Mapping national and subnational zero-dose prevalence and multidimensional inequities across 77 countries
- 1Huazhong University of Science and Technology
Abstract
Zero-dose children remain a marker of populations unreached by routine immunisation, but national averages can obscure substantial subnational and multidimensional inequities. We analysed the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys conducted between 2015 and 2024, including 170,553 children aged 12-23 months from 77 countries and 1,571 first-level administrative areas. Zero-dose prevalence ranged from 0.22% to 37.21% nationally, and 33 subnational areas had prevalence of at least 50%. Using the Vaccine Economics Research for Sustainability and Equity (VERSE) framework, we found that zero-dose children were consistently concentrated among multidimensionally disadvantaged groups, although the magnitude and drivers of inequity varied across countries. Maternal education, household wealth, geographic region, residence and health insurance were context-specific contributors. Combining burden, subnational distribution and multidimensional inequity can help identify where zero-dose children are concentrated and which barriers should be prioritised to advance equitable immunisation.
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BibTeX
@misc{huang2026mapping,
title = {{Mapping national and subnational zero-dose prevalence and multidimensional inequities across 77 countries}},
author = {C. Huang and R. Chi and Y. Gong and C. Yan and G. De Broucker and H. Fang and X. Yin and H. Zhang and B. N. Patenaude},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.03.26362103},
url = {https://www.medrxiv.org/content/10.64898/2026.09.03.26362103v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Mapping national and subnational zero-dose prevalence and multidimensional inequities across 77 countries
AU - C. Huang
AU - R. Chi
AU - Y. Gong
AU - C. Yan
AU - G. De Broucker
AU - H. Fang
AU - X. Yin
AU - H. Zhang
AU - B. N. Patenaude
PY - 2026
DA - 2026/09/03
PB - medRxiv
DO - 10.64898/2026.09.03.26362103
UR - https://www.medrxiv.org/content/10.64898/2026.09.03.26362103v1
AB - Zero-dose children remain a marker of populations unreached by routine immunisation, but national averages can obscure substantial subnational and multidimensional inequities. We analysed the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys conducted between 2015 and 2024, including 170,553 children aged 12-23 months from 77 countries and 1,571 first-level administrative areas. Zero-dose prevalence ranged from 0.22% to 37.21% nationally, and 33 subnational areas had prevalence of at least 50%. Using the Vaccine Economics Research for Sustainability and Equity (VERSE) framework, we found that zero-dose children were consistently concentrated among multidimensionally disadvantaged groups, although the magnitude and drivers of inequity varied across countries. Maternal education, household wealth, geographic region, residence and health insurance were context-specific contributors. Combining burden, subnational distribution and multidimensional inequity can help identify where zero-dose children are concentrated and which barriers should be prioritised to advance equitable immunisation.
ER -