New UNICEF report shows 12.7 million children in Africa missed out on one or more vaccinations over three years

Dakar/Nairobi/Johannesburg, 20 April 2023 – UNICEF’s The State of the World’s Children 2023: For Every Child, Vaccination reveals today that 12.7 million children in Africa missed out on one or more vaccinations over three years. In the world, a total of 67 million children missed out on vaccinations between 2019 and 2021, with vaccination coverage levels decreasing in 112 countries.

Africa is the region with the highest number of unvaccinated and under-vaccinated children: 12.7 million children were under-vaccinated in 2021, including 8.7 million who did not receive a single dose, also called “zero-dose” children. Half of the top 20 countries in the world with the largest number of zero-dose children are in Africa. Nigeria and Ethiopia are the two countries with the largest number of zero-dose children on the continent with more than 2.2 million and 1.1 million respectively. Two in five zero-dose children in Africa live in one of these two countries.

Today’s report shows that the world has experienced the largest sustained backslide in childhood immunization in 30 years, fuelled by the COVID-19 pandemic. The pandemic interrupted childhood vaccination almost everywhere, especially due to intense demands on health systems, the diversion of immunization resources to COVID-19 vaccination, health worker shortages and stay-at-home measures. Ongoing challenges such as conflicts, climate change and vaccine hesitancy also contributed.

“Immunization is one of the world’s most effective public health interventions. Yet, millions of children in Africa are still deprived of life-saving vaccination – often the same children who live in communities missed across the spectrum of essential services such as health, nutrition, education and other social services”, said Marie-Pierre Poirier, UNICEF Regional Director for West and Central Africa. “We must act urgently to make sure that every child who has been left out is vaccinated. Using routine immunization as an entry point to strengthen primary healthcare and community systems will also help deliver other essential services, so that together with governments and partners, we can address multiple child deprivations and accelerate progress for children”.

In Africa, the pandemic also exposed – and exacerbated – lack of resilience and persistent weaknesses in health systems and primary health care whereas before the pandemic. Far too many primary health-care systems suffered from a lack of skilled health workers, limited access to essential supplies and equipment, weak capacity for collecting and using data and conducting disease surveillance, shortages at the local level of key medicines and vaccines, and barriers to using available resources efficiently and effectively.

“The recent resurgence of measles, cholera, and poliovirus in Africa is a warning that we need to step up our efforts. African leaders must act now and take strong political action to reduce the gap in vaccination and make sure that all children are immunized and protected,” said Mohamed M. Fall, UNICEF Regional Director for Eastern and Southern Africa. “The right policy decisions and increased budget allocations for primary health care for children, including immunization, in underserved communities in Africa can boost our efforts toward a healthier, safer, and more prosperous continent.”  

Children born just before or during the pandemic are now moving past the age when they would normally be vaccinated, underscoring the need to catch up on those who were missed and prevent more deadly disease outbreaks. In 2022, 34 of the 54 countries in Africa experienced disease outbreaks such as measles, cholera and poliovirus. To address this child survival crisis, UNICEF is calling on governments in the region to double-down on their commitment to increase financing for immunization and to work with stakeholders to unlock available resources, including leveraging COVID-19 funds, to urgently implement and accelerate catch-up vaccination efforts to protect children and prevent disease outbreaks. Global and regional actors and the private sector on the continent also have a key role to play.

The report is urging governments to:

• Urgently identify and reach all children, especially those who missed vaccinations during the COVID-19 pandemic
• Prioritise funding to immunization services and primary health care
• Build resilient health systems through investment in female health workers, innovation and local manufacturing
• Strengthen demand for vaccines, including by building confidence

“Immunizations have saved millions of lives and protected communities from deadly disease outbreaks,” said UNICEF Executive Director, Catherine Russell. “We know all too well that diseases do not respect borders. Routine immunizations and strong health systems are our best shot at preventing future pandemics, unnecessary deaths and suffering. With resources still available from the COVID-19 vaccination drive, now is the time to redirect those funds to strengthen immunization services and invest in sustainable systems for every child.”

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Notes to Editors:

The State of the World’s Children is UNICEF’s flagship report. The 2023 edition is the first edition of the report solely dedicated to routine immunization. UNICEF reaches almost half of the world's children every year with lifesaving vaccines.

You can explore a special interactive feature on our website and download the report here.