Invitation: WUENIC 2025 Results Webinar

Dear colleagues, 

Please find below the webinar materials: 

• Presentation slides: https://www.technet-21.org/en/resources/presentation/2025-who-and-unicef-national-estimates-of-immunization-coverage-wuenic-presentation-slides 
• Video recording in English (original version): https://youtu.be/iBdTmOPgoD8 
• Video recordings with interpretation in: 
  • Arabic: https://youtu.be/klZgdTECFWo 
  • Chinese: https://youtu.be/DUCNmRoIAvA 
  • French: https://youtu.be/5mA092jS9jc 
  • Portuguese: https://youtu.be/bB6r12ge2WI 
  • Russian: https://youtu.be/1kIpPa-3SyI 
  • Spanish: https://youtu.be/_6MAQWK550E

Finally, you will find the full Q&A from the webinar below: 

2025 WUENIC WEBINAR Q&A

1. Can you confirm that Indonesia is always plotted within WPR in the year-to-year analysis?         

Yes. We use Indonesia consistently in the WHO Western Pacific Region across the full time series so that trends are not affected bythis re-assignment.

2. What are the major factors which have contributed to SE Asia’s regional increase in coverage?

Several countries in the region have developed robust, high performing immunization programmes, which influence the regional average.  For example, India has a very strong programme which has been very focused on addressing equity.  Nepal is another example.  Bangladesh has a strong programme, historically, but in the past 1-2 years has had temporary issues that have impacted coverage in a signficant way and led to the large measles outbreak.

3. Sudan also is absent from the two lists of lowest DTP and MCV in this report. Can you please explain the vaccination situation?             

Sudan experienced severe recent disruptions as a result of violence, followed by a strong rebound in the latest estimates. Sudan launched an Emergency Immunization Plan 2024-2025 with key partners, to address the fall in coverage and risk of disease outbreaks. However, interpretation should remain cautious because conflict and population movement can affect service delivery and the data environment.

4. Was Slide 11 presenting a box-and-whisker plot? If so, will the presentations for the other antigens also include the median value?

It was not a box-and-whisker plot. It was a violin plot showing the distribution of MCV1 coverage by WHO region over time. If median values are important for interpretation, they could be added as a design choice, but the plot type itself is intended to show distributional shape rather than only quartiles.

5. The presentation so far is around DPT and MCV. Hope we would also hear about progress with other newer vaccines in the spirit of life course vaccination.      

Yes, the scope of the estimates is broader than DTP and measles. WUENIC includes multiple routine childhood vaccine-dose combinations including BCG, DTP1, DTP3, MCV1, MCV2, RCV1, HepB3, HepB birth dose, Hib3, rotavirus last dose, PCV complete/last dose, yellow fever for at-risk countries, IPV measures and MenA for countries in the meningitis belt. HPV is reported through a related but separate estimation process. Malaria is not yet reported on through WUENIC — this will come in future years. Influenza, C-19 are reported separately in the months to come but primarily through a numerator trend analysis, not a WUENIC coverage process.

6. How are zero-dose children calculated, and is there a margin of error for zero-dose figures?

Zero-dose children are calculated from the DTP1 estimate: zero-dose prevalence equals 100 minus WUENIC DTP1 coverage, and the number of zero-dose children is that prevalence applied to the UN-estimated surviving infant population. WUENIC does not provide classical confidence intervals; uncertainty is described through the grade of confidence and accompanying country text.

7. The chart showing relative % change in ZDC with the 25% indicator marked was very useful - is there a graphic or headline figure for overall progress towards IA2030 target in terms of ZDC reduction? 

For IA2030 communication, the most direct headline is the gap between the estimated number of zero-dose children and the milestone trajectory. The provided webinar answer gives 13.5 million zero-dose children in 2025, which is 3.9 million above the 2025 trajectory target of 9.6 million, against an IA2030 goal of 6.4 million by 2030. 

8. What country examples do we have of measles campaign efforts triangulating with this data (and WUENIC trends) and campaign data to understand and address 'zero dose' MCV1 and drop-out of MCV2, particularly as post-campaign routine measles intensification (and documentation for clients to validate 2 doses received)? India has done this effectively.

This area is a work-in-progress priority. We aim to increase country capacity for triangulation (SIA, admin and survey data) for measles immunity profiles and this is work in progress with partners.

9. Do FCV settings include all countries, irrespective of income classification? (Slide 22) 

Correct! 33 countries are in the list of countries with FCV settings (14 low-income, 12 lower-middle-income and 7 upper-middle-income)

10. Considering that FCV settings are falling behind in achieving IA2030 targets, what policy reforms and financing priorities should governments and global partners adopt to accelerate equitable immunization coverage for zero-dose children?

In FCV settings, priorities should start with sustaining basic service delivery, protecting outreach capacity, using local data to identify missed communities, and ensuring flexible financing that can operate in insecure or disrupted areas. However, WUENIC does not claim to identify policy reforms causally; WUENIC can show where coverage and zero-dose burdens are concentrated, while programme reviews should determine context-specific reforms.

11. GAVI cover area has good output.

Gavi countries have been doing well as a group. India is a notable example, but as it gradutaes beyond suport, the group of countries during Gavi 6.0 will be more challenging, and have much lower coverage.

12. I don't quite understand your interpretation of the Breadth of Protection graphs. You highlighted improvement in the GAVI-supported countries, but the non-GAVI countries also improved over time and 2025 coverage is even higher than the GAVI countries. How can we explain this?

Both groups improved, but the point here is convergence. Gavi-supported countries started much lower and narrowed the gap considerably; non-Gavi countries can still have higher current coverage, so the appropriate interpretation is faster relative progress among Gavi-supported countries rather than higher absolute performance in every year. This is likely due to funding. Not shown here is that Middle Income Counzries that never received Gavi support have been slower to introduce new vaccines.

13. It was mentioned that overall progress for all antigens has stalled. Is this because the introduction of new vaccines poses a new challenge to the program, or is progress still slow even without considering new vaccines? 

The stalling is visible not only because newer vaccines have been added. Established indicators such as DTP and MCV also show slow progress or plateauing, while gains in breadth of protection often reflect vaccine introduction and scale-up rather than large improvements in reaching the remaining underserved children.

14. While Yellow Fever and MenA vaccines are shown, I did not see Malaria vaccine data. Why? 

Malaria vaccine coverage is not yet reported through WUENIC. Malaria vaccine programmes are still in introduction or scale-up phases, including subnational roll-out, so denominators and programme maturity are not yet stable enough for routine WUENIC-style coverage reporting. Performance is being actively monitored, in order to support the scale up and intros, but it always takes a couple years to get to a point at which reporting coverage is meaningful reflection of programme performance.

15. How should governments prioritize the introduction of new vaccines when fiscal constraints, donor transition, and competing health priorities limit resources, and what policy mechanisms can ensure equitable access without compromising routine immunization programs?

Important question! Countries should weigh disease burden, vaccine impact, affordability, programme readiness, and equity implications. WHO, UNICEF and partners can support these decisions through national immunization strategy (NIS) planning processes. WUENIC itself should be used as evidence on coverage gaps, not as a stand-alone prioritisation model.

16. Can we see the performance of Gavi-supported versus non-Gavi-supported countries?

Yes these analyses are available form the online resources.
• https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/global-monitoring/immunization-coverage/who-unicef-estimates-of-national-immunization-coverage
• https://worldhealthorg.shinyapps.io/wuenic-trends/
• https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/human-papillomavirus-vaccines-(HPV)/hpv-clearing-house/hpv-dashboardhttps://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/human-papillomavirus-vaccines-(HPV)/hpv-clearing-house/hpv-dashboard

17. How would you describe Kenya's DTP and MCV performance in the two lists in this report? Can you please explain the vaccination situation?

For DTP3, WUENIC estimates for Kenya are a bit higher than the Country reported data. Since 2019 (prior to the pandemic and baseline for IA2030), DTP3 performance in Kenya dropped a little bit from 93% in 2019 to 88% in 2025. For MCV1, WUENIc are at the same level than the reported data. We observe the same trend going from 89% in 2019 to 80% in 2025. The WUENIC team is aware of ongoing DHS and waiting for the final results, which may be included in next year's revision.

18. Ethiopia completed the MAC campaign in 2024, and the WUENIC coverage was 58%. Currently, the country is continuing to implement catch-up vaccination along with routine immunization for 10–14-year-old girls to fill the immunity gap. So, would it be considered to revise the MAC coverage retrospectively for the years to come?

es, multi-age cohort and catch-up efforts can be reflected in later HPV estimates when reported data allow the doses to be assigned to the relevant cohorts. The HPV methodology is designed to accommodate changing schedules, catch-up activities and vaccination of older girls. For HPV we also looking into estimate girls vaccinated by 15 years of age.

Many countries have done MACs in these last years and these efforts have indeed always been taken into account. In adiditon, many countries continue providing girls 10-14 opportunites for catch up -- as ndicated in WHO guidance and following the prinicples implemented with BCU as welll. The HPV methodology indeed always allows to use the doses given to older girls and reflect that in higher coverage in the relevant cohort when these girls reahc 15 years of age. 

19. It would be interesting to see an analysis of the Rota and PCV introductions.

More visuals will be published right after this webinar and available from: https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/global-monitoring/immunization-coverage/who-unicef-estimates-of-national-immunization-coverage. Introduction data for PCV and Rota is also published here: https://immunizationdata.who.int/global/wiise-detail-page/introduction-of-pcv-(pneumococcal-conjugate-vaccine)?ISO_3_CODE=&YEAR= and here: https://immunizationdata.who.int/global/wiise-detail-page/introduction-of-rotavirus-vaccine?ISO_3_CODE=&YEAR=

20. Are the US and Argentina included in this year's analysis?

WUENIC includes data from Argentine received through PAHO. The WUENIC estimates for USA follow the same rules as for any other non reporting countries. For these non-reporting countries, estimates were extrapolated from the last point informed by empirical data.

21. What is the WHO strategy to minimize the number of zero-dose children in each respective WHO region?

At regional level, the main strategy is to identify zero-dose communities, strengthen routine immunization, use catch-up where cohorts were missed and focus on equity. WUENIC helps monitor where the zero-dose burden is concentrated, but the specific operational strategy should come from regional and country immunization plans rather than from WUENIC estimates alone.

22. Has the closure of USAID and the reduction of health system support significantly affected the performance of some of these countries? 

Financing and health system support can certainly be associated with programme performance in the longer run, but WUENIC cannot establish causality without country-specific programme and financing analysis. The current plateau may in part be caused by financing gaps, although we cannot tell for sure what the countrefactual looks like.

23. Great presentation. Have these slides been shared with the WHO regional offices? We have an AFRO RITAG next week, and some of these slides would be very useful for the presentations if they have not already been shared.

Slides were published online after the webinar. :
https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/global-monitoring/immunization-coverage/who-unicef-estimates-of-national-immunization-coverage
Regional versions of these slides have also been shared with WHO regional offices.

24. Why does Nigeria still have the highest number of zero-dose children? Could you organize evidence-based implementation research to examine how India and Sudan reduced their numbers and what lessons Nigeria could learn? Similar work should be conducted in Nigeria.

A very important point. There is a lot of evidence already on how India has made the progress in their programme over a period of 15+ years. It did not happen overnight. It has come from high political commitment and leadership. What we mean by this is not what maybe this means to some people. We are not talking about speeches and statements. When we reference political commitment we are talking about domestic funding and investing in the capacity building of immunization —clinics, health workers, data systems that can drive action cycles, special programs and investments to reach (reliably, over and over) the hard to reach settings (in India this is Mission Indradhanuch). Political leadership is about accountability mechanisms that result in actions and adjustments to the program in order to get the results that are committed to. And it means very much leadership in these ways in state. province and district levels accompanied byhigh community leadership.

25. As more countries transition to new vaccines and schedules supported by Gavi, such as Hexa and DTP-containing boosters, how is WHO thinking about the evolution of WUENIC to ensure these investments can be systematically tracked and their coverage reported globally?

Together with UNICEF we will be reporting on hexavalent when those shifts occur. There will be a transition period for countries switching which we will have to deal with in the data. Following that transition it will mean that 6 antigens will have the same coverage estimates — making the coverage with hexa even more important! We will be supporting the countries who will be switching to hexavalent and monitoring how this is going.

26. Did any countries show significant differences in coverage by sex?

For routine childhood vaccines, WUENIC does not generally provide sex-disaggregated coverage, because at the national and global level, there is no evidence for bias. We do encourage countries to monitor any bias through surveys, and address any gender related barriers to immunization. Sex-disaggregated analysis is available for HPV indicators because HPV reporting distinguishes female and male programme indicators where relevant.

27. Given the significant gap between vaccine introduction and achieving high population coverage shown in the data, what accountability and governance reforms should national immunization programs adopt to ensure that vaccine introduction translates into equitable, high-impact coverage across all regions and vulnerable populations?

Programmes should focus on using post-introduction monitoring to detect low uptake, integrating new vaccines into routine service delivery, and acting on subnational inequities. WUENIC can highlight national and group-level gaps, but accountability mechanisms need country programme data and subnational monitoring.

28. Can Gavi-supported and non-Gavi-supported countries be analyzed separately by WHO region to compare coverage trends and cohort growth?

Yes. This is analytically feasible by stratifying countries by both Gavi support status and WHO region, then comparing coverage and target-population trends. Interpretation should account for different cohort sizes, country mix and vaccine introduction status within each region. We have provided regions with specific analytical sets that do just that.

29. Documenting lessons from Sudan may help replicate practical steps applicable in fragile countries, which remain a challenge.

Yes. Sudan could be documented as a case study, but the analysis should combine WUENIC time trends with programme, partner and operational information. WUENIC can show the coverage recovery; it cannot by itself identify which specific practical steps caused the recovery.

30. In a context where countries are experiencing continuous funding reductions, what should we do to reverse the current immunization landscape, where progress remains slow? What can we do differently to accelerate improvements?

This is a complex and important question for further reflection. Any answer includes for sure protecting routine immunization fundamentals: reliable service delivery, workforce, vaccine supply, data use, outreach and catch-up for missed cohorts. WUENIC shows progress is slow in many places, but decisions on what to do differently require country-level bottleneck analysis and financing review.

31. What is the source of the denominator data, especially for countries affected by conflict?

For zero-dose counts and regional/global aggregation, WUENIC applies coverage estimates to UN Population Division target populations, specifically the latest available World Population Prospects surviving infant estimates for most infant antigens.

32. Thank you for continuing to make this kind of endeavor possible. Ethiopia’s progress in reducing zero-dose children is quite notable and is particularly welcome news, as I had been seeing significant concern about DTP1 coverage trends from the latest DHS data release. What factors are contributing to Ethiopia’s successes, both since 2019 and in 2024? And how would you recommend interpreting these trends in total zero-dose children (which are declining), as measured by no-DTP1, alongside what appeared to be largely stalled DTP1 coverage improvements in the DHS data? 

You have hit on a long standing issue with Ethiopia: that subsequent surveys using different methods often show very different results. Results from the DHS will be incorporated when finalised and if needed, time series will be revised.

33. Thanks for this. What is driving coverage in the other countries in the absence of Gavi support?

Improvements may be associated with national ownership and financing, mature delivery systems, vaccine introduction and data/reporting changes, but WUENIC should not be used alone to attribute causes.

34. Great presentation. Is there a way to expand these presentations beyond coverage figures to provide better insights into implementation effectiveness?

Yes, but it requires additional programme data beyond national coverage estimates. WUENIC can show coverage levels and trends; implementation effectiveness and root cause analysis would need triangulation with stock, session, workforce, service quality, subnational, demand and equity data. This is the essential next step that is best done at national level.

35. When will we have access to subnational estimation data? This would greatly help us adjust our data regarding zero-dose children.

We release the subnational administrative data wherever it was provided through the eJRF. Multiple efforts have been made to try to develop “WUENIC” type subnational estimates which have not been difficult to do because of data limitations. WHO and UNICEF, with the support of Gavi, are heavily focused on the subnational data quality improvement and use efforts with countries. This is where the progress is needed. Intensification of the support to countries in this area is a top tier priorit for our agencies and for the Alliance, but it must be done through a health system approach, not through a bespoke vertical immunization only investment. Sustainability and local useability are the success measures.

36. Is there any correlation between coverage and supply? Are there ways to measure this linkage, and how accurate are they?

WUENIC can show drops that coincide with specific stockout events, but it does not routinely calculate a global supply-coverage correlation. Any linkage between supply and coverage should be measured through country-specific triangulation of stock, distribution, session and coverage data.

37. Could you also shed more light on South Sudan, as we would like to see the performance of this fragile country in comparison with other fragile and conflict-affected nations? 

South Sudan has made good tentative progress since 2019, with DTP3 coverage rising from 61% to 73%. This needs to be interpreted carefully as the last survey there refered to the year 2016, when estimated coverage was about 50%. Improvements since then are based on data reported by the country.

38. For HPV coverage, are you referring to a single dose in your data, given that not all countries have introduced this? Are you counting two doses for adequate HPV coverage in countries that still use a two-dose schedule? This might result in lower global coverage figures than if a single dose were used as the coverage indicator.

We report both HPVc (HPC completed course) and HPV1. As many countries shift to single dose, these coalesce. But for simplicty in this presentation we spoke to HPV1. Much further data are available in the online resources links on screen.

We distinguish HPV1 ( first dose coverage) and HPVc (completed schedule coverage). In single dose countries the same value is used for first and Completed dose. As a result HPVc global covage value now nearly converges with HPV1 coverage.

39. Were the denominators adjusted or considered for countries experiencing acute conflict when calculating vaccination coverage? Population displacement across borders can substantially affect the accuracy of coverage estimates. Sudan may be one such example where large-scale population movements could influence the reliability of the estimates.

For national WUENIC coverage, estimates draw on reported data, surveys and expert review; regional/global counts use UN population estimates. In conflict settings, displacement can affect both numerators and denominators, so the estimate should be interpreted with the country context and grade of confidence rather than as a precise measure of all population movement effects. 

40. Have you observed better HPV coverage when other vaccines are administered simultaneously, such as a Tdap booster?

This analysis is not yet available. Country case studies post-integration or other evaluation research would be needed to clarify it

41. How can we use the 2025 WUENIC data to identify and support regions with the lowest immunization coverage? 

Yes, we can use the 2025 data to rank or map regions and countries by relevant indicators such as DTP1, DTP3, MCV1, zero-dose children and under-vaccinated children. WUENIC can identify where needs are concentrated; operational planning should use subnational and programme data.

42. How quickly can these findings be translated into updates to the polio guidelines and inform decision-making, particularly in response to ongoing cVDPV outbreaks? 

WUENIC findings can inform polio risk discussions by highlighting immunity gaps, especially IPV/IPVC and broader routine immunization weakness. Actual updates to polio guidelines require review through the relevant WHO/GPEI policy and technical processes; WUENIC alone does not update guidelines.

43. Countries use their target populations to calculate coverage, while WUENIC uses United Nations population data; does this cause issues and discrepancies between WUENIC data and administrative data?

For national WUENIC estimates, the process reviews country-reported data, official estimates, surveys and contextual information, but no denominators per se. UN population estimates are used for regional/global aggregation and grade-of-confidence considerations. WUENIC and admin estimates mostly differ where surveys do not align with admin coverage

44. In what ways can community-level organizations better utilize these national estimates to drive awareness and improve vaccination uptake? 

Community organisations can use national estimates to frame the scale of gaps, advocate for resources and support demand generation, but they should combine WUENIC with local data to decide where to act. National estimates are not detailed enough to identify every missed settlement or community.

45. Beyond Gavi financing vaccines, to what extent can we attribute improvements in Gavi-supported countries to concomitant health system investments (HSS, EAF, CDS) within these countries?

The file does not support attribution of improvements to specific Gavi system investments. A careful answer is that WUENIC can show trends in Gavi-supported countries, but attribution to HSS, EAF, CDS or other investments requires evaluation designs and programme/financing data beyond WUENIC.

46. Vaccine introduction gaps are narrowing, as shown in the presentation, yet post-introduction coverage remains suboptimal for HPV and Yellow Fever. What strategies should be adopted to improve post-introduction uptake and sustain high coverage, particularly through integration with routine immunization and social and behavioral interventions?

Improving post-introduction uptake generally requires integrating the vaccine into routine delivery, monitoring drop-out, ensuring reliable supply, using social and behavioural insights, and addressing missed communities. WUENIC can show the coverage gap for HPV or YF, but the choice of strategy should be based on country-specific delivery bottlenecks.

47. Still regarding HPV, what are the main data sources? As far as I know, there is very limited survey data on HPV vaccination.

HPV estimates are based primarily on data submitted by Member States through the eJRF, with possible use of Ministry of Health websites, implementation partner information, population estimates and survey data where available. Survey data are limited for HPV, so many estimates rely heavily on administrative/programme reporting.

48. What is the global plan to digitize all vaccination recording and reporting by 2030?

No such plan exists, although countries are encouraged to review digital readiness and leverage digital innovation to pursue programme objectives.

49. For countries where no survey has been conducted in recent years, should WUENIC estimates rely on the most recent available survey, even if it is quite old?

Yes, an older final survey may still be considered, but WUENIC weighs it with caution because surveys measure previous birth cohorts and may be less timely. Estimates also use reported data, official estimates and contextual information. But it is certainly true that confidence is a lot lower where no recent survey exists.

50. Great presentation, WHO/UNICEF team. Thanks. I was hoping to see or hear comments on the performance of other newer vaccines, such as rotavirus vaccines and PCV, especially in the context of recent SAGE recommendations regarding 3+0 versus 2+1 or 1+1 schedules. 

These performances analyses will be published soon after the webinar on the WHO website. As far as the new SAGE recommendations on PCV, this was taken into consideration on how we are collecting the data through the eJRF (asking countries to report data for their last dose in schedule) and moving from PCV3 to PCVC (for complete schedule)

51. What is the difference between administrative coverage and the official coverage estimate? 

Both are reported by countries through the electronic Joint Reporting Form. Administrative coverage is calculated from programme data, typically doses administered divided by the target population. The official estimate is the country's submitted estimate of most likely coverage, which may adjust administrative data using survey evidence and contextual information. WUENIC then estimates the most likely coverage after reviewing these and other sources.

52. Are there any efforts to triangulate these estimates with those produced by other global agencies, such as IHME? If so, are there any insights regarding their statistical similarity or dissimilarity? 

We are in coordination with IHME and compare estimates regularly, in general trends and level are similar. There are some methodological differences mainly as WUENIC is not a statistical but a rule based model and incorporates local knowledge.

53. Djibouti introduced the HPV vaccine in 2025. What are the most effective strategies to build public trust and increase vaccine uptake among young girls in our context?

We would like to refer you to the HPV Introduction guide. https://www.who.int/publications/b/31376
Use local evidence to understand concerns, engage trusted community and school stakeholders, communicate clearly about the target age and schedule, and monitor uptake closely during introduction.

54. Political leadership, as noted by Kate, is more than just speeches! Is there a report with strategies on how to shift political support beyond rhetoric? 

Rhetoric of course needs to be followed by domestic investment, and local resource allocation, which is challenging for countries, but can achieve real change. We are working on tools to help with domestic investemnt planning.

55. In fragile and humanitarian settings, there are also fewer contact points available to deliver the full immunization course.

This is an important observation: fragile and humanitarian settings often have fewer reliable service contacts, making completion of multi-dose schedules harder. This points to the need for flexible delivery strategies, catch-up and stronger local monitoring in FCV settings.