Globally, approximately 14.5 million children have not received any routine immunizations in 2023, putting them at risk of death and disability from infectious diseases.
Although zero-dose children are present in many places, they often share characteristics that make them less likely to have access to vaccination. Understanding these obstacles is essential to designing innovative strategies to achieve them.
Unvaccinated children often belong to families who struggle to access other health services, such as medical care during pregnancy and childbirth.
Here are eight things we know today about zero-dose kids.
1. The number of zero-dose children has largely stagnated
Gavi defines a zero-dose child as a child who has not received any doses of diphtheria, tetanus and pertussis (DTP) vaccine – an indicator for assessing overall immunization coverage. Although the proportion of children receiving basic protection against these three diseases has increased significantly since 2000, progress has stalled in recent years.
2. Three-fifths of these children live in just ten countries
Although zero-dose children can be found in any country, most live in low-income countries – particularly those with high birth cohorts, weak health systems, or both.
However, some small countries have even lower vaccination coverage, such as Papua New Guinea (45%), Somalia (52%) and the Central African Republic (54%).
3. Living in a fragile or conflict-affected country significantly reduces a child’s chances of being vaccinated
Zero-dose children are disproportionately found in fragile or conflict-affected countries or territories, although these places account for only 28% of global births. Conflict often disrupts critical infrastructure and resources needed to administer vaccines.
According to Save the Children, the number of unvaccinated children is three times higher in conflict zones than in the rest of the world.
4. Children living in rural areas have less access to vaccines than those in urban areas
The chances of a child not being vaccinated also vary depending on their location within a country: isolated rural communities and poor urban slums are the hardest to reach.
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5. Zero-dose children more often come from poor households
Children from poor households are more likely to not be vaccinated than those from wealthier households. About two-thirds of zero-dose children live in households with incomes below the international poverty line of US$1.90 per day.
6. Their families often lack access to other health services
Unvaccinated children often belong to families who struggle to access other health services, such as medical care during pregnancy and childbirth. Their parents often themselves benefited from limited access to vaccination. This highlights the importance of strengthening health systems that deliver vaccines: it can also improve access to health care overall.
7. Zero-dose children more often have mothers with a low level of education
Although the link between vaccination and mothers’ education is complex, numerous studies show that zero-dose children often have mothers with little or no education beyond primary school. Better educated people generally have better access to health information, highlighting the importance of making vaccine information accessible to everyone.
8. Most zero-dose children live in homes with little access to television or radio
In low-income countries, the majority of unvaccinated children have mothers who watch television less than once a week. This limits their exposure to national public health campaigns and makes them more likely to be influenced by local opinions on vaccination.
