The Immunization Agenda 2030 (IA2030), endorsed in 2020, provides the global immunization strategy for 2021-2030 based on equity, country ownership, and partnership. Its 2025 WHO Mid-Term Review acknowledges progress—including 12% and 10% CAGR growth in vaccine ODA/OOF and philanthropy since 2018 (excluding COVID-19)—but finds most targets off-track amid crises like instability, climate impacts, and misinformation. It urges focused action on high-impact areas.
Key achievements include a record 72 million children vaccinated in Gavi countries in 2024, over 300 new vaccine introductions in LMICs since 2021, major reductions in zero-dose children in India and Ethiopia, and catch-up campaigns reaching over 11 million children by mid-2025. However, five of six IA2030 impact targets are behind schedule; only the LMIC new vaccine introduction target was exceeded (308 vs. 200).
Uneven Immunization Progress
Progress remains highly uneven. Fragile, Conflict, and Vulnerable (FCV) settings, home to only 24% of the global birth cohort, accounted for over 50% of the world’s zero-dose children in 2024. Significant coverage disparities persist between regions and income groups. For example, the weighted average coverage for the first dose of measles vaccine (MCV1) in the WHO African Region is 24 percentage points lower than in the European Region.
Many Middle-Income Countries (MICs) struggle to sustain coverage amidst constrained domestic financing and reduced external support, while the growing birth cohort in Low-Income Countries (LICs) increases the absolute number of children needing vaccination annually. Simply maintaining current global coverage levels risks widening existing inequities.
Governance Model Constraints
The review identifies significant gaps in the IA2030 governance model, which was designed as an inclusive, multi-level structure to foster collective action. Stakeholders at regional and national levels reported unclear roles, responsibilities, and decision-making processes across global, regional, and country levels.
Key bodies, such as the IA2030 Partnership Council (IAPC), lacked formal decision-making or financial oversight authority, limiting its role to an information-sharing forum rather than a strategic leadership body. Similar constraints related to resources, mandate, and structure hindered the effectiveness of the IA2030 Coordination Group, Secretariat, and Working Groups, limiting their impact on country-level action.
Opportunities in Emerging Trends
Respondents acknowledged a drastically changed global context since IA2030’s launch, noting several transformative trends. Accelerated integration of health services is a key shift, with disease-specific vertical programs increasingly merging into primary healthcare-based delivery. Major funders like Gavi (through its Health Systems Strengthening strategy) and the Global Fund are aligning with this trend.
The role of major institutions is also evolving, with an increased emphasis on country ownership in setting health priorities. The rapid rise of Artificial Intelligence (AI) presents disruptive potential for immunization—from identifying zero-dose communities and optimizing cold chains to enhancing real-time monitoring—though it necessitates careful data governance and equity considerations.
The Next Five Years: Focusing on Maximum Impact
Toto achieve IA2030 targets by 2030, the report argues for a strategic pivot. While IA2030’s core vision and strategic priorities should remain, the next five years must intensely focus on three high-impact targets: achieving 90% coverage for core vaccines, eliminating zero-dose children, and preparing for/responding to outbreaks of measles, polio, and other vaccine-preventable diseases.
The recommended key areas for dedicated investment and tailored support include:
- Integrate immunization with primary healthcare systems by moving beyond vertical disease-specific programs and embedding vaccination into comprehensive, life-course public health services.
- Prioritize fragile and conflict-affected settings through customized approaches and increased funding to cover higher operational costs, ensuring immunization aligns with humanitarian and development strategies.
- Strengthen support for MICs by equipping the new IA2030 MICs Working Group with necessary resources, a clear mandate, and objectives. Specific actions should focus on:
- Establishing an outbreak response mechanism for vaccine-preventable diseases.
- Enhancing market support for pooled procurement to secure better pricing.
- Defining clear priorities for new vaccine introduction amidst constrained resources.
- Continuously supporting the improvement of domestic financing mechanisms.
- Ensuring program sustainability within strong primary healthcare systems.
Finally, monitoring and evaluation must shift towards strengthening the data-to-action cycle at national and sub-national levels, linking performance tracking directly to annual action plans within national immunization strategies.
Content Editor: Xinyue Zhou
Page Editor: Ruitong Li
More can be found in the report:
https://www.who.int/publications/m/item/immunization-agenda-2030-mid-term-review
