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  Published in Health and Fitness on Saturday, August 2nd 2025 at 19:38 GMT by Mid Day
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India Leads Among Eight Nations Hosting Half of World's Unvaccinated Children in 2023, Reveals Lancet Study

In a stark revelation highlighting persistent gaps in global immunization efforts, a comprehensive study published in The Lancet has identified India as one of eight countries that collectively account for half of the world's unvaccinated children as of 2023. This finding underscores the uneven progress in childhood vaccination worldwide, with millions of children remaining at risk of preventable diseases despite ongoing international campaigns. The study, drawing on data from the World Health Organization (WHO) and UNICEF, paints a concerning picture of stalled recovery from the disruptions caused by the COVID-19 pandemic, conflicts, and socioeconomic challenges.

At the heart of the issue are "zero-dose" children—those who have not received even the first dose of the diphtheria-tetanus-pertussis (DTP) vaccine, a key indicator of access to routine immunization services. Globally, the number of such children stood at approximately 14.5 million in 2023, a figure that has barely budged from the previous year and remains higher than pre-pandemic levels. Of these, around 7.2 million—half of the total—are concentrated in just eight countries: India, Nigeria, Ethiopia, the Democratic Republic of the Congo (DRC), Indonesia, Pakistan, Angola, and Brazil. India tops this list, with an estimated 2.4 million zero-dose children, reflecting the immense challenges posed by its vast population and diverse geographic and socioeconomic landscape.

The study's authors emphasize that this concentration is not merely a statistical anomaly but a symptom of deeper systemic issues. In India, for instance, vaccination coverage has historically been robust through programs like the Universal Immunization Programme (UIP), which aims to vaccinate all children against 12 life-threatening diseases. However, the pandemic exacerbated existing inequalities. Lockdowns, healthcare system overloads, and supply chain disruptions led to a significant drop in routine immunizations. Rural areas, where access to health facilities is limited, bore the brunt, with many children missing out on essential doses. Urban slums, migrant populations, and communities affected by misinformation about vaccines further compounded the problem. The study notes that while India has made strides in measles and rubella vaccination, reaching over 90% coverage in some states, the zero-dose metric reveals pockets of vulnerability, particularly in states like Uttar Pradesh, Bihar, and Madhya Pradesh, where logistical hurdles and low awareness persist.

Comparatively, Nigeria follows closely with about 1.8 million unvaccinated children, driven by factors such as ongoing insurgencies in the northeast, which disrupt health services, and widespread vaccine hesitancy fueled by cultural and religious beliefs. Ethiopia and the DRC face similar woes, with conflict zones making it nearly impossible for health workers to reach remote villages. In Ethiopia, civil unrest in regions like Tigray has led to the destruction of health infrastructure, leaving thousands of children unprotected. The DRC's challenges are amplified by its vast, forested terrain and recurrent Ebola outbreaks, which divert resources from routine vaccinations. Indonesia and Pakistan, meanwhile, grapple with natural disasters and political instability; Indonesia's archipelago geography poses distribution challenges, while Pakistan contends with anti-vaccination sentiments in certain tribal areas.

Angola and Brazil represent African and Latin American perspectives in this group. Angola's oil-dependent economy has not translated into equitable health investments, resulting in high zero-dose rates in underserved provinces. Brazil, once a model for vaccination in the Americas, has seen a reversal due to political shifts and reduced funding for public health, leading to outbreaks of diseases like measles in indigenous communities.

The Lancet study delves into the broader implications of these trends. Unvaccinated children are not only at personal risk but also contribute to community-level vulnerabilities. Diseases like measles, which require herd immunity thresholds of around 95% to prevent outbreaks, can spread rapidly in under-vaccinated populations. In 2023 alone, several countries reported surges in measles cases, with India experiencing notable clusters in states with low coverage. Polio, another vaccine-preventable disease, remains a threat in Pakistan and Afghanistan, with wastewater surveillance detecting the virus in unvaccinated hotspots. The study warns that without targeted interventions, these gaps could undo decades of progress toward eradicating such diseases.

Globally, the picture is mixed. While 2023 saw some recovery in vaccination rates— with the global DTP3 coverage (third dose) inching up to 84% from 81% in 2021—it falls short of the 90% target set by the Immunization Agenda 2030. Low- and middle-income countries, which house 95% of zero-dose children, continue to lag. The study highlights that 20 countries account for 75% of all unvaccinated children, with the eight mentioned forming the core. Factors like climate change, which exacerbates displacement and disrupts services, and economic downturns post-COVID, have further strained resources.

Experts quoted in the study call for multifaceted strategies to address this crisis. Strengthening primary healthcare systems is paramount, they argue. In India, initiatives like Mission Indradhanush, which focuses on intensifying immunization in hard-to-reach areas, have shown promise, vaccinating millions since its inception in 2014. However, scaling such programs requires increased funding, better data tracking, and community engagement to combat hesitancy. Digital tools, such as mobile apps for tracking vaccinations and SMS reminders, could enhance coverage, as piloted in some Indian districts.

Internationally, organizations like Gavi, the Vaccine Alliance, play a crucial role. Gavi has supported the vaccination of over 1 billion children since 2000, but the study urges more equitable distribution of resources. For conflict-affected countries like the DRC and Ethiopia, humanitarian corridors for health workers are essential. In Pakistan and Nigeria, partnerships with religious leaders have helped build trust and increase uptake.

The study also touches on gender dimensions, noting that in some regions, girls are disproportionately affected due to cultural biases favoring boys' healthcare. In India, while gender disparities in vaccination are narrowing, rural girls still face barriers. Broader social determinants, such as maternal education and household income, strongly correlate with vaccination status. Children from the poorest quintiles are up to 18 times more likely to be zero-dose than those from wealthier families.

Looking ahead, the authors advocate for a "big catch-up" approach, prioritizing zero-dose children through targeted campaigns and integrating immunization with other health services like nutrition and maternal care. The COVID-19 experience, they note, has built resilience in supply chains and cold storage, which can be leveraged for routine vaccines. However, without political will and sustained investment, the goal of leaving no child behind remains elusive.

This Lancet analysis serves as a wake-up call, reminding us that vaccination is not just a medical intervention but a cornerstone of equity and global health security. For India and its counterparts, bridging these gaps is critical not only for national health but for preventing future pandemics. As the world moves toward 2030 targets, concerted efforts must ensure that every child, regardless of location or circumstance, receives the lifesaving protection they deserve. The study's data, while alarming, provides a roadmap for action, emphasizing that progress is possible with innovation, collaboration, and commitment.