1.6 million children unvaccinated in India; Afghanistan and Pak rank better

Persistent socio-economic barriers and geographical disparities hinder immunisation efforts, with significant impact on global health

India recorded 1.6 million zero-dose children in 2023, according to the latest World Health Organization (WHO) and United Nations Children's Fund (Unicef) estimate of national immunisation coverage (WUENIC),

India ranks among the ten worst countries in mass immunisation, alongside Nigeria, Ethiopia, Congo, Sudan, Yemen, Indonesia, Angola, Pakistan, and Afghanistan.

Nigeria tops the list with 2.1 million unvaccinated children in 2023. India’s neighbourhood has a somewhat better trend. Pakistan recorded around 3,96,000 unvaccinated children with Afghanistan at 4,67,000 in the category during the period.

Zero-dose children, as defined by WHO, are defined as those who lack access to, or are never reached by routine immunisation services.

The number of completely unvaccinated, "zero-dose" children globally stands at 14.5 million, which is 1.7 million higher than in 2019.

This indicates no meaningful change in coverage compared to 2022, when the world was grappling with the aftermaths of the Covid-19 pandemic. Performance has not yet been restored to the 2019 levels which is the baseline value for the Immunisation Agenda 2030.

Unvaccinated children in crisis settings

The worrying part is that zero dose children mostly belong to countries and territories with fragile, conflict, and vulnerable (FCV) settings.

Around 55 per cent of unvaccinated children live in 31 countries with FCV settings, while these countries account for only 28 per cent of the global birth cohort. Many of these countries have also experienced worrying declines in immunisation since 2019. The size of the bubbles is proportional to the number of unvaccinated children in each country.
 

Measles vaccine gaps

Additionally, 10 countries accounted for 55 per cent of children without a measles vaccine. Three of these are also among 10 countries with lowest MCV1 coverage.

In India, around 1.6 million people have not received a single dose of measles vaccine. India is followed by only two countries including Nigeria and DR Congo with 2.8 million and two million children without the measles vaccine. Neighbouring countries like Pakistan and Afghanistan rank better on the list with 1.1 million and 6,37,000 thousand “measles zero dose children”.
 

HPV vaccine coverage surge

The HPV vaccine coverage does not follow the same trend, however. Its coverage has nearly restored to pre-pandemic level in several countries with around 37 countries starting the implementation of a single-dose schedule, both in higher and lower-income settings.

The global HPV coverage among girls has increased, driven particularly by new introductions and programme expansion combined with encouraging signs of recovery of coverage in existing programmes.

High drop-out rate persists

The report further expands that around 13 per cent children do not finish the entire recommended schedule, resulting in a high drop-out rate.  

The region of the Americas is the only territory to perform better than the end-of-year targets. All other regions have zero-dose children above their target trajectory. The Immunization Agenda 2030 calls on all countries to reduce the number of zero-dose children in 2019 by half by 2030.

However, it’s integral for the countries to realise that a single-minded focus on zero dose (DTP1) does not guarantee full immunisation. The person might still be prone to other antigens for which a robust vaccination drive is integral.