Q&A: Mid-Term Check-In on the Immunization Agenda 2030

With Benedict Millinchip, Project Management Officer, Immunization, Vaccines & Biological Department, World Health Organization.


1. As IA2030 reaches its midpoint, how would you assess global progress so far, and where are we most off track?

During this decade, immunization has continued to be one of the most successful public health interventions. Across all the IA2030 targets, we have seen progress. Between 2021-24, 16.7 million future deaths were averted. In 2024 alone, more children than ever before (72 million) were vaccinated in the 57 Gavi-eligible countries. DTP3 coverage continues to increase, and the number of zero-dose children continue to fall (down by another 500,000 in 2024). More than 300 new vaccines have been introduced. However, we must acknowledge that this progress is lower than the targets set by countries back in 2020. At current pace, it is estimated there will be 1.6 million avoidable future deaths by the end of the decade. The Covid-19 pandemic certainly played a significant part in this, and while the ‘Big Catch Up’ initiative did reach more than 11 million children missed during the pandemic, the total missed has been estimated at 25 million. Coverage challenges (often compounded by poor quality follow-up campaigns) is, in turn, leading to persistently high levels of vaccine-preventable disease outbreaks, particularly of measles and polio. In 2024, 105 large or disruptive outbreaks were reported. 

2. The Mid-Term Review points to persistent equity gaps, including zero-dose children. What practical strategies are proving most effective to reach the unreached?

Indeed, the MTR shows that, across regions and income groups, immunization coverage rates differ markedly. The gap is particularly stark for low-income countries, where coverage of the first dose of measles-containing vaccine is 27 percentage points lower than in high-income countries. Across all regions there remain countries that are substantial outliers. Some of these outliers have experienced recent military conflict, or are managing other fragilities, while others may reflect crisis in demand or trust. Closing gaps in coverage and maximizing equitable coverage requires addressing the specific contexts of and challenges facing outlying countries. 

Practical strategies that are being pursued include:

1. Knowing where to find the populations. In many cases, overall data at national level can mask significant variations within countries. Work is underway to improve sub-national data to address this and highlight where those not being reached can be found and help governments and those supporting them to make more informed decisions.

2. Capturing them in national strategies. More and more countries are now developing mature National Immunization Strategies. These define plans, performance targets and allow for local-level targeting in a more structured way than before.

3. Addressing systems issues. Stockouts at local level, driven by broken procurement and delivery mechanisms, can increase inequity and access. Work to improve supply chain resilience continues along the different stages of the delivery process.

3. How can countries strengthen routine immunization and integrate it more effectively with primary health care, especially in fragile and resource-constrained settings? 

The mid-term review calls for the continued integration of immunization services within primary health care. It also calls out fragile, vulnerable and conflict settings as a specific priority area – dedicating a section on this topic. 

To strengthen and embed immunization within primary health care, vaccinations must be delivered alongside antenatal care, nutrition, growth monitoring and other NCD services. This reduces missed opportunities and strengthens continuity of care. As noted, data quality is then key. Investments in district-level electronic records help to track more accurately those being reached and where true gaps persist. This data must be backed-up by monitoring that then makes use of it to inform updated national strategies. Finally, the MTR highlights that domestic financing needs to keep increasing, especially in light of forecast, continued reductions in external funding.

It is important first to note that fragile settings are not a uniform environment. Therefore, a number of different approaches are needed. Outreach needs to be more tailored, for example through the use of mobile clinics, while the delivery approach will often be in partnership with humanitarian organizations and alongside other interventions they coordinate. It is crucial immunization is integrated in humanitarian response and recovery plans, while trust building through continuous community engagement will also play a key role, especially in areas with limited national government presence.

4. With increasing financial pressures and competing health priorities, how can immunization programmes sustain momentum and introduce new vaccines?

First, it will be important to acknowledge this new reality. Financial pressure, requiring greater prioritization, is increasing for many countries and is forecast to continue. In this situation, the case for immunization programmes must continue to be fought. Certainly, immunization starts from a strong position. It continues to have one of the greatest returns on investment and provides a crucial foundation to many countries’ primary health care services. Yet, immunization programmes must show that they can prioritise to reflect national and local circumstances. This is why National Immunization Strategies and even sub-national planning have been and will continue to increase in importance – allowing countries to tailor their immunization programme to their specific needs. For example, where new vaccines were previously introduced nationally, in future they may be brought in via a phased approach – starting in highest-burden areas – when national rollouts are not affordable.

We have discussed already the need to integrate immunization within wider health services. With increased financial pressure, this requirement becomes even more imperative as countries will need efficient primary care services that allow citizens to access multiple interventions at the same time. 

Finally, immunization must continue to innovate. Whether through new and improved vaccines that require fewer doses, are more thermostable or can be manufactured at a reduced cost, innovation will allow immunization programmes to achieve more even with reduced resources. 

5. Looking ahead to 2030, what gives you the greatest confidence in achieving IA2030’s vision, and what role can immunization professionals play in accelerating progress?

The vision and goals of Immunization Agenda 2030 were deliberately ambitious, and rightly so. History shows that by setting challenging targets, we collectively push ourselves further than we might otherwise have done in pursuit of them. When considering where we are today and looking ahead, it is also important to take into account the intervening time. The IA2030 goals were set before we had a global pandemic, and before the contraction in global health funding we have seen in the past 12 months. 

Despite those and other ‘headwinds’, the Mid-Term Review shows how much progress we have made globally, across a vast range of vaccines. It is this evidence that gives me the confidence that we can now push on, collectively and with ambition towards 2030. Through a challenging first five years, we succesfully vaccinated millions of children, introduced hundreds of vaccines, ended a pandemic and reduced the number of children who have never received a vaccine. Immunization professionals are behind those achievements and will be the backbone of those we realise – together – over the next five years. 

The Mid-Term Review highlights several, specific things we can do:

First – we need to be pragmatic in our positivity. We can achieve great successes by 2030, but we need to do so within the environment as it exists. We need to prioritise and focus on the highest impact areas, and we need better data to inform the decisions on where to direct funds and vaccines. 

Second – we need to accelerate and support the path towards country self-sufficiency. It is clear the era of large-scale external funding for immunization programmes is ending. Work now on national strategies, data strengthening, maturing regulatory bodies and domestic financing is all therefore crucial.

Finally, we need to reform the model by which we work together – the Mid-Term Review highlights the need to update how the leadership of IA2030 is structured, as well as the need to focus more on the regional and the national, away from the global. 

----