Why Reaching Zero-Dose Children Holds the Key to Achieving the Sustainable Development Goals

Daniel R. Hogan · Anuradha Gupta

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Vaccine Coverage and Hesitancy Child Nutrition and Water Access Global Maternal and Child Health

Abstract

Immunization has one of the highest coverage levels of any health intervention, yet there remain zero-dose children, defined as those who do not receive any routine immunizations. There were 18.2 million zero-dose children in 2021, and as they accounted for over 70% of all underimmunized children, reaching zero-dose children will be essential to meeting ambitious immunization coverage targets by 2030. While certain geographic locations, such as urban slum, remote rural, and conflict-affected settings, may place a child at higher risk of being zero-dose, zero-dose children are found in many places, and understanding the social, political, and economic barriers they face will be key to designing sustainable programs to reach them. This includes gender-related barriers to immunization and, in some countries, barriers related to ethnicity and religion, as well as the unique challenges associated with reaching nomadic, displaced, or migrant populations. Zero-dose children and their families face multiple deprivations related to wealth, education, water and sanitation, nutrition, and access to other health services, and they account for one-third of all child deaths in low- and middle-income countries. Reaching zero-dose children and missed communities is therefore critical to achieving the Sustainable Development Goals commitment to "leave no one behind".

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References

2019Mapping diphtheria-pertussis-tetanus vaccine coverage in Africa, 2000–2016: a spatial and temporal modelling study 2014Slum Residence and Child Health in Developing Countries 2021Zero-dose children and the immunisation cascade: Understanding immunisation pathways in low and middle-income countries 2021Lives saved with vaccination for 10 pathogens across 112 countries in a pre-COVID-19 world 2022Estimates of the number and distribution of zero-dose and under-immunised children across remote-rural, urban, and conflict-affected settings in low and middle-income countries

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2024High prevalence of zero-dose children in underserved and special setting populations in Ethiopia using a generalize estimating equation and concentration index analysis 2023Defining the Zero Dose Child: A Comparative Analysis of Two Approaches and Their Impact on Assessing the Zero Dose Burden and Vulnerability Profiles across 82 Low- and Middle-Income Countries 2024Status of Routine Immunization Coverage in the World Health Organization African Region Three Years into the COVID-19 Pandemic 2024In-depth reasons for the high proportion of zero-dose children in underserved populations of Ethiopia: Results from a qualitative study 2024Estimating the health effects of COVID-19-related immunisation disruptions in 112 countries during 2020–30: a modelling study

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