India accounts for 6.4 per cent of global zero-dose children in 2024: UN

India constituted 6.4 per cent of the global population of children who did not receive a single dose of any vaccine in 2024, according to a United Nations report.

The new national immunisation coverage data released on Monday by the World Health Organisation (WHO) and UNICEF also highlighted that "India accounted for 49.2% of zero-dose children in South Asia", as per statistics from the Regional Office for South Asia (ROSA).

The term "zero-dose children" refers to those who have not received any routine immunisations, including the first dose of the DTP (diphtheria, tetanus, and pertussis) vaccine. This metric is a critical indicator of access to immunisation services and overall healthcare infrastructure.

The report said India accounted for "6.4% of zero-dose children globally". Every 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. Gavi said nearly half (4.9 million) of all the 10.2 million zero-dose children in lower-income countries live in five populous nations — Nigeria, DR Congo, India, Pakistan, and Ethiopia.

It pointed out that coverage with the first dose of the DTP vaccine (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 per cent in 2024 – nearly recovered from a four percentage point decrease during the Covid-19 pandemic.

"This means there are half a million fewer zero-dose children in lower-income countries in 2024, thanks mainly to targeted efforts in populous countries like India, DR Congo, and Ethiopia," Gavi said.

The report said in 2024, 89 per cent of infants globally — about 115 million — received at least one dose of DTP vaccine, and 85 per cent — roughly 109 million — completed all three doses. Compared to 2023, around 171,000 more children received at least one vaccine, and one million more completed the full three-dose DTP series.

While the gains are modest, they signal continued progress by countries working to protect children, even amid growing challenges, the report said.

Still, nearly 20 million infants missed at least one dose of DTP-containing vaccine last year, including 14.3 million “zero-dose” children who never received a single dose of any vaccine.

That’s four million more than the 2024 target needed to stay on track with Immunisation Agenda 2030 goals and 1.4 million more than in 2019, the baseline year for measuring progress, the report said.

"Vaccines save lives, allowing individuals, families, communities, economies, and nations to flourish," WHO director-general Dr Tedros Adhanom Ghebreyesus said.

"It's encouraging to see a continued increase in the number of children being vaccinated, although we still have a lot of work to do. Drastic cuts in aid, coupled with misinformation about the safety of vaccines, threaten to unwind decades of progress," he said.

The report noted that children often remain un- or under-vaccinated due to a combination of factors, such as limited access to immunisation services, disrupted supply, conflict and instability, or misinformation about vaccines.

Data from 195 countries show that 131 countries have consistently reached at least 90 per cent of children with the first dose of DTP vaccine since 2019, but there has been no significant movement in expanding this group.

Among the countries that reached less than 90 per cent in 2019, only 17 managed to increase their coverage rates in the past five years. Meanwhile, in 47 countries, progress is stalling or worsening. This includes 22 countries that achieved and surpassed the 90 per cent target in 2019 but have since declined.

The data shows conflict and humanitarian crises can quickly erode vaccination progress. A quarter of the world's infants live in just 26 countries affected by fragility, conflict, or humanitarian crises, yet they make up half of all unvaccinated children globally.

Concerningly, in half of these countries, the number of unvaccinated children has expanded rapidly from 3.6 million in 2019 to 5.4 million in 2024, underscoring the need for humanitarian responses to include immunisation, the report said

Immunisation coverage in the 57 low-income countries supported by Gavi has improved in the past year, reducing the number of un- and under-vaccinated children by roughly 650,000.

At the same time, signs of slippage are emerging in upper-middle- and high-income countries that have previously maintained at least 90 per cent coverage. Even small declines in immunisation coverage can dramatically raise the risk of disease outbreaks and place additional strain on already overstretched health systems.

"The good news is that we have managed to reach more children with life-saving vaccines. But millions of children remain without protection against preventable diseases, and that should worry us all," said UNICEF executive director Catherine Russell.

"We must act now with determination to overcome barriers like shrinking health budgets, fragile health systems, along with misinformation and access constraints because of conflicts. No child should die from a disease we know how to prevent," she said.