Top 5 Takeaways

  1. Global Decline in Routine Vaccinations: The estimated global coverage for key vaccines, including the three-dose diphtheria-tetanus-pertussis vaccine (DTPcv3) and the first dose of the measles-containing vaccine (MCV1), dropped to 81% in 2021, marking the lowest levels since 2008.
  2. Increased Number of Unvaccinated Children: In 2021, approximately 25.0 million children were either unvaccinated or incompletely vaccinated, a significant increase from 19.1 million in 2019.
  3. Regional Disparities: The decline in vaccination coverage was most pronounced in the South-East Asia Region, with notable decreases also in the Americas.
  4. Impact of COVID-19 Pandemic: Disruptions caused by the COVID-19 pandemic have severely impacted routine immunization services globally.
  5. Need for Context-Specific Strategies: Recovery and enhancement of immunization programs are vital, requiring targeted approaches to address gaps and improve access across different life stages.

Original Article Author and Citation

Corresponding Author

Audrey Rachlin, .

Suggested Citation

Rachlin A, Danovaro-Holliday MC, Murphy P, Sodha SV, Wallace AS. Routine Vaccination Coverage — Worldwide, 2021. MMWR Morb Mortal Wkly Rep 2022;71:1396–1400. DOI: .


The report outlines a significant decrease in global routine childhood vaccination coverage during 2019-2021. The decline is attributed to disruptions caused by the COVID-19 pandemic. In 2021, the coverage for key vaccines like DTPcv3 and MCV1 plummeted to the lowest since 2008, with millions of children missing vaccinations.


The WHO and UNICEF generated estimates of immunization coverage through the review of country-specific data, including administrative and survey-based coverage. These organizations assessed the performance of routine immunization programs and identified children with no or incomplete vaccination.


The decline in vaccination coverage is a global health concern, with the largest decreases observed in the South-East Asia Region. Factors contributing to this decline include strained health systems due to the pandemic, supply chain challenges, and increasing vaccine hesitancy. The report emphasizes the importance of Gavi, the Vaccine Alliance, in supporting low- and middle-income countries. However, the transition out of Gavi support has led to sharper declines in some countries.


To reverse the declining trends in vaccination and prevent outbreaks, there’s a need for targeted, context-specific strategies. These strategies should prioritize routine vaccination as an essential health service, improve access across the lifespan, and address the needs of zero-dose and incompletely vaccinated children. The report suggests leveraging the COVID-19 pandemic response to strengthen routine immunization services and increase health care resilience.


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