The September 2025 meeting of the Strategic Advisory Group of Experts on Immunization (SAGE), held from 22–25 September alongside the Malaria Policy Advisory Group (MPAG), underscored both the progress and ongoing challenges in global immunization. While global vaccination coverage has largely returned to pre-pandemic levels, recovery remains uneven, especially in fragile and conflict-affected regions. Persistent funding gaps, geopolitical instability, and declining public trust continue to hinder vaccine uptake and acceptance.
During its mid-term review of the Immunization Agenda 2030 (IA2030), SAGE reaffirmed the continued relevance of its goals but emphasized the need for accelerated action. It called for stronger partnerships to integrate immunization within primary health care systems and enhance data-driven decision-making to guide program strategies.
The meeting also reviewed the global COVID-19 situation, noting fewer reported cases but persistently inequitable vaccine coverage. SAGE discussed the forthcoming updated guidance, which will include revised prioritization strategies and new evidence on vaccine effectiveness during the Omicron period, with special attention to pregnancy and birth outcomes.
On polio, SAGE highlighted the urgency of eliminating wild poliovirus transmission in Pakistan and Afghanistan and addressing ongoing outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2). The group recommended bolstering immunization strategies, expanding the use of nOPV2 and fractional-dose IPV, and reinforcing political commitment and accountability to achieve eradication goals.
In vaccine innovation, SAGE noted encouraging developments, including five tuberculosis vaccine candidates currently showing proof-of-concept efficacy — raising hopes for the first new TB vaccine for adults and adolescents by 2028. It issued updated recommendations on influenza A(H5) vaccine use among high-risk groups, reaffirmed the importance of a four-dose malaria vaccine schedule, and supported the advancement of combination vaccines to simplify delivery and boost community acceptance.
Looking ahead, the G20 Health Ministers’ Meeting in November 2025 in Limpopo, South Africa, is expected to strengthen political leadership and mobilize support for immunization priorities. Additionally, the TB Vaccine Accelerator Council’s Finance and Access Working Group, co-convened by WHO, the Government of South Africa, and Gavi, will release a pivotal report on equitable access and sustainable financing for new TB vaccines.
Collectively, these developments signal both the urgency and the promise of the current moment — offering an opportunity to safeguard hard-won gains, bridge persistent gaps, and ensure equitable access to the life-saving benefits of vaccines for all communities worldwide.
