Immunization efforts are under growing threat as misinformation, population growth, humanitarian crises and funding cuts jeopardize progress and leave millions of children, adolescents and adults at risk, warn WHO, UNICEF, and Gavi during World Immunization Week, 24–30 April. Outbreaks of vaccine-preventable diseases such as measles, meningitis and yellow fever are rising globally, and diseases like diphtheria, that have long been held at bay or virtually disappeared in many countries, are at risk of re-emerging. In response, the agencies are calling for urgent and sustained political attention and investment to strengthen immunization programmes and protect significant progress achieved in reducing child mortality over the past 50 years. “Vaccines have saved more than 150 million lives over the past five decades,” said WHO Director-General, Dr Tedros Adhanom Ghebreyesus. “Funding cuts to global health have put these hard-won gains in jeopardy. Outbreaks of vaccine-preventable diseases are increasing around the world, putting lives at risk and exposing countries to increased costs in treating diseases and responding to outbreaks. Countries with limited resources must invest in the highest-impact interventions – and that includes vaccines.” Rising outbreaks and strained health systems Measles is making an especially dangerous comeback. The number of cases has been increasing year on year since 2021, tracking the reductions in immunization coverage that occurred during and since the COVID-19 pandemic in many communities. Measles cases reached an estimated 10.3 million in 2023, a 20% increase compared to 2022. The agencies warn that this upward trend likely continued into 2024 and 2025, as outbreaks have intensified around the world. In the past 12 months, 138 countries have reported measles cases, with 61 experiencing large or disruptive outbreaks – the highest number observed in any 12-month period since 2019. Meningitis cases in Africa also rose sharply in 2024, and the upward trend has continued into 2025. In the first three months of this year alone, more than 5500 suspected cases and nearly 300 deaths were reported in 22 countries. This follows approximately 26 000 cases and almost 1400 deaths across 24 countries last year. Yellow fever cases in the African region are also climbing, with 124 confirmed cases reported in 12 countries in 2024. This comes after dramatic declines in the disease over the past decade, thanks to global vaccine stockpiles and use of yellow fever vaccine in routine immunization programmes. In the WHO Region of the Americas, yellow fever outbreaks have been confirmed since the beginning of this year, with a total of 131 cases in 4 countries. These outbreaks come amidst global funding cuts. A recent WHO rapid stock take with 108 country offices of WHO – mostly in low- and lower-middle-income countries – shows that nearly half of those countries are facing moderate to severe disruptions to vaccination campaigns, routine immunization and access to supplies due to reduced donor funding. Disease surveillance, including for vaccine-preventable diseases, is also impacted in more than half of the countries surveyed. At the same time, the number of children missing routine vaccinations has been increasing in recent years, even as countries make efforts to catch up children missed during the pandemic. In 2023, an estimated 14.5 million children missed all of their routine vaccine doses – up from 13.9 million in 2022 and 12.9 million in 2019. Over half of these children live in countries facing conflict, fragility, or instability, where access to basic health services is often disrupted. “The global funding crisis is severely limiting our ability to vaccinate over 15 million vulnerable children in fragile and conflict-affected countries against measles,” said UNICEF Executive Director Catherine Russell. “Immunization services, disease surveillance, and the outbreak response in nearly 50 countries are already being disrupted – with setbacks at a similar level to what we saw during COVID-19. We cannot afford to lose ground in the fight against preventable diseases.” Continued investment in the ‘Big Catch-Up initiative’, launched in 2023 to reach children who missed vaccines during the COVID-19 pandemic, and other routine immunization programmes will be critical. How immunization addresses these challenges Joint efforts by WHO, UNICEF, Gavi and partners have helped countries expand access to vaccines and strengthen immunization systems through primary health care, even in the face of mounting challenges. Every year, vaccines save nearly 4.2 million lives against 14 diseases – with nearly half of these lives saved in the African Region. Vaccination campaigns have led to the elimination of meningitis A in Africa’s meningitis belt, while a new vaccine that protects against five strains of meningitis holds promise for broader protection, with efforts underway to expand its use for outbreak response and prevention. Progress has also been made in reducing yellow fever cases and deaths through increasing routine immunization coverage and emergency vaccine stockpiles, but recent outbreaks in Africa and in the Region of the Americas highlight the risks in areas with no reported cases in the past, low routine vaccination coverage and gaps in preventive campaigns. In addition, the past two years have seen substantial progress in other areas of immunization. In the African Region, which has the highest cervical cancer burden in the world, HPV vaccine coverage nearly doubled between 2020 and 2023 from 21% to 40%, reflecting a concerted global effort towards eliminating cervical cancer. The progress in immunization also includes increases in global coverage of pneumococcal conjugate vaccines, particularly in the South-East Asia Region, alongside introductions in Chad and Somalia, countries with high disease burden. Another milestone is the sub-national introduction of malaria vaccines in nearly 20 African countries, laying the foundation to save half a million additional lives by 2035 as more countries adopt the vaccines and scale-up accelerates as part of the tools to fight malaria. Call to action UNICEF, WHO, and Gavi urgently call for parents, the public, and politicians to strengthen support for immunization. The agencies emphasize the need for sustained investment in vaccines and immunization programmes and urge countries to honour their commitments to the Immunization Agenda 2030 (IA2030). As part of integrated primary health-care systems, vaccination can protect against diseases and connect families to other essential care, such as antenatal care, nutrition or malaria screening. Immunization is a ‘best buy’ in health with a return on investment of $54 for every dollar invested and provides a foundation for future prosperity and health security. “Increasing outbreaks of highly infectious diseases are a concern for the whole world. The good news is we can fight back, and Gavi’s next strategic period has a clear plan to bolster our defences by expanding investments in global vaccine stockpiles and rolling out targeted preventive vaccination in countries most impacted by meningitis, yellow fever and measles,” said Dr Sania Nishtar, CEO of Gavi, the Vaccine Alliance. “These vital activities, however, will be at risk if Gavi is not fully funded for the next five years and we call on our donors to support our mission in the interests of keeping everyone, everywhere, safer from preventable diseases.” Gavi’s upcoming high-level pledging summit taking place on 25 June 2025 seeks to raise at least US$ 9 billion from our donors to fund our ambitious strategy to protect 500 million children, saving at least 8 million lives from 2026–2030. #####   Notes to editor: Download multimedia content here: https://weshare.unicef.org/Package/2AM4086M4S1G About WHO Dedicated to the health and well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere, an equal chance at a safe and healthy life. We are the UN agency for health. We connect nations, partners and people on the front lines in 150+ locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health issues and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable. www.who.int About UNICEF UNICEF works in some of the world's toughest places, to reach the world's most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. For more information about UNICEF and its work, visit: www.unicef.org. About Gavi, the Vaccine Alliance Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate more than half the world’s children against some of the world’s deadliest diseases. Since its inception in 2000, Gavi has helped to immunize a whole generation – over 1.1 billion children – and prevented more than 18.8 million future deaths, helping to halve child mortality in 78 lower income countries. Gavi also plays a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningococcal and yellow fever vaccines. After two decades of progress, Gavi is now focused on protecting the next generation, above all the zero-dose children who have not received even a single vaccine shot. The Vaccine Alliance employs innovative finance and the latest technology – from drones to biometrics – to save lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency. Learn more at www.gavi.org.  

In a bid to tackle the leading cause of death globally among 15–19-year-old girls, the World Health Organization (WHO) today released a new guideline aimed at preventing adolescent pregnancy and its significant related health complications. Among other strategies, the guideline urges rapid action to end child marriage, extend girls’ schooling, and improve access to sexual and reproductive health services and information – all critical factors for reducing early pregnancies among teenagers around the world. “Early pregnancies can have serious physical and psychological consequences for girls and young women, and often reflect fundamental inequalities that affect their ability to shape their relationships and their lives,” said Dr Pascale Allotey, Director of Sexual and Reproductive Health and Research at WHO and the United Nations’ Special Programme in Human Reproduction (HRP). “Tackling this issue therefore means creating conditions where girls and young women can thrive – by ensuring they can stay in school, be protected from violence and coercion, access sexual and reproductive health services that uphold their rights, and have real choices about their futures.” More than 21 million adolescent girls become pregnant each year in low and middle-income countries, around half of which are unintended. With impacts on girls’ education, social connection and future employment prospects, early pregnancy can create cycles of intergenerational poverty that become difficult to break. It also brings serious health risks, including relatively higher rates of infections and preterm births as well as complications from unsafe abortions – linked to particular challenges in accessing safe and respectful care. Reasons for early pregnancy are varied and interrelated, including gender inequities, poverty, lack of opportunity and inability to access sexual and reproductive health services. There is a strong correlation with child marriage: in low- and middle-income countries, 9 in 10 adolescent births take place among girls who were married before the age of 18. The guideline recommends holistic efforts to provide viable alternatives to early marriage by strengthening girls’ education, savings and employment prospects. If all girls finished their secondary schooling, it has been estimated that child marriages could be reduced by as much as two thirds. For girls at highest risk, the guideline recommends considering incentives to support secondary school completion, such as targeted financial stipends or scholarship programmes. The guideline also recommends laws to prohibit marriage below the age of 18, consistent with human rights standards, and community engagement to prevent the practice. “Early marriage denies girls their childhood and has severe consequences for their health,” said Dr Sheri Bastien, Scientist for Adolescent Sexual and Reproductive Health at WHO. “Education is critical to change the future for young girls, while empowering adolescents – both boys and girls – to understand consent, take charge of their health, and challenge the major gender inequalities that continue to drive high rates of child marriage and early pregnancy in many parts of the world.” The recommendations highlight the need to ensure adolescents can access high quality, adolescent-responsive sexual and reproductive health services including contraceptive options. In some countries, consent from an adult is required to access services, which is a significant barrier to their use. Young girls who get pregnant also need to be able to access high quality and respectful healthcare during and after pregnancy and birth, free from stigma and discrimination, as well as safe abortion care. Finally, comprehensive sexuality education is essential for both boys and girls to ensure they know where to access such services and how to use different types of contraception. It has been shown to reduce early pregnancies, delay the onset of sexual activity, and improve adolescents’ knowledge about their bodies and reproductive health.  This guideline updates an earlier edition of the guideline on adolescent pregnancy prevention from 2011 and focuses particularly on preventing child marriage and improving adolescents’ access to and use of contraception. It complements WHO’s related guidance around health services for adolescents, comprehensive sexuality education and gender-based violence. Globally, there has been progress in reducing adolescent pregnancies and births. In 2021, an estimated 1 in 25 girls gave birth before the age of 20, compared to 1 in 15 two decades prior. There remain significant disparities. In some countries, close to 1 in 10 adolescent girls (15–19 years) give birth each year.