By Dr Satish K. Gupta
Referring to studies that suggest vaccine refusal rates are rising because of ideological resistance along with lack of awareness, the World Health Organization (WHO) experts today called for urgent policy shifts to counter vaccine scepticism before it results in major outbreaks. They stressed that localized interventions (e.g., parent education sessions) were more effective than global messaging campaigns, and highlighted that people trust medical professionals more than government sources for vaccine advice.
Against the backdrop of the current political and societal developments that it claimed jeopardized global health, including vaccination programmes worldwide, the Strategic Advisory Group of Experts on Immunization (SAGE), convened by WHO, held its biannual meeting from March 10–13, 2025 in Geneva.
This session addressed critical updates in vaccine policies, scientific analyses of immunization schedules, and the unprecedented risks posed by funding cuts and misinformation. It announced that the Gavi strategy 2026-2030 (Gavi 6.0) will be launched in 2026 with a focus on introducing and scaling up new vaccines, strengthening country programmes, supporting optimization and prioritization processes, ensuring sustainability, providing tailored support, and reducing zero-dose children. (Gavi is an international organisation bringing together public and private sectors with the shared goal of saving lives and protecting people’s health by increasing equitable and sustainable use of vaccines).
Underlining the major contribution of vaccination to improved global child survival and health, while being one of the public health measures with the highest returns on investment, SAGE expressed its deep concern about the current situation with the diversion of resources away from public health, which creates a risk of further backsliding just when countries are recovering from the impact of the COVID-19 pandemic.
It warned that this could adversely affect the ability of global immunization programmes to sustain the tremendous gains they have made and progress towards the goals of the Immunization Agenda 2030 (IA2030).
During the meeting, a report from the Department of Immunization, Vaccines, and Biologicals highlighted the severe strain and threat to immunization programmes at global, regional and country levels with recent abrupt changes in donor budgets and capacity in global health and decreases in fiscal space domestically. According to the report, the most prominent were the threats to measles vaccine coverage improvements, disease surveillance, laboratory networks and outbreak response capacity, which are being acutely affected by budget cuts. This comprehensive report integrated the latest scientific data, expert concerns, and policy recommendations discussed at WHO’s SAGE meeting. It highlighted the urgent global vaccination challenges and proposes solutions to ensure that immunization efforts remain strong despite funding and misinformation threats.
The WHO SAGE meeting served as a wake-up call to policymakers, global health leaders, and communities worldwide. While scientific advances have optimized vaccine schedules, the threats of funding withdrawal, vaccine hesitancy, and policy disruptions jeopardize decades of progress. With rising outbreaks of measles, polio, and other preventable diseases, urgent action is required to ensure that immunization remains a public health priority.
WHO called for sustained investments, better public engagement, and stronger policies to protect global populations from vaccine-preventable diseases.
Some key concerns raised during the meeting were:
- Scientific updates on pneumococcal, varicella, polio, and measles vaccines.
- Concerns over the rising burden of vaccine-preventable diseases (VPDs) due to funding disruptions.
- The role of misinformation and vaccine hesitancy in derailing immunization programs.
- Global strategies to sustain and expand vaccination efforts despite challenges.
Dr Hanna Nohynek (Chair, SAGE), Dr Kate O’Brien (Director, WHO’s Department of Immunization), and Dr Joachim Hombach (WHO Senior Health Advisor) led discussions on how data-driven policies can help counteract these challenges.
1. Scientific Advances in Vaccination Policies
a. Pneumococcal Conjugate Vaccine (PCV): A Revised Global Strategy
- WHO now strongly endorses a 2+1 schedule for pneumococcal vaccination in children (two primary doses plus a booster).
- A 1+1 schedule (one primary dose + one booster) may be effective in high herd immunity settings, cutting costs while maintaining effectiveness.
- For high-risk groups with low immunity, WHO is exploring single-dose PCV strategies as a feasible alternative.
b. Varicella Vaccination: A Stronger Push for Universal Coverage
- The latest recommendations reinforce a two-dose varicella schedule (given four weeks apart) for children.
- Healthcare workers without previous varicella exposure should be vaccinated on priority to reduce nosocomial outbreaks.
c. Polio & Measles: The Rising Threat of Resurgence
- WHO reported sustained poliovirus transmission in Pakistan & Afghanistan, requiring transformational shifts in eradication strategies.
- The 30% surge in measles outbreaks across Europe and North America was highlighted as a major public health threat, linked to vaccine hesitancy and dismantling of immunization programs.
2. The Scientific Process: How WHO Collects and Interprets Vaccine Data
During the conference, WHO scientists outlined how vaccine policies are shaped by data-driven projections. The methodology involves:
- Surveillance systems tracking disease burden in different regions.
- Mathematical modelling predicting outbreaks based on declining vaccine coverage.
- Clinical trial data and real-world evidence guiding vaccination schedules.
- Herd immunity thresholds determine the necessity of booster doses.
- Dr Kate O’Brien emphasized the role of global epidemiological networks in forecasting disease patterns.
- The SAGE committee’s updated vaccine recommendations are based on continuous data monitoring and meta-analysis of immunization outcomes worldwide.
The Fallout of the United States Funding Cuts: A Looming Global Health Crisis
One of the most pressing concerns discussed at the meeting was the U.S. withdrawal of key immunization funding, estimated at $25 million for measles surveillance and outbreak response.
Potential Consequences of Funding Cuts:
- Measles surveillance collapsed in many parts of Africa and Asia.
- Increased vaccine stock shortages, leading to 500,000 additional deaths per year.
- Disruptions in polio and HPV vaccination programs, setting back years of progress.
Dr. Joachim Hombach warned that if funding gaps are not addressed, we may see resurgences of diseases once thought to be controlled.
WHO expressed concerns that misinformation campaigns are undermining vaccine acceptance. Misinformation about vaccine side effects, false claims of infertility, and conspiracy theories are discouraging parents from vaccinating their children.
Proposed Strategies to Counter Hesitancy
- Trust-building through community leaders (religious heads, local influencers).
- Fact-checking mechanisms to debunk false claims in real time.
- Stronger engagement of healthcare professionals in direct communication with patients.
- Transparency in vaccine safety data to reassure the public.
- New Research on Public Perception of Vaccines
Global Call to Action: Urgent Steps to Sustain Immunization
To prevent immunization setbacks, WHO recommended:
- Governments must increase domestic health budgets to sustain programs without relying on uncertain donor funding.
- Alternative financing models (crowdsourcing, public-private partnerships) should be explored.
- Heads of state should engage in direct dialogue with the U.S. to negotiate transitional funding solutions.
4. Better integration of immunization with primary healthcare services to improve accessibility.
Dr. Nohynek emphasized that “vaccines are among the most cost-effective public health interventions. Scaling back now would be a catastrophic mistake.”
Key Takeaways from the WHO SAGE Meeting
- Revised pneumococcal and varicella vaccination schedules for better effectiveness.
- Rising outbreaks of polio & measles linked to declining vaccine coverage.
- U.S. funding cuts threatening key global immunization programmes.
- Misinformation and vaccine hesitancy increasing refusal rates.
- Urgent need for alternative funding & stronger immunization policies.
