The high cost of closing the global vaccine gap

Health · Published 18 October 2026 Swipe more like this →

In short: While routine childhood vaccinations have averted 154 million deaths since 1974, progress is stalling. Despite massive global expansion, millions of children remain 'zero-dose'—completely unprotected against preventable diseases. This persistent inequity highlights a growing divide between global health targets and the reality of reaching the world's most vulnerable populations.

The Essential Programme on Immunization (EPI) has been a cornerstone of global health since 1974. While it successfully averted an estimated 154 million childhood deaths, the data reveals a complex landscape of progress and regression. Global coverage for core vaccines like DTP3, measles, and polio nearly doubled between 1980 and 2023. However, this long-term success masks a troubling recent trend: coverage gains slowed significantly between 2010 and 2019, with declines observed in 21 of 36 high-income countries.

The COVID-19 pandemic acted as a major disruptor, causing global vaccine rates to drop sharply since 2020. While newer vaccines like those for rotavirus and pneumococcal disease saw continued scale-ups during the pandemic, they did so at slower rates than expected. Looking toward 2030, the Immunization Agenda 2030 (IA2030) targets remain daunting. Forecasts suggest that only the DTP3 vaccine is likely to reach the 90% global coverage target, and even then, only under an optimistic scenario.

A critical bottleneck is the concentration of 'zero-dose' children—those who have not received a single dose of DTP1. While these numbers fell by 74.9% between 1980 and 2019, they spiked to a peak of 18.6 million in 2021 during the pandemic. Today, more than half of the 15.7 million global zero-dose children live in just eight countries, primarily in conflict-affected regions and areas with severe resource constraints, notably in sub-Saharan Africa. Addressing this requires not just medicine, but a massive expansion of the health workforce, which currently faces a global shortfall of millions of doctors, nurses, and midwives to reach universal health coverage.

The human resource gap is stark: while the global health workforce grew by 198.5% since 1990, sub-Saharan Africa maintains the lowest densities across most cadres. To achieve moderate universal health coverage, the world requires an additional 7.1 million doctors and 23.9 million nurses and midwives. Bridging this gap is essential to ensuring that the next generation of vaccines can actually reach the children who need them most.

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