Immunisation Agenda 2030: prioritising sustainable immunisation financing.

More than 2 years after the 2021 launch of the Immunisation Agenda 2030 (IA2030) by WHO, questions remain on how successful the agenda will be. The Editorial from April 22, 2023, succinctly reflected on the important issues to be tackled to reverse the decline of routine immunisation, especially in the aftermath of the COVID-19 pandemic.1The LancetRoutine immunisations: reversing the decline.Lancet. 2023; 4011313Summary Full Text Full Text PDF Scopus (0) Google Scholar It identified, among other issues, the growing challenge of weak health-care systems and vaccine hesitancy as challenges that continue to threaten the actualisation of the IA2030 goals, while acknowledging that the agenda's success will depend on efficient and sustainable immunisation financing. The unstable nature of global immunisation financing is, in our view, the most important challenge for a successful agenda to tackle. Addressing this instability is particularly crucial as countries with the biggest immunisation coverage gaps tend to struggle the most with mobilising and sustaining funding for their routine immunisation programmes.2Saxenian H Alkenbrack S Freitas Attaran M et al.Sustainable financing for Immunization Agenda 2030.Vaccine. 2022; (published online Dec 2.)https://doi.org/10.1016/j.vaccine.2022.11.037Crossref Scopus (1) Google Scholar Moreover, the COVID-19 pandemic has exacerbated economic challenges and debt distress in many low-income and middle-income countries (LMICs), with debt repayments hitting US$43 billion in 2022.3UN Conference on Trade and DevelopmentFour key challenges facing least developed countries.https://unctad.org/news/four-key-challenges-facing-least-developed-countriesDate: April 4, 2022Date accessed: April 25, 2023Google Scholar Current global economic and debt crises, which disproportionately affect LMICs, could have adverse implications for routine immunisation services, as countries might have to divert resources away from their health-care systems to service debts and potentially default on their co-financing obligations to multilateral immunisation financing initiatives such as Gavi, the Vaccine Alliance.4Williams OD Yung KC Grépin KA The failure of private health services: COVID-19 induced crises in low- and middle-income country (LMIC) health systems.Glob Public Health. 2021; 16: 1320-1333Crossref Scopus (27) Google Scholar To achieve the ambitious targets of the IA2030, it is imperative that global and multilateral efforts to prioritise strategies for fiscal sustainability and efficiency for routine immunisation are made, particularly those of LMICs. Such strategies could include innovative financing and co-financing mechanisms, and debt restructuring and relief, while nudging domestic resource mobilisation and deployment of immunisation services in fiscally prudent and cost-efficient ways. The ongoing global economic crisis means that external financing from donors could continue to dwindle. Hence, innovative immunisation financing mechanisms are essential for accelerating and sustaining global efforts towards achieving the IA2030 aim of universal access to immunisation by the end of the decade. We declare no competing interests. The views and opinions expressed here are those of the authors only and do not necessarily represent those of their affiliated institutions. Routine immunisations: reversing the declineOver the past 3 years, the COVID-19 pandemic has shown the power and potential of vaccination in real time. But it has also disrupted health services and caused supply chain challenges, resulting in stagnation and backsliding of routine vaccinations. For example, global coverage of the third dose of the diphtheria–tetanus–pertussis vaccine fell from 86% in 2019 to 81% in 2021—the lowest level since 2008. Many other routine vaccinations showed similar reductions. 25 million children missed out on life-saving measles, diphtheria, and tetanus vaccines in 2021. Full-Text PDF