The September 2025 meeting of the Strategic Advisory Group of Experts on Immunization (SAGE), held from 22–25 September with a joint session with the Malaria Policy Advisory Group (MPAG), brought renewed focus to both the progress and persistent challenges facing global immunization. While vaccination coverage worldwide has largely rebounded to pre-pandemic levels, recovery remains uneven — particularly in fragile and conflict-affected settings. Funding constraints, geopolitical instability, and an ongoing erosion of public trust continue to threaten vaccine acceptance and uptake.
SAGE's mid-term review of the Immunization Agenda 2030 (IA2030) reaffirmed the relevance of its vision, but calls for accelerated action and stronger partnerships to help countries integrate immunization into primary health care and strengthen data use for driving and implementing programme strategies.
Discussions on the global COVID-19 situation, highlighted declining case reports but persistently low and inequitable vaccine uptake. Updated guidance is expected soon, including revised prioritization strategies and further assessment of vaccine effectiveness during the Omicron period, with a particular focus on pregnancy and birth outcomes.
On polio, SAGE stressed the need for urgent action to overcome ongoing transmission of wild poliovirus in Pakistan and Afghanistan and continued outbreaks of cVDPV2. Recommendations included the need to strengthen immunization strategies, expanded use of nOPV2 and fractional-dose IPV — supported by strong political commitment and accountability.
In the areas of vaccine innovation, SAGE noted cautious optimism on the horizon: six tuberculosis vaccine candidates are currently in Phase 3 trials – raising hopes for the first new TB vaccine for adults and adolescents in decades by 2028. SAGE issued updated recommendations on the use of influenza A(H5) vaccines in high-risk populations, reaffirmed the importance of a four-dose malaria vaccine schedule, and encouraged continued efforts to prioritize the development of combination vaccines to simplify delivery and increase acceptance.
Looking ahead, the G20 Health Ministers' Meeting (4–7 November, Limpopo, South Africa), will provide a critical platform to bolster political leadership and support countries in advancing immunization goals. Meanwhile, momentum continues to build for TB vaccine innovation. The Finance and Access Working Group of the TB Vaccine Accelerator Council, co-convened by WHO, the Government of South Africa, and Gavi, the Vaccine Alliance, will release a new report on catalysing equitable access and sustainable financing for novel TB vaccines on 6 November on the sidelines of this meeting.
Together, these developments reflect both the urgency and the opportunity of the moment — a chance to protect progress, close gaps, and ensure that every community can benefit from the life-saving power of vaccines.
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