Vaccination: Progress and Challenges

Vaccination: Progress and Challenges | Photo: CDC

The United Nations’ 2025 Sustainable Development Goals Report, released on 14 July 2025, casts a sobering light on the state of global health, revealing significant setbacks in achieving SDG 3: Good Health and Well-Being.

The lingering effects of the COVID-19 pandemic, compounded by ongoing conflicts and climate-related challenges, have disrupted progress towards universal health coverage (UHC) and equitable access to essential healthcare services. Despite notable achievements, such as 146 out of 200 countries being on track to meet under-5 mortality targets and a 52% reduction in AIDS-related deaths since 2010, the report underscores persistent inequalities and a troubling regression in key areas like childhood vaccinations.

Addressing these challenges is critical not only for health outcomes but also for fostering sustainable development, reducing poverty, and building resilient global societies.

Persistent inequalities in healthcare access

The report highlights stark disparities in healthcare access, particularly in low-income countries where wealthier, urban, and more educated populations benefit disproportionately from reproductive, maternal, and child health services.

Sub-Saharan Africa, for instance, lags 20 percentage points behind global averages in skilled birth attendance, with only 64% of births assisted by trained professionals between 2015 and 2021. This gap reflects broader systemic issues, including underfunded health infrastructure and a shortage of trained health workers, sub-Saharan Africa has just 2.3 medical doctors per 10,000 people, compared to 39.4 in Europe.

The decline in childhood vaccination rates is particularly alarming. Coverage for the diphtheria-tetanus-pertussis (DTP3) vaccine, a key indicator of immunization programme strength, fell from 86% in 2019 to 81% in 2021, marking the largest sustained drop in three decades. As a result, 25 million children missed critical doses in 2021, leaving them vulnerable to preventable diseases like measles and polio.

Tuberculosis (TB) and malaria deaths have also risen, with sub-Saharan Africa bearing over 90% of global malaria cases, totalling 219 million cases and 435,000 deaths in 2017 alone. These setbacks threaten the SDG 3 target to end epidemics of AIDS, TB, malaria, and neglected tropical diseases by 2030.

Resilient systems: The role of immunization and innovation

Despite these challenges, innovative efforts offer hope. Immunization remains one of the most cost-effective health interventions, averting an estimated 2–3 million deaths annually. Gavi, the Vaccine Alliance, has been pivotal in addressing immunization gaps, supporting countries to strengthen vaccination campaigns through its 2025 mid-term review. In sub-Saharan Africa, Gavi’s partnerships with local governments have expanded access to vaccines like the pneumococcal conjugate vaccine (PCV), though global coverage remains below 50%. These initiatives underscore the need for sustained investment in health systems to close coverage gaps and build resilience against future crises.

Science-based approaches, such as data-driven disease surveillance, are also gaining traction. Predictive health strategies, which leverage real-time data to anticipate outbreaks, are being piloted in high-risk regions. For example, community health workers in sub-Saharan Africa are being trained to use mobile technologies to track disease patterns, enabling faster responses to emerging threats. These efforts, though underfunded, demonstrate the potential of grassroots innovation to complement global health strategies.

The unsung heroes

Local actions often go unnoticed in global discourse but are critical to achieving SDG 3. In regions with high disease prevalence, community health workers are bridging gaps in healthcare delivery. In rural sub-Saharan Africa, for instance, these workers are trained to administer vaccines and provide basic care in remote areas, where health facilities are scarce. Yet, funding shortages limit their impact, only $2.7 billion was allocated to basic healthcare globally in 2021, a fraction of what is needed to achieve UHC.

Grassroots organizations are also partnering with local governments to strengthen health systems. In Liberia, UN Women and partners have installed solar lighting in 26 clinics, improving maternal health services in remote areas where maternal mortality remains high at 1,072 deaths per 100,000 live births. Such initiatives highlight the importance of community-driven solutions in addressing health inequities and building resilient systems.

A call for global commitment

The 2025 SDG Report serves as a clarion call for renewed global commitment to health equity and resilience. The rise in TB and malaria deaths, coupled with declining vaccination rates, signals a broader fragility in health systems exacerbated by climate crises, conflicts, and economic instability. To meet the 2030 targets, governments and international partners must prioritise health financing, with a focus on training and retaining health workers, particularly in low-income countries. The global health workforce shortage is projected to reach 11.1 million by 2030, with over half in Northern and sub-Saharan Africa.

Investing in resilient health systems is not just a health imperative but a cornerstone of sustainable development. Every dollar invested in maternal and child health yields significant returns, fostering economic stability and social cohesion. The UN’s High-Level Political Forum in 2025, themed “Advancing sustainable, inclusive, science- and evidence-based solutions,” will provide a platform to accelerate these efforts.