Despite significant strides in routine childhood immunization over the past four decades, Pakistan remains among the eight countries that account for over half of the world’s “zero-dose” children – those who receive no vaccinations during their first year of life. A landmark global study published by The Lancet on Tuesday reveals that the COVID-19 pandemic reversed years of steady progress, pushing millions of children globally, and thousands in Pakistan, into vaccine deprivation.
The Global Burden of Disease (GBD) Study 2023, which analyzed trends from 1980 to 2023 and projected coverage to 2030, found that while the number of zero-dose children in Pakistan significantly decreased by 2019, the country is still a top contributor alongside Nigeria, India, and Ethiopia.
The study highlights that from 1980 to 2019, the global number of zero-dose children fell by nearly 75%, but this progress has since stalled. As of 2023, Pakistan was home to a considerable portion of the 15.7 million global zero-dose children – those who had not received even the first dose of the diphtheria-tetanus-pertussis (DTP1) vaccine.
The COVID-19 pandemic dealt a major setback, as Pakistan, like many other nations, experienced disruptions to immunization services due to lockdowns, resource diversion, and vaccine misinformation. Globally, between 2020 and 2023, an estimated 15.6 million fewer children received DTP3, 15.6 million missed measles vaccines (MCV1), and 15.9 million missed polio vaccines compared to a pre-pandemic scenario.
While Pakistan’s recovery is underway, the report notes that coverage has yet to return to pre-pandemic levels. The Expanded Programme on Immunisation (EPI), launched in 1974, has globally saved an estimated 154 million lives, predominantly children under five. Pakistan, despite chronic governance and logistical challenges, has benefited from EPI and Gavi support, improving coverage for vaccines like DTP3 and Bacillus Calmette–Guérin (BCG).
However, inequities persist, both across provinces and between urban and rural populations. The Lancet study warns that without immediate action, Pakistan is unlikely to meet the 2030 target of halving its zero-dose children from 2019 levels.
The Immunisation Agenda 2030 (IA2030), endorsed by the World Health Assembly, aims for 90% coverage of life-course vaccines such as DTP3, pneumococcal conjugate vaccine (PCV3), and the second measles dose (MCV2). The study forecasts that globally, only DTP3 has a realistic chance of meeting this goal, and only under optimistic conditions.
Globally, while coverage for older vaccines like BCG and DTP1 nearly doubled from 1980 to 2019, gains have plateaued or declined in recent years. Even high-income countries have seen stagnation or reductions in the uptake of some vaccines. The COVID-19 pandemic caused the largest disruption to immunization services in recent history.
South Asia, which accounted for 12.5% of the world’s zero-dose children in 2023, must significantly accelerate its efforts. Pakistan, despite showing some post-COVID improvement, will need to raise its immunization coverage by at least two percentage points annually to meet IA2030 targets—a pace historically achieved by few countries.
