IPM Take
A first dose is a beginning, not protection completed.
The global average moved in the right direction, but averages conceal the children who disappear between appointments. Vaccination policy should be judged not only by doses delivered, but by whether conflict, poverty, distance and weak follow-up still decide who completes a schedule.
Executive Summary
WHO and UNICEF estimated that 90% of infants, nearly 116 million children, received a first dose of a diphtheria, tetanus and pertussis vaccine in 2025, while 85% completed the three-dose series. An estimated 13.5 million children remained zero-dose. Another 7.3 million received DTP1 but dropped out before their first measles dose. Fifty-seven countries reported large or disruptive measles outbreaks in 2025.
Why it matters
- Policymakers: Need sustained domestic and international financing that protects routine delivery and surveillance before funding cuts appear as outbreaks.
- Public authorities: Need local data that identifies zero-dose children and those who start but do not complete vaccination schedules.
- Civil society: Need trusted outreach that can address practical barriers and misinformation without treating families as the problem.
The global immunisation story improved by one percentage point. A child does not live inside an average.
WHO and UNICEF estimate that nearly 116 million infants received at least one DTP-containing vaccine in 2025. That brought global first-dose coverage to 90%. Completion of the three-dose series reached 85%. Both figures rose, and the number of zero-dose children fell by almost 750,000.
Those are real gains. They are also incomplete.
An estimated 13.5 million infants still received no routine vaccine in their first year of life. A further 7.3 million began the schedule but dropped out before receiving their first measles dose. The distance between those two numbers is where health systems often lose sight of families: after the first contact, before protection is complete.
Measles exposes the consequences. First-dose coverage stood at 84%, and second-dose coverage at 77%, both far below the 95% level needed to prevent outbreaks. Fifty-seven countries reported large or disruptive measles outbreaks in 2025. The virus is doing what it always does when immunity gaps are allowed to accumulate.
The distribution is political. More than half of zero-dose children live in fragile, conflict-affected or vulnerable settings, even though those settings account for roughly one third of the world’s child population. Reaching a child may require mobile teams, negotiated access, cold-chain reliability, transport, records that survive displacement and health workers who are present when families arrive.
But the problem is not confined to the poorest countries. WHO and UNICEF also point to slipping coverage in middle- and high-income settings, where vaccines may be formally available but political commitment, service design or public confidence has weakened. Availability on a national schedule is not the same as accessibility at the household level.
There is another warning inside the report: the evidence base itself is thinning. Only 18 national immunisation surveys were undertaken and submitted in the latest round, down from 50 in 2024. When data systems weaken, missed children become harder to find and governments receive the warning later. Funding cuts can therefore damage coverage twice, first by disrupting services and then by obscuring the disruption.
The right response is not to celebrate progress less. It is to define progress more honestly. A programme succeeds when a child receives every dose needed, at the right time, with a pathway that can find them again if an appointment is missed. That requires continuity, not campaigns alone.
For IPM, the most important gap is the one between entry and completion. The world reached more children in 2025. It now has to stop losing them before protection is finished.
