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Kate O’Brien, Director of the Department of Immunization, Vaccines and Biologicals at WHO

The Strategic Advisory Group of Experts on Immunization (SAGE) convened for its biannual meeting from 23 to 26 September, during which SAGE also celebrated 25 years of pivotal contributions to global vaccination policies.

Key recommendations and outcomes from the SAGE meeting include:

• Infant RSV prevention through Maternal Vaccination and Monoclonal Antibodies: Many years of research have finally paid off with two approaches to preventing serious RSV disease among infants that have demonstrated efficacy and safety.
• Transitioning from Bivalent Oral Poliovirus Vaccines: As part of the ongoing planning for a global phase-out of oral polio vaccine, a new risk-tiering framework will guide the approach.
• Rubella Vaccine Introduction: Eliminating the prerequisite of 80% measles coverage prior to rolling out the rubella vaccine will accelerate the remaining switches to combination measles/rubella vaccine and hasten the prevention of congenital rubella syndrome.
• SAGE impact over the past 25 years: SAGE recommendations have played a crucial role in guiding countries to achieve equitable access to vaccines, sustain health gains, and to address pressing global health challenges, including the Sustainable Development Goals (SDGs) and health security. Recommendations have influence and shape vaccine technology, research and development, programme innovations, primary health care integration, and emergency response approaches to vaccine preventable diseases.

While we celebrate these advancements the stark reality is that many nations are failing to meet their immunization targets. An alarming 14.5 million children worldwide are classified as “zero-dose,” lacking receipt of even a single vaccine through the routine immunization programme. Over half of these children reside in fragile and conflict-affected areas, underscoring a deepening crisis in access to essential healthcare. Immunization backsliding triggered by the COVID-19 pandemic has yet to recover in some countries, and in others worsened in 2023.

Despite the availability of measles vaccines worldwide, not enough children are being vaccinated to halt the rising number of cases and outbreaks. New estimates from the WHO and CDC revealed large or disruptive measles outbreaks in 57 countries in 2023, with more than 10 million people infected — a 20% increase from the previous year. As a result, an estimated 107,500 people died from measles last year, highlighting the countries and communities where vaccination efforts are severely lacking.

It is this that requires action, now, to not only urgently fill the immunity gaps through catch-up measures, but to act with a hyper-focused approach to establish quality essential immunization services that deliver every week of every year.

High vaccination rates are being achieved in many countries through exactly this primary health care approach, driven by strong governance and commitment of resources, while others struggle due to inadequate political will and investment. Both of these are amenable to change as we see from successes of 2023.

The reinvigorated rollout of the human papillomavirus (HPV) vaccine in 2023 and the introduction of new malaria vaccines in 16 African countries in 2024 demonstrate that progress is more than possible. These successes serve as blueprints for future immunization initiatives, emphasizing the crucial role of SAGE recommendations, partner collaboration and most important country leadership, decision-making and adaptable, localized approaches.

The United Nations General Assembly (UNGA) in September highlighted the urgency of addressing antimicrobial resistance (AMR). The Political Declaration on AMR calls for coordinated international efforts to combat this pressing health threat, which currently contributes to nearly 5 million deaths annually due to treatment failures.

AMR complicates the treatment of existing diseases and threatens vaccination efforts. A new WHO study indicates that improving vaccine use against 23 pathogens could reduce global antibiotic consumption by 22%, equivalent to 2.5 billion doses annually. Existing vaccines for pneumococcus, Hib, and typhoid could advert over 106,000 AMR-related deaths, while new vaccines for tuberculosis and Klebsiella pneumoniae hold great promise to advert an additional 543,000 deaths. This report is a critical step in prioritizing vaccine research for low- and middle-income countries, where the burden of disease is highest. By focusing on pathogens that cause the most harm, the report aims to guide global vaccine development and ensure that life-saving vaccines reach those who need them most, addressing both public health and socioeconomic impact. The economic burden of AMR is staggering, with treatment costs reaching $730 billion annually. Widespread vaccine rollout could save a third of these costs, underscoring the need for investment in vaccines as both a health and economic imperative.

Moving forward, the need for world leaders to prioritize immunization programmes as essential health interventions is greater than ever. As GAVI, the Vaccine Alliance, prepares for its replenishment to fund programmes and initiatives over the next five years, the stakes could not be higher. Without sufficient financial backing and political commitment, the goal of vaccinating the next billion children will slip away, lives will be lost that should not have been, creating personal, community and economic suffering. As we continue to mark the 50th anniversary of the Expanded Programme on Immunization (EPI), themed “Humanly Possible,” let us remember that achievements of vaccines and immunization are a testament to both scientific progress and a collective commitment to prevent disease, suffering, and loss. The deployment of vaccines and the development of new ones showcase what is unimaginably possible.

Each of us has a role to play—driven by science, evidence, experience, common purpose, and common sense. Whether through advocating for local health initiatives, raising community knowledge and awareness, progressing public policy decisions, delivering on the ground, or amplifying efforts to protect those most marginalized or vulnerable, the time is now. Together, we must be clear that every child and every adult has a right to be immunized and protected from vaccine preventable diseases. This is humanly possible.

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