The World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) have warned that funding shortfalls could reverse recent gains in routine immunisation across lower-income countries despite record vaccination coverage achieved in 2025.
The warning is contained in the latest WHO and UNICEF Estimates of National Immunisation Coverage (WUENIC), analysed by Gavi, the Vaccine Alliance.
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According to the report, lower-income countries immunised a record 73 million children with Gavi-supported vaccines in 2025, the highest number ever recorded.
It said three-fourths of all countries maintained or improved coverage with the third dose of the diphtheria, tetanus and pertussis (DTP3) vaccine in 2025, the highest proportion in more than two decades.
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It added that two-thirds of countries have a DTP3 coverage rate of 80 per cent or higher.
Average coverage across Gavi-supported vaccines, referred to as the “breadth of protection”, reached 65 per cent in 2025, matching the global average for the first time.
According to the report, this represents a 16-percentage-point increase since 2019, driven largely by the introduction and expansion of new vaccines.
Progress in fragile settings
The report also highlighted improvements in countries affected by fragility and conflict.
Average DTP3 coverage across the 12 countries classified as fragile or conflict-affected increased by five percentage points to 66 per cent in 2025.
Sudan recorded the world’s largest improvement, with DTP3 coverage rising by 32 percentage points.
Despite the progress, the report noted that these countries have yet to recover to pre-pandemic immunisation levels.
It added that one-quarter of all zero-dose children in lower-income countries live in fragile and conflict-affected settings.
HPV and malaria vaccines
The report highlighted progress in efforts to prevent cervical cancer and malaria through vaccination.
According to the findings, lower income countries have now protected 95 million girls with the human papillomavirus (HPV) vaccine, including 79 million in the past three years alone. This exceeded Gavi’s target of protecting 86 million girls by the end of 2025.
The report said HPV vaccine coverage now stands at 29 per cent, close to the global average of 31 per cent.
It also noted that malaria vaccines are now being delivered through routine immunisation programmes in 25 African countries, representing more than 70 per cent of the world’s malaria burden.
Although WUENIC does not yet include malaria vaccine data, the report said countries are already reporting reductions in severe malaria cases, deaths and hospitalisations.
It cited Ghana, where under-five malaria deaths fell by 86 per cent between 2019 and 2024, and Burkina Faso, which reported a 32 per cent decline in malaria cases between 2024 and 2025 following nationwide expansion of the malaria vaccine programme.
Measles immunity gaps
Despite the gains, the report warned that immunity gaps for measles remain a significant concern.
Coverage with the first dose of the measles-containing vaccine remained at 80 per cent in lower income countries, while coverage with the second dose increased to 72 per cent in 2025.
However, about 15.6 million children in Gavi-supported countries still missed their first dose of the measles vaccine.
The report warned that the immunity gaps remain a significant concern because of the high transmissibility of the virus and the risk of serious outbreaks.
Funding concerns
Despite the progress recorded in 2025, Gavi warned that sustaining the gains will require continued investment.
The report noted that 2025 was the last fully funded year of Gavi’s current strategic period.
However, it stated that Gavi’s next strategic period, covering 2026 to 2030, is not yet fully funded, putting progress at risk.
According to the report, reduced financing could affect investments in key areas, including malaria vaccine programmes, the introduction of hexavalent and multivalent meningitis vaccines, preventive vaccination campaigns and global vaccine stockpiles.
The report also identified fiscal pressures, geopolitical instability, disease outbreaks, rising birth cohorts and vaccine hesitancy as challenges that are making progress more difficult.
Although the number of zero-dose children declined in 2025, about 9.5 million children in lower income countries still had not received a single vaccine dose.
The report stressed that reaching these children, many of whom live in underserved communities, remains critical to saving lives, promoting equity and strengthening global health security.
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Sustained investment
The Chief Executive Officer of Gavi, Sania Nishtar, said the record level of immunisation demonstrates what can be achieved when governments and partners work towards a common goal.
Ms Nishtar said sustaining the progress would require continued commitment as countries face funding constraints, geopolitical uncertainty and increasing disease outbreaks. She added that greater efforts would also be needed to reach children who still do not have access to immunisation.
“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”, she said.
Ms Nishtar noted that as Gavi heads into a new five-year period, its greatest challenge will be maintaining the momentum in the face of funding constraints, geopolitical uncertainty and increasing outbreaks, while working harder to reach children who still do not have access to immunisation.
She called on countries to increase domestic financing for immunisation and urged donors to support Gavi’s 2026–2030 strategic period.
