The World Health Organisation (WHO), UNICEF and Gavi have warned that the rising cases of vaccine-preventable diseases are threatening progress made over the years through immunisation.

In a joint statement on Thursday, the organisations said immunisation efforts are under a growing threat as misinformation, population growth, humanitarian crises, and funding cuts jeopardise progress and leave millions of children, adolescents, and adults at risk.

They said 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.

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In response, the agencies are calling for urgent and sustained political attention and investment to strengthen immunisation programmes and protect significant progress achieved in reducing child mortality over the past 50 years.

They highlighted the need for sustained investments in immunisation efforts amid looming funding cuts.

“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

The statement said measles is making an especially dangerous comeback. The number of cases has been increasing year-on-year since 2021, tracking the reductions in immunisation 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 would likely continue 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 immunisation 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 amid global funding cuts. A recent WHO rapid stock taking 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 immunisation, 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 with 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. “Immunisation 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 immunisation programmes will be critical.

Situation in Nigeria

Nigeria records the highest number of under-five deaths as a result of vaccine-preventable diseases.

The country has persistently recorded outbreaks of vaccine-preventable diseases such as meningitis, diphtheria, M-Pox and measles, among others.

While Nigeria was declared Wild Polio Virus (WPV) free in 2020, it has, however, since 2021, been contending with the challenge of the circulating variant poliovirus (cVPV2) – another form of the virus that has mutated over time and started spreading.

A total of 17 circulating variant poliovirus type 2(cVPV2) cases have been recorded across 15 LGAs in eight states this year, the National Primary Health Care Development Agency (NPHCDA) said this week.

The agency said It has recorded progress with the roll-out of Human Papilloma Virus (HPV) vaccination against cervical cancer.

NPHCDA said HPV vaccines are available free of charge in PHC facilities across the country, like every other vaccine in the national immunisation schedule.

Experts had earlier warned of shortfall in vaccine, availability and distribution of vaccines following USAID- funding freeze.

The Chief Executive Officer of Vaccine Network for Disease Control (VNDC), Chika Offor, said it is affecting Nigeria’s immunisation efforts in the country.

She said, “Shrinking fiscal space and competing national priorities further threaten immunisation programmes. If we do not act swiftly, we risk reversing the progress made in 2024.”

Resurgence and increase in cases

Experts express concern that increase in cases of common vaccine-preventable diseases in the country as well as resurgence of outbreaks of those not currently recorded could lead to loss of lives and hamper well-being and national development.

This is against the backdrop that the country has been caught unprepared for some diseases over time.

Last year, the country recorded a massive outbreak of diphtheria, a vaccine-preventable disease, with calls to address challenges for effective immunisation in the country.

How immunisation addresses these challenges

Joint efforts by WHO, UNICEF, Gavi and partners have helped countries expand access to vaccines and strengthen immunisation 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 immunisation 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 immunisation. 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 immunisation 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, politicians and the public to strengthen support for immunisation. The agencies emphasise the need for sustained investment in vaccines and immunisation programmes and urge countries to honour their commitments to the Immunisation Agenda 2030 (IA2030).

As part of integrated primary healthcare systems, vaccination can protect against diseases and connect families to other essential care, such as antenatal care, nutrition or malaria screening. Immunisation 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 “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,” said Dr Sania Nishtar, CEO of Gavi, the Vaccine Alliance.

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.

Ways to strengthen immunisation coverage in Nigeria – Experts

Iyiola Oladunjoye, a public health advocate, said vaccine-preventable diseases are a significant public health issue in Nigeria, as they contribute to high morbidity and mortality rates, especially among children under five years of age.

He said low immunisation coverage rates, inadequate healthcare infrastructure, and vaccine hesitancy are some of the factors that have contributed to the persistence of these diseases in Nigeria.

He said urgent national and international efforts are needed to improve access to routine immunisations through dedicated funding schemes.

He said, “These measures can save lives and help prevent future public health crises. There is also the need to ensure that lessons learnt from COVID-19 are incorporated into making our Expanded Programme on Immunisation (EPI) more effective.

“Vaccination is undoubtedly one of the most crucial public health interventions that have been implemented in modern medicine. It not only saves lives, but also plays a significant role in preventing the transmission and spread of contagious diseases within communities.

“However, its importance goes far beyond these basic benefits. Vaccines improve quality of life and contribute to global economic development.”

According to the Chairman of the National Health Insurance Authority (NHIA), Ibrahim Oloriegbe, and former chair of the Senate Committee on Health in the 9th Assembly, there is need for consistent vaccine financing in the country.

Speaking at a stakeholders’ workshop on immunisation, he said there was a need to address challenges in the vaccine supply chain.

He said, “The cold chain is a critical part of that entire chain. Without proper storage and temperature control, vaccines lose their efficacy.”

Mohammed Usman, a former member of the House of Representatives, called for improved efforts for local vaccine production.

He also called for prompt release of immunisation budgets.

Project lead of the Measles-Rubella (MR) vaccine advocacy project, of the Centre for Well-being and Integrated Nutrition Solutions (C-WINS), Dr Nihinlola Mabogunje, said a lot of funding for vaccines comes from Gavi, noting that while Nigeria is doing a lot, it is time for local governments to start investing money in immunisation.

She said, “Vaccines must be routinised. When we routinise vaccines, it means less money is spent on campaigns.  Mothers should go to the facilities and get their children vaccinated at birth and all other times they are supposed to be vaccinated.”

She said there was low awareness about rubella despite the fact that it is wreaking havoc among children.

Dr Mabogunje said many children suffer from congenital rubella syndrome, which is a long-term illness.

She further said this therefore underscores the need to add the rubella component to the measles vaccine.

She said no child should die or be left behind in vaccination for measles and rubella.

Dr Mohammad  Lecky, chairman of HRSC, said disease outbreaks and emergencies  require a systematic approach  through robust legislation and institutional policy programmatic responses that are properly contextualised in a credible national emergency response framework.

He said, “We must as a nation have the ability to protect ourselves from various threats to health, be it an emergency disease outbreak or natural or manmade disaster. It is imperative that we are positioned to prevent, detect and respond, taking actions that are prioritised as national security responses to safeguard public health, the economy and national security.”

On preparedness for disease generally, Joseph Enegela, a medical doctor and Chief Executive Officer (CEO) of the Africa Disease Prevention and Research Development Initiative (ADRAP), said the major thing is that our healthcare systems need to be strengthened. We need health systems strengthening in all aspects starting from disease reportage.

He said, “So, our surveillance system first of all needs to be on point so that when something happens somewhere, we report it quickly, and our response can be faster.

“Our reporting systems are poor and therefore somebody may have Lassa fever in my village and before you find out or before it is reported to the Nigerian Centre for Disease Control and Prevention (NCDC) it has spread to sevéral people. So, our surveillance system needs to be strong.

“It is also important for us to understand the simple principle of disease response; that is the one that we have always been singing, “In time of peace, prepare for war”. So, in time of peace before the outbreaks start, what do you do? If you know that what you need is ABCD for response to yellow fever outbreak, have some in your store waiting. You don’t wait until when it breaks out before you start procuring. If you know that there is a seasonal occurrence of outbreak of Lassa fever, and it happens between October and March of the following year, what do you do in that period? You make sure that you do simulation exercises, you ensure that you build the capacity of healthcare workers.

“Preparedness is what we require. We are not there yet, so we must make that clock work.”

The Executive Director of the National Primary Health Care Development Agency (NPHCDA), Dr Muyi Aina, said routine immunisation has progressively improved with administrative and survey data showing increases in Penta3 coverage from 50% in 2018 to 54% in NDHS 2023.

“We have rejigged our health campaign strategies for improved effectiveness to fast-track the interruption of the circulating variant polio virus type 2 (cVPV2) transmission, and control outbreaks of vaccine-preventable diseases,” he said.