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

Geneva, 15 July 2026 – 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.

HEADLINES

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.

QUOTE

Dr Sania Nishtar, CEO of Gavi, the Vaccine Alliance

“The historic levels of immunisation that we are seeing across lower income countries shows what can be achieved when all stakeholders work together towards a shared objective. As Gavi heads into a new five-year period, our great challenge now will be to maintain this momentum in the face of funding constraints, geopolitical uncertainty, and increasing outbreaks - while working harder to reach those children that still do not have access to immunisation.”

DEEP DIVES

A closer look at key topics

HPV vaccines 

  • Cervical cancer claimed nearly a quarter of a million lives in 2024, the vast majority in lower-income countries – despite the existence of the safe and highly effective HPV vaccine.
  • In 2023, Gavi began an effort to revitalise HPV vaccination in lower-income countries. With 13 million girls reached by end 2022, the aim was ambitious: protecting a total 86 million girls by the end of 2025.
  • This year’s results confirm that this target was surpassed: 95 million girls have been protected. Coverage stands at 29%, a few percentage points away from the global average of 31%.
  • This is a considerable achievement in three years – even more so when taking into account the age group for this vaccine (9-14 year old girls), given lower-income countries’ routine immunisation systems are largely built to reach young children under the age of 5.

Malaria vaccines

  • 25 African countries, which represent more than 70% of the world's malaria burden, have introduced malaria vaccines into routine immunisation programmes with Gavi support. Since 2023, more than 59 million doses have been delivered across some of the world's highest-burden and most operationally complex malaria settings
  • This new programme does not yet have WUENIC data – but initial reports from countries are promising.
  • Ghana reported that under-five malaria deaths in the country fell by 86% between 2019 and 2024.
  • Following nationwide expansion to all 70 health districts, Burkina Faso reported a 32% decline in malaria cases between 2024 and 2025, substantial reductions in cases among children under five, and nearly a 50% reduction in malaria-related child deaths. The Ministry of Health estimates more than US$26.6 million in household savings from avoided direct health care costs.

Measles vaccines

  • Coverage with a first dose of measles-containing vaccine held steady in lower income countries, at 80%. Coverage with a second dose (MCV2) rose to 72% in 2025.
  • This still leaves 15.6 million children in Gavi-supported countries missing a first dose of measles vaccine.
  • These measles immunity gaps remain a significant concern, given the high transmissibility of the virus and risk for serious outbreaks.

Zero-dose children

  • The number of zero-dose children in lower-income countries decreased by 640,000 in 2025 - however 9.5 million children under the age of 1 were still zero-dose.
  • The number of infants missing out annually is now nearly back at pre-pandemic levels (9.1 million in 2019), despite pandemic disruptions and a rising birth cohort.
  • Additional efforts like the Big Catch Up have now reached more than 15 million older zero-dose children – those that missed out before the age of 1 but then continued to miss out as they got older – and caught them up with essential vaccines.

Fragility and conflict 

  • DTP3 coverage in 12 fragile and conflict-affected countries* increased by 5pp to 66% in 2025 – remarkable progress in some of the most difficult contexts in the world.
  • Seven out of 12 countries increased coverage – Sudan (+32pp), Central African Republic (+4pp), Chad (+3pp), Somalia (+2pp), Mali (+1pp), Niger (+1pp), and Papua New Guinea (+1pp).
  • On the other hand, Syria experienced a substantial decline from 2024 to 2025 (-13pp) due to conflict. Yemen (-3pp), Afghanistan (-2pp), and Haiti (-2pp) also saw smaller declines in 2025.
  • Overall, these countries still have not recovered to pre-pandemic (2019) levels.
  • A quarter of all zero-dose children in lower-income countries live in these fragile and/or conflict-affected settings.

Notes to Editors

* Afghanistan, Central African Republic, Chad, Haiti, Mali, Niger, Papua New Guinea, Somalia, South Sudan, Sudan, Syrian Arab Republic, and Yemen

About Gavi, the Vaccine Alliance

Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate more than half the world’s children against some of the world’s deadliest diseases. The Vaccine Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Gates Foundation and other private sector partners. View the full list of donor governments and other leading organisations that fund Gavi’s work here.

Since its inception in 2000, Gavi has helped to immunise a whole generation – over 1.2 billion children – and prevented more than 20.6 million future deaths, helping to halve child mortality in 78 lower‑income countries. Gavi also plays a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningococcal and yellow fever vaccines. After two decades of progress, Gavi is now focused on protecting the next generation, above all the zero-dose children who have not received even a single vaccine shot. The Vaccine Alliance employs innovative finance and the latest technology – from drones to biometrics – to save lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency. Learn more at www.gavi.org and connect with us on Bluesky, Facebook, Instagram, LinkedIn, TikTok, X and YouTube.

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