ISLAMABAD: Global childhood immunization continued its slow recovery in 2025, with nearly 116 million infants receiving at least one dose of the vaccine that protects against diphtheria, tetanus and pertussis (DTP). Yet despite these gains, an estimated 13.5 million children worldwide still received no vaccines at all during their first year of life, while Pakistan remains among the countries carrying one of the world's largest burdens of zero-dose children, according to the latest estimates jointly released by the World Health Organization (WHO) and UNICEF.
The annual WHO-UNICEF Estimates of National Immunization Coverage (WUENIC) show that 90% of infants globally received at least one dose of a DTP-containing vaccine in 2025, representing nearly 116 million children, while 85%—about 110 million infants—completed the recommended three-dose series.
Although both indicators improved by one percentage point compared with 2024, global coverage remains one percentage point below pre-pandemic levels recorded in 2019, highlighting how recovery has largely stalled over the past several years.
Millions of children are still missing life-saving vaccines
Despite modest progress, WHO and UNICEF warn that the world remains far from ensuring every child receives routine immunization.
An estimated 13.5 million infants were classified as zero-dose children in 2025, meaning they did not receive even the first dose of the DTP vaccine during their first year of life.
While that represents nearly 750,000 fewer zero-dose children than in the previous year, another worrying trend has emerged.
Globally, approximately 7.3 million infants started their vaccination schedules by receiving the first DTP dose but dropped out before receiving their first measles-containing vaccine (MCV1).
Health experts say these growing dropout numbers leave millions of children vulnerable to preventable diseases.
Measles outbreaks remain a major global threat
The report warns that measles vaccination coverage continues to lag well below the level required to prevent outbreaks.
Only 84% of children received their first measles vaccine dose, while 77% completed the recommended second dose.
Public health experts estimate that around 95% vaccination coverage is needed to interrupt measles transmission.
As a consequence, 57 countries experienced large or disruptive measles outbreaks during 2025, demonstrating how immunity gaps continue to fuel disease resurgence worldwide.
UNICEF: Millions remain vulnerable
Catherine Russell, Executive Director of UNICEF, said global immunization has recovered from the setbacks caused by the COVID-19 pandemic but warned that millions of children continue to be left behind.
"Governments and health workers have helped global vaccination rates bounce back after dropping significantly during the COVID-19 pandemic," she said.
"But millions of vulnerable children are still being left unprotected due to conflict, displacement, and poverty. We must reach every child, and we must rebuild trust where it is fraying. No child should suffer from a disease that a simple vaccine can prevent."
Vaccines: "One of humanity's greatest health investments"
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, described immunization as one of the most effective and equitable public health interventions.
"Every child, whether born into wealth or poverty, peace or conflict, deserves the life-giving protection that vaccines provide," he said.
"Our greatest security begins with ensuring that everyone, wherever they may live, is protected from deadly diseases that vaccines have the power to prevent."
Pakistan records high DTP coverage—but half a million children remain completely unvaccinated
The latest WHO-UNICEF estimates paint a mixed picture for Pakistan.
According to the report, 93% of Pakistani infants—around 6.7 million children—received their first DTP vaccine dose during 2025, reflecting continued progress in routine immunization coverage.
However, around 500,000 children still did not receive a single DTP vaccine dose during their first year of life, placing Pakistan among the countries with the world's largest populations of zero-dose children.
WHO said reaching these children remains a priority.
The organization also highlighted Pakistan's extensive immunization workforce, noting that nearly 400,000 frontline polio workers are mobilized nationwide with support from WHO and its partners.
Nearly 60% of these frontline workers are women, enabling vaccination teams to reach children in communities where access may otherwise be difficult.
WHO Regional Director Dr Hanan Balkhy recently met female frontline polio workers in Pakistan to better understand their experiences and identify ways to further strengthen immunization efforts.
PMA terms immunization gap a national public health emergency
Responding to the latest global findings, the Pakistan Medical Association (PMA) issued what it described as a national public health red alert, warning that Pakistan continues to face an alarming burden of unvaccinated children.
In its statement, the PMA cited 651,000 zero-dose children in Pakistan based on World Health Organization Eastern Mediterranean Region (EMRO) epidemiological data and formally declared the situation a National Public Health Emergency.
According to Dr Abdul Ghafoor Shoro, Secretary General of the Pakistan Medical Association, the country's immunization gap reflects a serious breakdown in preventive healthcare.
"From a clinical and public health perspective, the presence of over half a million zero-dose children represents a systemic collapse of primary preventive healthcare."
He said Pakistan's inclusion among the Eastern Mediterranean Region's worst-affected countries is particularly concerning because, unlike Sudan, Yemen and Somalia, the country is not facing nationwide armed conflict.
Why do WHO and PMA cite different zero-dose numbers?
Readers may notice that the PMA's figure of 651,000 zero-dose children differs from the approximately 500,000 children reported in the latest WHO-UNICEF estimates.
The difference does not reflect two different definitions of a zero-dose child.
Both WHO datasets define a zero-dose child as one who did not receive the first dose of a diphtheria, tetanus and pertussis (DTP1) vaccine during the first year of life.
Instead, the figures come from different WHO reporting datasets and publication cycles.
The 500,000 estimate comes from the latest WHO-UNICEF Estimates of National Immunization Coverage (WUENIC) for 2025, while the PMA cited WHO Eastern Mediterranean regional epidemiological data, which reflects a different reporting dataset.
PMA blames governance failures and demands reforms
The PMA argued that Pakistan's immunization crisis stems largely from governance failures rather than conflict.
It cited weak Expanded Programme on Immunization (EPI) services, corruption, administrative negligence, inadequate outreach in remote communities, delayed funding, poor political commitment and vaccine hesitancy as major contributors to the country's large zero-dose population.
The association called for urgent reforms, including independent audits of provincial immunization funds, stronger accountability, improved cold-chain systems, GIS-based identification of unvaccinated children, better support for frontline vaccinators and sustained investment in routine immunization.
The PMA also offered its nationwide network of physicians to assist government authorities in strengthening immunization services and rebuilding public confidence in vaccines.
Regional recovery remains uneven
Behind the global averages lie significant regional differences.
According to the report, the Americas and South-East Asia have fully recovered to—or exceeded—their pre-pandemic vaccination levels.
Africa, Europe and the Eastern Mediterranean Region have made progress but continue to remain below 2019 coverage levels.
The Western Pacific Region experienced further declines during 2025, making it the region furthest below its pre-pandemic baseline.
The agencies also warned that more than half of the world's zero-dose children now live in fragile and conflict-affected settings, despite these countries accounting for only about one-third of the global child population.
Funding cuts could threaten future progress
WHO and UNICEF cautioned that recent reductions in international health financing have not yet been fully reflected in the latest estimates but may threaten future immunization gains.
The agencies noted that only 18 national immunization surveys were conducted and submitted during the latest reporting cycle, down sharply from 50 surveys in 2024.
Weakening surveillance and data systems, they warned, could make it increasingly difficult to identify children who remain unvaccinated before outbreaks occur.
WHO, UNICEF and Gavi urge countries to act now
WHO, UNICEF and Gavi, the Vaccine Alliance, called on governments to strengthen immunization services, particularly in fragile settings, increase domestic and international financing, combat vaccine misinformation and invest in stronger surveillance systems.
Dr Sania Nishtar, Chief Executive Officer of Gavi, the Vaccine Alliance, said the historic gains achieved through international immunization partnerships demonstrate what coordinated global action can accomplish.
"The historic levels of immunization that we are seeing across lower-income countries show what can be achieved when all stakeholders work together towards a shared objective," she said.
She warned, however, that sustaining this momentum while reaching the children who remain completely outside immunization systems will become increasingly challenging amid funding constraints, geopolitical instability and growing disease outbreaks.
Despite encouraging improvements in global vaccination coverage, WHO and UNICEF stress that the world remains off track to achieve the Immunization Agenda 2030 targets. Without sustained investment, stronger health systems and targeted efforts to reach every missed child, preventable diseases such as measles, diphtheria and polio will continue to threaten millions of children worldwide—including hundreds of thousands in Pakistan.
Stay informed, stay alert!
CLICK HERE TO JOIN Medical News Pakistan on WhatsApp for real-time health alerts, expert insights, and breakthrough medical discoveries.