The State of the World’s Children 2023: For every child, vaccination


The State of the World’s Children is an annual report published by the United Nations Children’s Fund (UNICEF) since the year 1980. Each edition aims to promote awareness on key issues affecting children around the world. This latest edition of the report, titled 'For Every Child, Vaccination' was published in April 2023. The report focuses on the importance and the urgent need of accelerating vaccination programmes for children worldwide.

Vaccines help prevent and eradicate diseases, including Covid-19. Yet, one in five children are ‘zero-dose’ (unvaccinated) and under-vaccinated. These children are often from the “poorest, most remote and most marginalised” communities, the report states. This report examines, using various parameters, whether or not a child is vaccinated, vaccine hesitancy among communities and the factors which result in low levels of vaccination. It also presents a set of recommendations to expand immunization among children.

This 226-page document is divided into six chapters: How Covid-19 pandemic set back vaccination (Chapter 1); Zero-dose children matter (Chapter 2); Immunization and primary health care (Chapter 3); How can we build vaccine confidence? (Chapter 4); Funding and innovation for the future (Chapter 5); For every child, vaccination: An equity agenda (Chapter 6).


  1. Covid-19 pandemic proved disastrous for child immunization, the report states. Between 2019 and 2021, 67 million children had partially or fully missed out on regular vaccination, out of which, 48 million had missed it fully.

  2. The Covid-19 pandemic interrupted vaccination campaigns due to the new demands in placed on health systems, the inadequacies in the infrastructure like lack of skilled workforce and the recommendation to stay indoors.

  3. In the poorest households, over one in five children are zero-dose. In the wealthiest households, one in 20 children are zero-dose.

  4. Lack of education among mothers increases the chances of a child being unvaccinated. Among mothers with no education, 23.5 per cent of children are zero-dose.

  5. The report states that the strength of primary healthcare systems and the health workforce is crucial to accelerating immunization programmes among children.

  6. The report states that there is a there is a decline in the confidence people have on the value of vaccination, especially after Covid-19. To combat this, the report recommends engaging with communities and investing time in understand the cause of vaccination hesitancy.

  7. Immunization Agenda 2030 is an international strategy to ensure that across the globe, immunization covers everyone eligible for vaccines across different age groups. Equitable investment – especially in low- and middle-income countries will ensure proper disbursement of vaccines, the report states.

  8. Children in parts of Africa and South Asia are more likely to have skipped vaccination. In 2021, there were 6.8 million children in West and Central Africa who were under-vaccinated (including zero-dose children). In South Asia, 4.6 million children were under-vaccinated.

  9. The report offers a plan of action to promote immunization equity. In order to ensure that every child receives life-saving vaccines, it makes four important suggestions to international, national and local stakeholders. These are: make vaccination more equitable by ensuring that these programmes reach every child, everywhere; strengthen demand for vaccination by informing caregivers, especially mothers, about the benefits; investing more on immunization and healthcare by prioritizing primary healthcare; building resilient systems which are “people-centred, rather than disease-centred”.

    Focus and factoids by Neeraja Parthasarathy.

    PARI Library’s health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.


United Nations Children’s Fund


United Nations Children’s Fund


Apr, 2023