The pandemic may feel like a distant memory, but its aftershocks are far from over. In the quiet gaps, a different story is unfolding, affecting the world’s most vulnerable. Among those left behind in the rush to return to normal are millions of children who have not received even a single vaccine. They are known as the zero-dose children.
In 2019, there were around 12.9 million zero-dose children globally. When the pandemic hit, it caused severe disruptions in global immunization coverage — the worst backslide in 30 years. This drop in coverage resulted in a nearly 40% spike in the number of zero-dose children. Five years later, progress is encouraging: the number of zero-dose children has dropped by 21%.
But before you breathe a sigh of relief, thinking, “Well, we’ve bounced back,” the current figures remain 11% higher than where we started in 2019, when the number stood at 12.9 million. The truth is that we are still failing millions of these zero-dose children.
Who Are These Zero-Dose Children?
Muslima Ahmed holds her child as she waits for him to receive a vaccination at the outreach vaccination facility in Walaag 1 IDP camp in Baidoa, Somalia in September 2024. This effort is a part of the Reach Zero Dose Children campaign in Somalia.
Almost half of these children are found in urban slums, isolated rural areas, and regions affected by conflict zero-dose children are those who have not received even a single routine vaccine. Almost half of them live in urban areas, remote communities, and conflict-affected regions within low- and lower-middle-income countries.
As of 2019, two-thirds of zero-dose children were concentrated in just five countries: Nigeria, India, the Democratic Republic of the Congo (DRC), Pakistan, and Ethiopia. An additional 18% lived in 16 fragile states. DRC and Ethiopia had the highest numbers in remote rural areas, while Nigeria accounted for the largest share of zero-dose children affected by conflict.
They face the highest risk of deadly but preventable disease outbreaks, and what makes it worse is how hard they are to reach. This is because they live in areas that face multiple deprivations and vulnerabilities, including lack of services, socio-economic inequities, and gender-related barriers.
But it's not just their lives at risk. When these children remain unvaccinated, it creates pockets where dangerous diseases can thrive and endanger entire communities. Ignoring zero-dose children risks reigniting long-eradicated diseases we have worked so hard to defeat.
Is Anyone Doing Anything To Help Them?
Yes, Gavi, the Vaccine Alliance is stepping up. Founded in 2000 with a mission to leave no one behind, Gavi has helped immunize millions of children who would otherwise go unprotected. So far, Gavi-supported vaccines have saved over 17 million lives, and child deaths from vaccine-preventable diseases have dropped by 70% in Gavi-supported countries.
But the pandemic widened the cracks in global health equity. To recover lost ground, Gavi set ambitious goals to reduce the number of zero-dose children by 25% by 2025 and by 50% by 2030.
Rahuma Namata mobilizes the community to receive immunizations by making announcements on her megaphone. Rahuma is the head of the Village Health Team in Kampala, Uganda, volunteering for the Zero-dose Immunization Program for nearly three years.
How Is Gavi Reaching Children in Hard-To-Access Regions?
Reducing zero-dose children is at the heart of Gavi’s 2021–2025 strategy. Their multi-faceted approach combines fundraising, policy partnerships, country co-financing, and technology innovations to break down barriers and reach these zero-dose children.
Gavi also works closely with governments, global health organizations, and local community leaders to facilitate vaccine delivery to these populations, overcome social/gender barriers that hinder immunization, and empower frontline health workers to boost vaccine uptake in these regions. Take Nigeria’s Borno State, for example. Because years of conflict had kept children unvaccinated, Gavi partnered with the Nigerian government, UNICEF, and local groups to launch mobile vaccination teams, host community dialogues, and use data to pinpoint uncovered areas.
While zero-dose children account for nearly half of all child deaths from vaccine-preventable illnesses worldwide, they aren’t the only ones Gavi is working to protect from vaccine-preventable illnesses. The Alliance also supports vaccines against 20 infectious diseases, including cholera, ebola, polio, human papillomavirus (HPV), malaria, and others.
You might think, “Well, Gavi’s handling it. I can sit this one out.” Not so fast.
Like many global organizations, Gavi depends on “replenishment campaigns” — multi-year fundraising drives that call on wealthy nations and partners to step up. This year, Gavi needs an additional $9 billion to help fund its $11.9 billion budget for 2026–2030. Why? This funding will help power the expansion of its vaccine coverage from 20 to 24 preventable diseases, strengthen local vaccine production, and invest in the kind of health infrastructure that builds resilience and saves lives. Simply put, Gavi can’t do it alone.
And this is where you come in.
How can I support Gavi’s work of protecting the zero-dose children?
Talk about it. Post about it. Tweet about it.
Most people outside global health circles haven’t heard of Gavi, but they should. By sharing verified information about Gavi’s work and impact, you’re helping to put vaccine equity and global health on the radar of both citizens and policymakers. The more people understand, the more power we have to mobilize support.
If you live in the US, UK, Germany, Canada or another donor nation, your voice can help unlock billions in life-saving funding. Contact your representatives and tell them: supporting Gavi is not just about vaccines. It’s about giving every child, especially zero-dose children in hard-to-reach communities, a fair chance at a healthy life. Because when we rally together, we’re not just supporting a campaign, we’re building a world where no child is left behind.
Sign our petition and join thousands in advocating for critical funding to give millions the healthy lives they deserve.