the country globally that saw the greatest progress, with DTP3 coverage improving by 32 percentage points in 2025.

Major efforts by countries against cervical cancer and malaria are yielding strong results: Lower-income countries have now protected 95 million girls with the HPV vaccine – 79 million in the past three years alone. This exceeds Gavi’s target of 86 million girls by the end of 2025. As a result, coverage is nearly on par with the global average, at 29%. Malaria vaccines are now being delivered across 25 African countries – the fastest routine vaccine rollout in Gavi’s history – and countries are already reporting reductions in severe cases, deaths, and hospitalizations. 

Progress has been achieved despite major immunisation challenges that persist: These achievements are remarkable in the context of both the COVID-19 pandemic which led to severe disruptions, increasing numbers of outbreaks straining health systems, and a rising birth cohort – which means lower-income countries must reach more children each year to simply maintain coverage levels. 

Challenges ahead underscore need for sustained investment

2025 was the last fully-funded year of Gavi’s work: The progress that was made demonstrates what is possible with sustained financial and political commitment. 

Gavi’s next strategic period from 2026-2030 (Gavi 6.0) is not yet fully funded, putting progress at risk: With reduced financing, countries have difficult choices to make when it comes to prioritizing immunisation programmes. The gap means reduced investments in key areas, such as the malaria vaccine programme, switches to powerful new tools like the hexavalent and multivalent meningitis vaccines, preventive vaccination campaigns, and global vaccine stockpiles.

Fiscal pressures, geopolitical instability, outbreaks, rising birth cohorts, and hesitancy are increasingly making progress more difficult: These external factors are raising the bar for progress, requiring increased effort to simply maintain coverage rates. 

In the future, Gavi’s support will be focused on countries most in need:According to Gavi’s model, countries pay more towards their their immunisation programmes as their economies grow. As high performing countries transition out of Gavi support, the Alliance will increasingly focus on countries where coverage rates are lower, drop out rates are higher, and pandemic recovery has not been as robust.  

Reaching the most vulnerable will be a key area of focus moving forward:Despite progress, there were still 9.5 million zero-dose children in lower-income countries in 2025. Reaching them and the missed communities they often live in is critical to saving lives, achieving equity, and ensuring health security. Despite funding constraints, Gavi’s new strategic period will see it increase investments in fragile and humanitarian contexts – focusing on supporting the most vulnerable. 

Immunisation must be prioritised as one of the most cost-effective investments in health, security and prosperity: Vaccines save lives, keep the world safe from outbreaks, and deliver hundreds of billions in socioeconomic benefits. Gavi is calling on countries to increase domestic financing for immunisation, and for sovereign and philanthropic donors to invest in Gavi 6.0. 

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