20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines such as measles, diphtheria and tetanus in 2018, according to new data from WHO and UNICEF.

Globally, since 2010, vaccination coverage with three doses of diphtheria, tetanus and pertussis (DTP3) and one dose of the measles vaccine has stalled at around 86 percent. While high, this is not sufficient. 95 percent coverage is needed – globally, across countries, and communities - to protect against outbreaks of vaccine-preventable diseases.

“Vaccines are one of our most important tools for preventing outbreaks and keeping the world safe,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “While most children today are being vaccinated, far too many are left behind. Unacceptably, it’s often those who are most at risk– the poorest, the most marginalized, those touched by conflict or forced from their homes - who are persistently missed.”

Most unvaccinated children live in the poorest countries, and are disproportionately in fragile or conflict-affected states. Almost half are in just 16 countries - Afghanistan, the Central African Republic, Chad, Democratic Republic of the Congo (DRC), Ethiopia, Haiti, Iraq, Mali, Niger, Nigeria, Pakistan, Somalia, South Sudan, Sudan, Syria and Yemen.

If these children do get sick, they are at risk of the severest health consequences, and least likely to access lifesaving treatment and care.

Measles outbreaks reveal entrenched gaps in coverage, often over many years

Stark disparities in vaccine access persist across and within countries of all income levels. This has resulted in devastating measles outbreaks in many parts of the world – including countries that have high overall vaccination rates.

In 2018, almost 350,000 measles cases were reported globally, more than doubling from 2017.

“Measles is a real time indicator of where we have more work to do to fight preventable diseases,” said Henrietta Fore, UNICEF’s Executive Director. “Because measles is so contagious, an outbreak points to communities that are missing out on vaccines due to access, costs or, in some places, complacency. We have to exhaust every effort to immunize every child.”

Ten countries with highest reported incidence rate of measles cases (2018) Coverage with measles first dose (2010) Coverage with measles first dose (2018) Ukraine 56 91 Democratic Republic of the Congo 74 80 Madagascar 66 62 Liberia 65 91 Somalia 46 46 Serbia 95 92 Georgia 94 98 Albania 99 96 Yemen 68 64 Romania 95 90

Ukraine leads a varied list of countries with the highest reported incidence rate of measles in 2018. While the country has now managed to vaccinate over 90 percent of its infants, coverage had been low for several years, leaving a large number of older children and adults at risk.

Several other countries with high incidence and high coverage have significant groups of people who have missed the measles vaccine in the past. This shows how low coverage over time or discrete communities of unvaccinated people can spark deadly outbreaks.

Human papillomavirus (HPV) vaccine coverage data available for the first time

For the first time, there is also data on the coverage of human papillomavirus (HPV) vaccine, which protects girls against cervical cancer later in life. As of 2018, 90 countries – home to 1 in 3 girls worldwide - had introduced the HPV vaccine into their national programmes. Just 13 of these are lower-income countries. This leaves those most at risk of the devastating impacts of cervical cancer still least likely to have access to the vaccine.

Together with partners like Gavi, the Vaccine Alliance and the Measles & Rubella Initiative, WHO and UNICEF are supporting countries to strengthen their immunization systems and outbreak response, including by vaccinating all children with routine immunization, conducting emergency campaigns, and training and equipping health workers as an essential part of quality primary healthcare.

About the data

Since 2000, WHO and UNICEF jointly produce national immunization coverage estimates for Member States on an annual basis. In addition to producing the immunization coverage estimates for 2018, the WHO and UNICEF estimation process revises the entire historical series of immunization data with the latest available information. The 2018 revision covers 39 years of coverage estimates, from 1980 to 2018. DTP3 coverage is used as an indicator to assess the proportion of children vaccinated and is calculated for children under one year of age. The estimated number of vaccinated children are calculated using population data provided by the 2019 World Population Prospects (WPP) from the UN.