The World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF) have warned that a lack of funding could undo recent progress in routine immunisation in low-income countries. This comes despite record vaccination coverage achieved in 2025.
The warning is from the latest WHO and UNICEF Estimates of National Immunisation Coverage (WUENIC), which Gavi, the Vaccine Alliance, analysed.
According to the report, lower-income countries vaccinated a record 73 million children with Gavi-supported vaccines in 2025. This is the highest number ever recorded.
The report states that three-fourths of all countries maintained or improved coverage with the third dose of the diphtheria, tetanus, and pertussis (DTP3) vaccine in 2025. This is the best proportion in over 20 years.
It also added that two-thirds of countries have a DTP3 coverage rate of 80 percent or higher.
Average coverage for Gavi-supported vaccines, known as the “breadth of protection,” reached 65 percent in 2025. This matches the global average for the first time.
The report shows that this is a 16-percentage-point increase since 2019. This increase is mainly due to the introduction and expansion of new vaccines.
Progress in fragile settings
The report also highlighted improvements in countries affected by conflict and instability.
Average DTP3 coverage across 12 fragile or conflict-affected countries increased by five percentage points to 66 percent in 2025.
Sudan had the biggest improvement, with DTP3 coverage rising by 32 percentage points.
Despite this progress, the report noted that these countries have not yet returned to pre-pandemic immunisation levels.
It added that one-quarter of all zero-dose children in lower-income countries live in fragile and conflict-affected areas.
HPV and malaria vaccines
The report also pointed out progress in preventing cervical cancer and malaria through vaccination.
Lower-income countries have now protected 95 million girls with the human papillomavirus (HPV) vaccine. This includes 79 million girls in just the last three years. This has exceeded Gavi’s target of protecting 86 million girls by the end of 2025.
The report said HPV vaccine coverage now stands at 29 percent, which is close to the global average of 31 percent.
It also mentioned that malaria vaccines are now being given through routine immunisation programmes in 25 African countries. This represents over 70 percent of the world’s malaria burden.
Though WUENIC does not yet include malaria vaccine data, countries are already reporting fewer severe malaria cases, deaths, and hospitalisations.
For example, Ghana saw under-five malaria deaths drop by 86 percent from 2019 to 2024. Burkina Faso reported a 32 percent decline in malaria cases between 2024 and 2025 after expanding its malaria vaccine programme nationwide.
Measles immunity gaps
Despite these gains, the report warned about significant immunity gaps for measles.
Coverage with the first dose of the measles vaccine remained at 80 percent in lower-income countries. Coverage with the second dose increased to 72 percent in 2025.
However, about 15.6 million children in Gavi-supported countries still missed their first dose of the measles vaccine.
The report warned that these immunity gaps are concerning due to the highly contagious nature of the virus and the risk of serious outbreaks.
Funding concerns
Even with the progress made in 2025, Gavi warned that keeping these gains will need ongoing investment.
The report noted that 2025 was the last fully funded year for Gavi’s current strategy.
However, the next strategic period, from 2026 to 2030, is not yet fully funded. This puts progress at risk.
According to the report, reduced funding could impact investments in critical areas. This includes malaria vaccine programmes, introducing hexavalent and multivalent meningitis vaccines, preventive vaccination campaigns, and global vaccine stockpiles.
The report also pointed out challenges like financial pressures, geopolitical instability, disease outbreaks, growing birth rates, and vaccine hesitancy that are making it harder to progress.
While the number of zero-dose children fell in 2025, about 9.5 million children in lower-income countries still have not received any vaccine.
The report stressed that reaching these children, especially those in underserved areas, is critical for saving lives and improving global health security.
Sustained investment
The Gavi Chief Executive Officer, Sania Nishtar, said the record immunisation levels show what can happen when governments and partners work together.
Ms Nishtar said sustaining this progress needs ongoing commitment. Countries are facing funding challenges, geopolitical uncertainty, and rising disease outbreaks. She added that more effort is needed to reach children without access to immunisation.
“The historic levels of immunisation we see in lower-income countries show what is possible when all stakeholders work together,” she said.
Ms Nishtar noted that as Gavi enters a new five-year period, the biggest challenge will be keeping the momentum while facing funding issues, geopolitical uncertainty, and outbreaks. She called on countries to increase domestic funding for immunisation and asked donors to support Gavi’s 2026, 2030 strategy.
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