# One in five children unvaccinated: reading the dropout curve

> 20% of Ethiopian children aged 12–23 months have received no vaccinations at all. But the more actionable number is the gap between the first dose and the last — a tracking failure, not an access failure.

Source: https://www.medicine.et/research/zero-dose-immunisation  
Site: Bloom Medicine — https://www.medicine.et  
Last updated: 2026-07-25

---

Population health · Immunisation · published July 25, 2026

## Key findings

- 30% of children aged 12–23 months are fully vaccinated with basic antigens, down from 39% in 2016; 20% have received no vaccinations at all.
- 72% received BCG but only 40% completed the third DTwP-Hib-HepB dose — most children who start the schedule do not finish it.
- Urban coverage is 50% against 22% rural, so the national average conceals two very different problems.
- Because BCG is usually given at birth or first clinic contact, the 72%-to-40% fall happens after the health system already has the child on its books.

Most of the 2024–25 EDHS is a story of improvement. Childhood immunisation is the exception, and it is worth isolating, because a *negative* trend in an otherwise improving dataset usually points at something structural.

## The numbers

Among children aged 12–23 months in the 2024–25 EDHS [1]:

- **30%** are fully vaccinated with basic antigens
- **20%** have received **no vaccinations at all**
- **72%** received BCG
- **40%** received three doses of DTwP-Hib-HepB
- **51%** received a first dose of measles-containing vaccine

Full basic coverage has fluctuated since 2000, peaking at **39% in 2016** and bottoming at 17% in 2000 [1]. The share receiving nothing has also swung — from 14% in 2000 up to a high of 24% in 2005 [1]. Today's 30%/20% split is a retreat from the 2016 position, not a new low, but a retreat all the same.

```chart
{
  "type": "trend",
  "title": "Children aged 12–23 months fully vaccinated with basic antigens",
  "subtitle": "Three points the Key Indicators Report states explicitly: the 2000 low, the 2016 high, and today.",
  "unit": "%",
  "max": 50,
  "source": "EDHS 2024–25 Key Indicators Report [1]",
  "data": [
    { "label": "2000", "value": 17 },
    { "label": "2016", "value": 39 },
    { "label": "2024–25", "value": 30 }
  ]
}
```

## The dropout curve is the finding

Read the coverage figures against the schedule and the shape is unmistakable — the first contact is crowded and the finish line is empty:

```chart
{
  "type": "funnel",
  "title": "From first contact to a completed schedule",
  "subtitle": "Children aged 12–23 months. Darker steps sit later in the schedule; coverage is not monotone, because the measles dose at ~9 months is better covered than the third pentavalent dose at ~14 weeks.",
  "unit": "%",
  "max": 100,
  "source": "EDHS 2024–25 Key Indicators Report [1]",
  "data": [
    { "label": "BCG — birth or first contact", "value": 72 },
    { "label": "DTwP-Hib-HepB 3rd dose — ~14 weeks", "value": 40 },
    { "label": "Measles 1st dose — from ~9 months", "value": 51 },
    { "label": "All basic antigens complete", "value": 30 }
  ]
}
```

BCG in Ethiopia is normally given **at birth or at first clinic contact** [1]. So for roughly seven children in ten, the health system has already met the child, opened a record, and knows the child exists. The subsequent fall to 40% on the third pentavalent dose is not happening to children the system has never seen. It is happening to children it has already registered and then lost track of.

That reframes the problem. Getting a child to a first contact is an access question — distance, cost, outreach, trust. Getting the same child back for doses two, three and the measles visit is a **recall question**: does anyone know this child is due, and does anyone notice when they do not arrive?

## The urban–rural split means two different problems

**50% of urban children are fully vaccinated, against 22% of rural children** [1] — a gap wide enough that a single national strategy will misfire on one side of it.

```chart
{
  "type": "bars",
  "title": "Full basic vaccination by residence",
  "subtitle": "The national figure of 30% is an average of two very different situations.",
  "unit": "%",
  "max": 100,
  "source": "EDHS 2024–25 Key Indicators Report [1]",
  "data": [
    { "label": "Urban", "value": 50 },
    { "label": "National", "value": 30 },
    { "label": "Rural", "value": 22 }
  ]
}
```

In rural areas with 22% coverage, the binding constraint plausibly is access and outreach reach. In urban areas at 50%, half of children are still missing doses despite facilities being close, which is much harder to explain by distance. Urban dropout looks like a scheduling and follow-up failure.

## What a clinic can act on

- **A due-date list is not the same as a register.** A register records who came. A due list records who *should* come, which is the only view that makes a missed dose visible.
- **The first contact is the moment to capture reachable contact details.** After BCG, the system has one chance to record a phone number that will still work in four months.
- **Defaulter tracing has to be somebody's job.** In the EDHS shape, the children being lost are known children — traceable in principle, if anyone is looking.
- **Measure completion, not visits.** A clinic can run a high volume of immunisation visits and still have poor completion, because the two are different denominators.

## What this note does not claim

The EDHS measures household-reported and card-verified coverage nationally; it does not attribute the decline to any cause. The 2016–2025 interval covers conflict, displacement, and the COVID-19 pandemic, all of which plausibly disrupted routine services, and this report separates none of them [1].

It also says nothing about the private sector's share of immunisation, and the "recall failure" reading above is an inference from the shape of the dropout curve — a reasonable one, but not something the survey tests directly.

## References

1. Ethiopian Statistical Service, Ministry of Health, Ethiopian Public Health Institute, ICF. *Ethiopia Demographic and Health Survey 2024–25: Key Indicators Report*. Addis Ababa, Ethiopia and Rockville, Maryland, USA (22,540 households; fieldwork August 2024 – April 2025), 2026. https://ess.gov.et/wp-content/uploads/2026/01/edhs-2024-25-kir-01172026.pdf