Zero-Dose Children

Children who have never received a single vaccine dose, making them highly susceptible to measles.

What are Zero-Dose Children?

Zero-dose children is a term used in global health and immunization programs to describe children who have not received even a single dose of routine childhood vaccines, most often referring specifically to the first dose of the diphtheria-tetanus-pertussis vaccine (DTP1), which serves as a standard marker for access to immunization services. These are children who are essentially “off the grid” of public health systems—not just under-immunized, but completely unvaccinated.

This term has become central to global vaccine strategy, especially within the work of Gavi, the Vaccine Alliance, UNICEF, and the World Health Organization (WHO).

Zero-dose children are a signal of deep health system failures. Their existence tells us that families likely face enormous barriers to care, e.g., poverty, conflict, geographic isolation, discrimination, displacement, or distrust of government and healthcare systems.

Why Zero-Dose Children Matter in Infectious Disease Control

Reaching zero-dose children is about much more than just delivering vaccines. It requires understanding and addressing the structural, social, and economic factors that exclude families from care. Public health experts view zero-dose children not only as being at the highest risk for vaccine-preventable diseases like measles, polio, and diphtheria, but also as a vulnerable group for malnutrition, poor education, and preventable death.

Common Characteristics of Zero-Dose Children

• Living in remote or hard-to-reach areas.
• Residing in conflict zones or fragile states.
• Belonging to marginalized ethnic or religious groups.
• Experiencing extreme poverty or food insecurity.
• Living in informal settlements or refugee camps.
• Having limited contact with formal healthcare systems.

Key Strategies to Reach Zero-Dose Children

• Community outreach and engagement.
• Mobile vaccination campaigns.
• Partnerships with local leaders and organizations.
• Integration of vaccination with other health and social services.
• Improving trust in health systems.

Eliminating zero-dose status is essential to achieving global targets like Immunization Agenda 2030, which aims for universal access to immunization as a basic human right.

Recent Efforts and Impact

• In 2021, there were an estimated 18 million zero-dose children worldwide.
• Most lived in just 20 countries, heavily concentrated in Africa and South Asia.
• Gavi’s 2021-2025 strategy prioritizes reaching zero-dose children as its top mission.