Five Takeaways and Next Steps from the Immunization Agenda 2030

By Rose Weeks, Senior Research Associate, Johns Hopkins Bloomberg School of Public Health; and Imad Mikhael Aoun, Advocacy Manager, UNICEF.

The ongoing measles outbreak in the United States has been dominating the news, though measles outbreaks have been reported recently in dozens of countries, from Austria to Zambia. In 2023, the number of measles cases topped 10 million globally, a 20% increase from 2022. Because of its highly infectious nature, measles often serves as a "tracer" for weaknesses in access to and availability of basic health services, such as vaccines. In other words, the 57 large or disruptive measles outbreaks reported in 2023 across the world may be just the tip of the iceberg. The recently updated Immunization Agenda 2030 (IA2030) scorecard on the World Health Organization’s (WHO’s) Immunization Data Portal goes beneath the iceberg’s tip.

IA2030 is a global vision and strategy—co-created by countries and development partners and endorsed by WHO—for realizing a world where everyone, everywhere, at every age, fully benefits from vaccines to improve health and well-being. Launched in 2022, the IA2030 scorecard helps people around the world understand the current status of vaccine systems and progress toward meeting IA2030 vision and goals through 15 performance metrics. Users can view data by region, income group, or country. Below are highlights from the newest batch of data from WHO, UNICEF, and partners.

Five Key Takeaways

More large or disruptive outbreaks of vaccine-preventable disease are occurring.

It’s not just measles. The number of large or disruptive outbreaks of cholera, meningococcus, and circulating vaccine-derived polio has also increased since before the COVID-19 pandemic. This trend is particularly evident across Africa, the Middle East, and South Asia. At the same time, the number of large or disruptive Ebola outbreaks has dropped. Some credit a fast-acting funding mechanism for this improvement.

Coverage of routine vaccine services is still lower than pre-pandemic levels.

Ensuring equitable access to routine immunization services prevents vaccine-preventable disease outbreaks. Unfortunately, the proportion of children receiving all three doses of vaccines against diphtheria, tetanus, and pertussis (DTP3), the cornerstone of vaccination programs, is still lower than before the COVID-19 pandemic. For instance, in the East Asia and Pacific Region, DTP3 coverage has dropped by seven percent since 2019. In some regions, like the Americas, coverage has increased, yet only the European region saw coverage greater than 90% in 2023. This disappointing slump in global coverage occurred despite earlier signs of post-pandemic recovery that gave many hope that the IA2030 strategy’s target of 90% DTP3 coverage by 2030 would be met.

More children have access to pneumococcal conjugate and HPV vaccines.

Coverage of pneumococcal conjugate vaccine (PCV) and human papillomavirus (HPV) vaccine has increased by 4 and 15 percentage points, respectively, since 2022 but remains far from 90% coverage, the global strategy target for 2030. The jump in HPV vaccine coverage comes from new vaccine introduction in 31 countries since 2021, including Nigeria in 2023. Meanwhile, PCV coverage has increased steadily since 2019 as large countries like Indonesia gradually work to reach all children. However, an analysis of PCV coverage found that stagnation or declines in PCV program expansion across several other countries may be due to a range of factors, including conflict and misinformation. 

14.5 million infants did not get vaccines in 2023. 

Zero-dose children are those that are never reached by routine immunization services. They are measured as those who do not receive their first dose of DTP. The number of children who did not receive a single dose of the DTP vaccine was 14.5 million in 2023—a 13% increase over 2019. As such, the world is not on track to meet the strategy’s 2030 target of reducing the number of zero-dose children by half. 

Africa and the Americas are making progress in reducing the number of zero-dose children.

Across North and South America, the number of zero-dose children has decreased by 23%, bucking global trends. Considering serious disruptions, including changes to both vaccine supply and demand, this accomplishment is remarkable in a historically strong region, which was the first to eliminate smallpox, stamp out polio, and stop transmission of rubella through widespread vaccination campaigns. 

Further, in the African region, despite population growth, the number of zero-dose children dropped by 590,000 in one year. HPV vaccine coverage in Africa also increased dramatically, from 17 percent in 2019 to 72 percent by 2023.

How Can We Hasten Progress?

The IA2030 scorecard also tracks process measures—how countries work to improve or recover performance. Countries report on their use of critical strategies like ensuring political commitment to vaccination through legislation, increasing the availability of health workers, and using social marketing techniques to increase demand for immunization.

Introduce and scale up HPV vaccination.

To save 50 million lives through immunization by 2030, the target of the global immunization strategy, countries must continue to introduce and expand access to HPV vaccination. While access to HPV vaccination has often been hindered by supply gaps, several new supply options, including the confirmation of a fourth WHO-prequalified HPV vaccine for use in a single-dose schedule, have recently become available. This will allow more girls access to vaccines that prevent cancer.

Address disparities in vaccine coverage.

Trends displayed on the scorecard often obfuscate variations in immunization access within regions and countries, and these disparities in coverage can be significant. An analysis of administrative data from middle-income countries showed high and growing subnational inequities in vaccination coverage for the first doses of DTP and measles vaccine; the same is likely true across most vaccines. Differences in service availability within countries may be due to a number of reasons—failure to recover from pandemic impacts to the health system, humanitarian crises, stockouts, misinformation, or simply variations in program capacity. 

Recognize the longstanding success of vaccination.

At a global level, vaccination efforts have saved at least 154 million lives over the past 50 years. And even amidst challenges, vaccinating children and adolescents is averting more than 4 million deaths each year. Yet slower introductions of new vaccines and lowered and stagnating levels of protection with measles and other vaccines mean hundreds of thousands of avoidable deaths may occur.

Use digital strategies to drive accountability. 

Greater data disaggregation will characterize differences within countries and foster an improved opportunity to allocate tailored resources and support where immunization services are not reaching children. Digital strategies could help. Geospatial models estimating population sizes within a geographic area can enhance the enumeration of age-eligible children. Real-time monitoring with the widely used open-source software package DHIS2, even with known implementation-related shortcomings, must increasingly drive local strategies. Civil society leaders require this type of regionally precise data to increase accountability for service provision shortcomings at all levels.

Steering Back on Course

Is the scorecard alarming? Yes. However, the visualizations represent an innovation that supports easier access to and analysis of the data for corrective action. It’s through understanding what lies beneath the iceberg’s tip that we can safely steer the ship back on course.

Explore more measures of immunization system performance on the IA2030 Scorecard. 

The Immunization Agenda 2030 (IA2030) scorecard is a publicly available interactive tool displaying data that enables stakeholders at all levels—global, regional and country—to monitor the status of each indicator in the IA2030 Framework for Action. The scorecard is a collaborative effort which was coordinated by USAID MOMENTUM Country and Global Leadership from 2021 to 2024, in partnership with representatives from the IA2030 Communications & Advocacy Working Group and Monitoring & Evaluation Working Group, including specialists from the WHO, CDC, UNICEF, IVAC, and UN Foundation.