Ethiopia has made notable progress in its efforts to reduce the number of zero-dose (ZD) children—those who have not received any routine vaccinations. As of April 8, 2025, the country has reached 958,725 children, representing 24% of the estimated 3.9 million zero-dose children nationwide. This marks a significant increase from 16% coverage in December 2024, with nearly 100,000 children vaccinated in just the past two months.
The Re-Ignition of the Big Catch-Up (BCU) initiative, launched on February 22, 2025, played a crucial role in accelerating progress. The re-ignition revitalized immunization efforts by strengthening leadership engagement, enhancing partner coordination, and improving implementation at all levels. As a result, the national monthly reporting rate rose from 60% in Tir EFY (Jan–Feb 2025) to 95% in Yekatit (Feb 8–March 9, 2025)—a critical step in strengthening performance monitoring and accountability.
Ethiopia ranks among the top ten countries globally with the highest number of zero-dose (ZD) children—defined as those who have not received any routine vaccinations—with an estimated 3.9 million unvaccinated children. In response to this public health challenge, the Ministry of Health (MoH) introduced a catch-up vaccination policy in 2022, integrating catch-up efforts into routine immunization services utilizing existing vaccine stocks.
In 2023, the global immunization community launched the Big Catch-Up (BCU) initiative, aimed at supporting countries like Ethiopia by providing access to additional vaccines. Ethiopia joined this global initiative and received supplementary vaccine doses from GAVI in 2024. Subsequently, the country officially launched the BCU vaccination campaign on June 24, 2024.
Despite concerted efforts to institutionalize both the national catch-up policy and the BCU program, the progress made in reaching zero-dose children fell below initial expectations. As a result, the Ministry of Health conducted an intra-action review (IAR) in October 2024. The findings from this review were disseminated to regions and partners, leading to the proposal of a re-ignition strategy for the BCU initiative. This re-ignition plan, aimed at addressing identified gaps, was formally launched on February 22, 2025, in the presence of senior officials and partner representatives.
Speaking at the re-ignition launch, Honorable State Minister of Health, Dr. Dereje Duguma, highlighted ongoing challenges:“The country still has a significant number of zero-dose children, and all identified children are not yet vaccinated.”He called on all partners, particularly those working in ZD project woredas, to intensify their support in both planning and implementation.
Dr. Owen L. Kaluwa, WHO Representative to Ethiopia, also emphasized the importance of the initiative:“The re-ignition of the Big Catch-Up program is a critical step towards ensuring that no child is left behind in Ethiopia’s immunization efforts. WHO is committed to supporting the Ministry of Health and all partners in this vital initiative. Together, we can achieve a significant reduction in zero-dose and under-vaccinated children, contributing to the overall health and well-being of the population.”
Key partners, including WHO, have aligned their ZD projects with the re-ignition plan. This includes the GAVI-supported ZD projects in 30 woredas across Tigray and Amhara regions, as well as integrated measles vaccination campaigns in 38 drought-affected districts in Somali, Oromia, and South Ethiopia regions. These campaigns were funded through the Central Emergency Response Fund (CERF), providing essential support to Ethiopia’s immunization efforts.
Following the re-ignition, all regions revised their catch-up plans to address existing gaps and prevent the emergence of new ZD and under-vaccinated children (UVC). Revised activities include strengthening coordination and leadership at all levels, improving the monitoring and reporting of catch-up efforts, enhancing the understanding of catch-up schedules among health workers, validating ZD numbers through surveys, such as rapid community surveys (RCS), and intensifying demand-generation initiatives.
To further improve immunization coverage, regions have set specific targets and timelines, implementing a range of strategies such as routine immunization services at health facilities, outreach programs, mobile vaccination units, periodic intensified routine immunization (PIRI) campaigns, integration of catch-up efforts with other health services, and dedicated vaccination campaigns. Partners continue to support these efforts in alignment with the re-ignition plan.
The re-ignition initiative seeks to revitalize all thematic areas related to immunization, with a particular focus on strengthening routine immunization (RI), including COVID-19 vaccination. By institutionalizing catch-up vaccination as a core component of routine immunization, the initiative aims to address challenges related to identified but unvaccinated children, as well as counteract declining attention to catch-up activities. These issues have been further exacerbated by outbreaks of measles and circulating vaccine-derived poliovirus type 2 (cVDPV2) in certain regions. With stronger coordination and sustained partner engagement, the momentum created by the IAR is expected to drive continued progress.
WHO remains steadfast in its support for the Ministry of Health, working collaboratively to clear the backlog of zero-dose and under-vaccinated children. Together, the vision of ensuring that no child is left behind in Ethiopia’s immunization efforts is steadily advancing.
