Reaching Zero-Dose Children in Africa and South Asia

Despite decades of progress increasing access to immunizations in lower-income countries, at least 12.4 million children still go without basic, routine vaccines every year. One in five children in lower income countries have not received any vaccinations, leaving them vulnerable to some of the world’s deadliest diseases. These are zero-dose children, meaning they’ve never been reached by their country’s vaccine system.

Many zero-dose and under-vaccinated children live in challenging settings, such as remote rural communities, built-up urban settlements, and areas experiencing conflict and crises. These challenges are greatest in low- and middle-income countries, where about 1 in 10 children in urban areas are zero-dose; the figure is just under 1 in 6 in rural areas. Zero-dose children account for nearly half of all vaccine-preventable deaths.

The COVID-19 pandemic placed an unprecedented strain on health systems, including the delivery of essential immunization programs. Childhood immunization was severely disrupted with 67 million children missing out entirely or partially on routine immunization and 48 million of them missed out entirely between 2019-2021, leaving them vulnerable to a range of preventable diseases. Decrease in vaccination levels in over 100 countries is leading to rising outbreaks of measles, diphtheria and polio. Efforts to recover, restore and expand routine immunization are critical for global health security.

The Global Health Advocacy Incubator (GHAI) is committed to strengthening primary healthcare and immunization systems while helping countries prioritize health budgets to ensure all children can get life-saving vaccines. The immunization program, funded by the Gavi Alliance, will support civil society organizations (CSOs) to secure social and political will for equitable and sustainable financing for immunization and primary health care; work towards increasing immunization coverage and reducing the number of zero-dose children; and ensure efficient use and allocation of domestic resources and international donor funds for primary health care and immunization service delivery.

GHAI is in the process of finalizing CSO partners in Bangladesh, Ghana, Madagascar, Nigeria and Pakistan to engage political decision-makers on the need for sustainable financing for immunization and primary health care. This work will draw upon our budget advocacy framework and successes in increasing domestic financing for preventing epidemics to build government, civil society and media capacity to advocate for domestic health financing. We will work closely with these CSOs to develop political strategies to remove bottlenecks affecting the allocation and spending of immunization and primary health care funds.

This program aims to increase domestic resources mobilized for primary health care and immunization; more efficient use of domestic and donor funds to reach zero-dose children and increase immunization; and improve transparency and accountability for domestic and donor resources allocated to the immunization program and reduction in the number of zero-dose children in these countries.