June 24, 2025

expert reaction to study looking at global childhood vaccination coverage

A study published in the Lancet looks at global trends in routine childhood vaccination coverage.

Prof Beate Kampmann, Professor of Paediatric Infection and Immunity, and Director of The Vaccine Centre, London School of Hygiene & Tropical Medicine, said:

“This is a credible, large piece of work.

“Vaccines save lives, and the data published in the Lancet again strongly support this well-known evidence.  In low-and middle income countries, people on the ground have witnessed within their lifetime how vaccines against meningitis, pneumonia and diarrhoea have prevented morbidity and mortality, and they remain committed to uptake of vaccinations for their children – if only the vaccines are available.  This underlines that vaccine programs cannot exist in isolation but are part of efforts in health systems strengthening – and as such also an indicator of inequity between countries – and even within countries, as pointed out by the authors of the study.

“Whilst the problem of zero dose children needs to be addressed not only through vaccine initiatives, the investment in GAVI, who facilitate the availability of the life-saving interventions needs to be maintained, now even more to keep closing gaps.  Additional research and interventions are under way to inform approaches to further improvements, which are often very context-specific.

“Infectious diseases do not know borders – and we should really remember this from COVID-19 , and to jeopardise community immunity – be it for logistical or acceptancy reasons – is a risk for all of us.”

Dr Simon Clarke, Associate Professor in Cellular Microbiology, and Head of Division of Biomedical Sciences & Biomedical Engineering, University of Reading, said:

“These figures indicate a worrying level of children in the UK who are completely unvaccinated against childhood diseases.  While the comparative data do not show the specific causes of this rising trend over recent decades, the WHO and others are right to highlight it as a worrying trend.

“This is a very large assessment of multiple and large data sources, combined with models which are used to provide consistency between the data and provide forecasts into the future.  Such methodology provides both a clear overview of the past trajectories of immunisation rates along with an effective range of possible scenarios for the future, which appears to be robust and based on sound data.  The authors are clear about the limitations of their study but these do not detract from the overall message.

“The current move away from funding global health schemes through international aid in order to spend more on defence puts the whole world at greater risk of future epidemics and pandemics.  Our security against this in the UK is improved by supporting efforts to not let dangerous diseases take hold in populations elsewhere in the world.  Our experience of Covid reminds us that lethal human diseases can be very hard to contain on the other side of international borders.”

Dr David Elliman, Honorary Senior Associate Professor, UCL, said:

“Vaccination is one of the most cost-effective ways that the health service can improve the lives of children around the world. It is a great success story with more vaccines being introduced all the time.  Not only does vaccination save lives, but it often saves money. However, in the last ten to twenty years, many countries, worldwide, have seen a reduction in the proportion of children receiving all the available vaccines. This article by a large group of researchers has documented the decline.  It may be difficult to measure uptake of vaccination accurately, but the researchers have allowed for this.  It is clear that the decline in uptake is happening around the world.  This has resulted in outbreaks of disease, for examples measles and whooping cough in USA and Europe (including UK) as well as in resource poor countries.  These diseases can and do kill children.  While part of the fall in vaccination is related to COVID, the trend was clear before then.

“Declining vaccination rates are often blamed on misinformation, but there are many reasons, of which this is only one. Access to vaccines is often overlooked or underestimated as a factor, even in the UK.  Around the world, the increasing number of countries torn apart by civil unrest and wars, combined with the drastic cuts in foreign aid from rich nations, such as USA and UK, makes it difficult to get vaccines to many populations.  With the political changes in USA where it appears that policy is being made on the basis of ill-informed opinion, rather than science, we have a perfect storm. The researchers’ recommendations to strengthen primary health-care systems, address vaccine misinformation and hesitancy, and adapt to local contexts can, and should, be applied to all countries, including the UK.  In addition we should ensure that vaccines are available to all.

“It is in everyone’s interest that this situation is rectified.  Not only is it a moral imperative to improve the health of ALL children, wherever possible, but as was said during the COVID pandemic, no-one is safe, until everyone is safe. While vaccine-preventable infectious diseases, occur anywhere in the world, we are all at risk. Universal vaccination is a perfect example of ‘enlightened self interest’.”

Prof Sir Andrew Pollard FRCPCH FMedSci FRS, Director of the Oxford Vaccine Group, and Ashall Professor of Infection and Immunity, Pandemic Sciences Institute, University of Oxford, said:

“The study uses an established approach to track the global burden of disease and immunisation coverage and the authors have tried hard to get the most accurate data by using multiple sources and account for regional variation and inequalities. These types of study will always be limited by the lack of high quality national data from most countries in the world which means there has to be extrapolation and assumption.  Nevertheless these are important data providing a concerning picture of recent declines in vaccine coverage and an increase in the number of zero dose children which risks the future health and lives of millions of children.

“Incredible progress has been made in the past 50 years since the global expanded programme of immunisation was launched 50 years ago and over 150 million lives, mostly children, have been saved by the programme. The story is the same here in the UK with the launch of our own national programme by JCVI 62 years ago: deaths from infectious diseases of childhood have plummeted here too. The rarity of childhood severe disease and death from infection risks that we become complacent. But the danger remains out there: all of the diseases for which vaccines can protect children remain at large, only kept at bay by the shield which is provided by immunuisation. Unvaccinated children are vulnerable to a wide range of awful life-threatening bacteria and viruses, just as was the case for our population in the first half of the 20^th century. There is a worrying trend of falling vaccine coverage worldwide which has been manifest in the last year as the outbreaks in Europe and North America of measles and whooping cough, with measles deaths in Texas in 2025. Falling global vaccine coverage, an increase in the numbers of children receiving no vaccines, and delays in vaccination mean that more children will be hospitalised, permanently damaged and die from fully preventable diseases if the trend is not reversed. Alas, the cuts in global health funding mean that this situation is set to deteriorate. This is a big concern for the future of our health and global health security.”

Dr Ed Parker, Assistant Professor and Co-Director of the Vaccine Centre, London School of Hygiene & Tropical Medicine (LSHTM), said:

“This is a timely study that attempts to quantify global trends in childhood vaccine coverage since 1980.  The findings highlight the remarkable progress that has been made to deliver life-saving vaccines across the globe, while painting a clear picture of the challenges faced following disrupted vaccination during the COVID-19 pandemic and the stagnation in vaccination rates that preceded it.

“Underpinning the work is an immense data curation effort, drawing together data from household surveys, national coverage reports, and various other sources from across the globe. The study team estimated coverage trends with careful consideration of the biases, gaps, and inconsistencies that are inherent in these data, providing strong foundations for the study’s conclusions.

“A key uncertainty – acknowledged by the authors – is that it is too early to know what effect proposed funding cuts might have on vaccination programmes globally. The recent resurgence of measles, polio, and diphtheria – all preventable by vaccination – serves as a reminder of what is at stake if high and equitable vaccine coverage is not sustained.”

Prof Helen Bedford, Professor of Children’s Health, UCL, said:

“It is often said that, after clean water, vaccination is the most effective intervention for protecting the health of our children. While it can be challenging in many settings to measure vaccine uptake accurately, the researchers publishing the latest data from the World Health Organization have made allowance for this and it provides powerful evidence. It is estimated that vaccination has prevented an estimated 154 million deaths, mostly in the under-fives, across the globe in the last 50 years. However, we cannot rest on our laurels; this progress is stalling in many countries including the UK. In UK, although vaccination is the norm, with the overwhelming majority of parents vaccinating their babies, infants and children without hesitation, there has been a small but gradual decline in the number of parents doing so each year over the past 12 years with increasing inequity in uptake between social groups. This has resulted in recent outbreaks of disease with the largest number of confirmed cases of measles since the 1990s and the tragic deaths of eleven babies from whooping cough in 2024.

“The reasons for declining vaccine uptake are numerous and complex but require commitment and resource to meet the challenges of increasing social inequity, readily available mis-information about vaccine safety and necessity and improving public confidence in vaccination programmes. Vaccination remains one of our most powerful tools for protecting child health, but its continued success depends on sustained investment, equity, and public trust.”

‘Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030: a systematic analysis for the Global Burden of Disease Study 2023’ by GBD 2023 Vaccine Coverage Collaborators was published in the Lancet at 23:30 UK time on Tuesday 24 June 2025. 

DOI: 10.1016/S0140-6736(25)01037-2

Declared interests

Prof Beate Kampmann: “No COI except that I am a researcher in vaccinology.”

Dr Simon Clarke: “No conflicts of interest.”

Dr David Elliman: “No conflicts of interest.”

Prof Sir Andrew Pollard: “Professor Pollard is chair of JCVI which provides independent scientific advice on vaccines to DHSC.  The comment above is given in a personal capacity.”

Dr Ed Parker: “No COIs to declare.”

Prof Helen Bedford: “No conflicts.”