Zero-dose child

Zero-dose child
FieldPublic health, Global health, Immunization
OriginWorld Health Organization / UNICEF monitoring under Immunization Agenda 2030
PurposeEquity indicator identifying infants not reached by routine immunization services


A zero-dose child is a term in global public health for an infant who has not received any routine childhood vaccine doses. For operational monitoring, the WHO and UNICEF measure zero-dose status as the non-receipt of the first dose of a DTP-containing vaccine (DTP1) by the end of the first year of life.[1][2] The number of zero-dose children is a core equity indicator of the Immunization Agenda 2030 (IA2030).[1]

Definition and measurement

WHO and UNICEF track zero-dose children using the DTP1 proxy: those who did not receive a first dose of a DTP-containing vaccine –against diphtheria, pertussis (whooping cough), and tetanus (lockjaw)– by age one are counted as zero-dose.[1] Research sometimes uses broader definitions to identify children who truly received no vaccines at all (e.g., among children aged 12–23 months, having received none of BCG, polio, pentavalent/DTP-containing or measles-containing vaccines).[3][4]

According to WHO/UNICEF's 2024 coverage estimates released in 2025, about 14.3 million infants worldwide were zero-dose—meaning they received no routine vaccines in their first year of life—despite modest stabilization in overall coverage compared with 2023.[5][6] Zero-dose children are disproportionately found in settings affected by fragility, conflict or humanitarian crises. Barriers include limited access to primary health care, supply interruptions, displacement and misinformation.[7]

Policy and programmes

Reducing the number of zero-dose children is a central equity goal of IA2030 (target: a 50% reduction from the 2019 baseline by 2030).[8][1] Gavi prioritises "zero-dose children and missed communities," defining zero-dose programmatically as infants without DTP1 by age one and setting interim and long-term reduction targets.[9] Evidence syntheses emphasise that reaching zero-dose children is pivotal for achieving broader immunization and health goals and that strategies must address both access and demand barriers, often focusing on urban poor, remote rural and conflict-affected settings.[10]

Individual action

In addition to government and partner programmes, individual donors sometimes support efforts to increase routine immunization. Charity evaluators such as GiveWell have identified New Incentives' conditional cash transfer programme in northern Nigeria as a highly cost-effective opportunity for individuals seeking to increase vaccination uptake, based on evidence from an independent randomized evaluation and ongoing monitoring.[11][12] Reviews of incentive programmes note that conditional cash transfers can increase routine immunization coverage in low- and middle-income countries, though effects vary by context.[13]

See also

References

  1. ^ a b c d "IA2030 IG 2.1: Number of zero dose children". World Health Organization. Retrieved 28 August 2025.
  2. ^ "WHO & UNICEF Estimates of National Immunization Coverage (WUENIC): Notes for interpretation" (PDF). World Health Organization; UNICEF. 15 July 2024. Retrieved 28 August 2025.
  3. ^ Wonodi, Chizoba; Farrenkopf, Brooke A. (2023-09-28). "Defining 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". Vaccines. 11 (10): 1543. doi:10.3390/vaccines11101543. PMC 10611163. PMID 37896946.
  4. ^ Farrenkopf, Brooke A.; Zhou, Xiaobin; Shet, Anita; Olayinka, Folake; Carr, Kelly; Patenaude, Bryan; Chido-Amajuoyi, Onyema G.; Wonodi, Chizoba (2023-12-06). "Understanding household-level risk factors for zero dose immunization in 82 low- and middle-income countries". PLOS ONE. 18 (12) e0287459. Bibcode:2023PLoSO..1887459F. doi:10.1371/journal.pone.0287459. PMC 10703331. PMID 38060516.
  5. ^ "Global childhood vaccination coverage holds steady, yet over 14 million infants remain unvaccinated – WHO, UNICEF" (Press release). UNICEF. 15 July 2025. Retrieved 28 August 2025.
  6. ^ "IA2030 Scorecard – Number of zero-dose children (global)". World Health Organization. Retrieved 28 August 2025.
  7. ^ "Global childhood vaccination coverage holds steady, yet over 14 million infants remain unvaccinated – WHO, UNICEF" (Press release). UNICEF. 15 July 2025. Retrieved 28 August 2025.
  8. ^ "IA2030 Scorecard – Global targets". World Health Organization. Retrieved 28 August 2025.
  9. ^ "Zero-dose children and missed communities". Gavi, the Vaccine Alliance. 15 May 2025. Retrieved 28 August 2025.
  10. ^ Hogan, Dan; Gupta, Anuradha (2023). "Why Reaching Zero-Dose Children Holds the Key to Achieving the Sustainable Development Goals". Vaccines. 11 (4): 781. doi:10.3390/vaccines11040781. PMC 10142906. PMID 37112693.
  11. ^ "New Incentives". GiveWell. 2025. Retrieved 28 August 2025.
  12. ^ "Impact of Conditional Cash Transfers on Routine Childhood Immunizations: Evidence from North West Nigeria". IDinsight. 13 November 2020. Retrieved 28 August 2025.
  13. ^ Saunders, Mark J. (2025). "Incentives in immunisation campaigns in low- and middle-income countries: a scoping review mapping evidence on effectiveness and unintended consequences". BMJ Global Health. 10 (6) e019662. doi:10.1136/bmjgh-2025-019662. PMC 12211823. PMID 40588295. Retrieved 28 August 2025.
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