They are known as “zero-dose” children. These are infants who have never received a single routine vaccine, not even the first dose of the combined vaccine against diphtheria, tetanus and whooping cough, which is seen as the basic marker of access to healthcare. According to Gavi’s annual report, released on 7 October in Geneva, there were 9.5 million of them in 2025 across the 57 countries the Alliance supports.
The number is going down. It is 600,000 lower than in 2024 and 25% below the 2021 peak, when the Covid-19 pandemic disrupted vaccination campaigns. It nevertheless remains 4% above the 2019 level, partly because births are rising in several countries, the Nigerian daily Premium Times reports.
Africa bears a heavy share of the burden. According to UNICEF, about 2.2 million Nigerian children received no routine vaccine last year, the highest total on the continent. Nigeria is also among the countries where progress was recorded in targeted areas, alongside Ethiopia and Pakistan. Learning hubs devoted to zero-dose children operate there, as they do in Mali and Uganda.
The children missed by vaccination most often live in fragile regions affected by conflict or humanitarian crises. Health teams struggle to reach them and families are on the move. Studies carried out in several countries also point to gender-related barriers that limit mothers’ access to health centres.
The rest of the report is far more encouraging. More than 73 million children were vaccinated in 2025 through Gavi-supported programmes, an annual record, and more than 2.2 million future deaths are estimated to have been averted. Over the 2021 to 2025 period, the Alliance reports 351 million children protected, beyond its target of 300 million, and 7.8 million deaths averted.
Gavi puts the economic argument front and centre. By preventing illness, disability and death, vaccination is estimated to have generated more than 30 billion dollars in benefits in 2025, an unprecedented figure for a single year. Its chief executive, Sania Nishtar, believes the return on investment extends far beyond health. WHO Director-General Tedros Adhanom Ghebreyesus, for his part, considers the cost of failing to vaccinate far too great.
The countries receiving support are also contributing more. In 2025 they paid a record 301 million dollars in co-financing, up 18% on the previous year. By 2030, they are expected to cover nearly half the cost of their vaccines.
For 2026 to 2030, Gavi aims to protect 500 million more children and avert between 8 and 9 million deaths, with stronger attention to children who have never been vaccinated. The organisation acknowledges, however, that it has not yet raised all the funding it needs. For families in remote parts of Nigeria or the Sahel, the success of this plan will come down to something simple: a health centre within walking distance, and vaccines in stock on the day they get there.