The global vaccine platform, Gavi, is seeking $9 billion for its work over the next five years at a pledging summit in Brussels on Wednesday, amid news that 2030 childhood immunisation targets will be missed unless substantial improvements are made.

Only countries in the “high-income super region” are projected to reach the World Health Organization’s (WHO) 2030 immunisation target of halving the number of zero-dose children compared to 2019, according to a report published in The Lancet on Wednesday.

“Global immunisation goals for 2030 will not be met without targeted, equitable immunisation strategies, alongside primary healthcare strengthening and efforts to tackle vaccine misinformation and hesitancy,” according to a media release from the University of Washington’s Institute for Health Metrics and Evaluation (IHME). which conducted the analysis, based on the 2023 Global Burden of Disease study.

Coverage of 90% or greater for each of the life-course vaccines  – all three doses of the diphtheria-tetanus-pertussis (DTaP) vaccine, two measles vaccines, and pneumococcal vaccine – is the central target for 2030. Only 18 of 204 countries have already met this target.

In 2023, some 15.7 million zero-dose children received no DTaP vaccines in their first year of life, and over half lived in just eight countries.

Nigeria tops the list with the largest number of unvaccinated children (2.5 million), followed by India (1.4 million), the Democratic Republic of Congo (882,000), Ethiopia (782,000), Somalia (710,000), Sudan (627,000), Indonesia (538,000) and Brazil (452,000).

By proportion, a mere 25.7% of Somalian children were vaccinated in 2023, by far the lowest percentage in the world, followed by 56.3% in South Sudan.

Vaccination rates were under 75% in Guinea, Central African Republic, Angola, Democratic Republic of Congo, Nigeria, Mali and Madagascar.

“Successful vaccination programmes are built on understanding and responding to people’s beliefs, concerns, and expectations,” said lead author Dr Emily Haeuser. “Vaccination services must prioritise trust-building, engage community leaders, and tailor interventions with more culturally appropriate local strategies to improve vaccine confidence and uptake.”

Gates support, RFK address 

Ahead of the Gavi pledging event, the Global Summit: Health & Prosperity through Immunisation, the Gates Foundation announced it would commit $1.6 billion over the next five years to support Gavi.

“For the first time in decades, the number of kids dying around the world will likely go up this year instead of down because of massive cuts to foreign aid. That is a tragedy,” warned Bill Gates, chair of the Gates Foundation. “Fully funding Gavi is the single most powerful step we can take to stop it.”

The summit, co-hosted by the European Union and the Gates Foundation, seeks support for Gavi amid a global funding crisis. Overseas Development Assistance has plummeted over the past year, particularly since Donald Trump assumed the US presidency in January.

US Health and Human Services Secretary Robert F Kennedy Jr is expected to give a speech at the summit, according to Devex.

A year ago, the Biden administration pledged around $1.58 billion to Gavi over five years but the Trump administration has backtracked on this, and its 2026 budget, it has nothing allocated to the global vaccine platform.

However, the US government recently put forward Mark Lloyd as its representative to the Gavi board. Lloyd is the assistant administrator for Global Health at the US Agency for International Development. A long-time conservative activist for the Tea Party, he was a USAID religious freedom advisor in the previous Trump administration and was criticized for anti-Islamic comments. 

It is unclear what Kennedy will tell the Gavi summit, given his antipathy towards vaccines. The US is in the midst of one of its worst measles outbreaks in 30 years, and Kennedy recently fired the 17-person entire Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and replaced it with eight people comprising mostly of vaccine sceptics.

Kennedy faces heat in the US, including from Republican Senator Bill Cassidy, who has called for the meeting of the new ACIP – also scheduled for Wednesday – to be delayed.

Although the appointees to ACIP have scientific credentials, many do not have significant experience studying microbiology, epidemiology or immunology. In particular, some lack experience studying new technologies such as mRNA vaccines, and may even have a preconceived bias…

— U.S. Senator Bill Cassidy, M.D. (@SenBillCassidy) June 23, 2025

 “Wednesday’s meeting should not proceed with a relatively small panel, and no CDC Director in place to approve the panel’s recommendations,” said Cassidy on X.

“The meeting should be delayed until the panel is fully staffed with more robust and balanced representation – as required by law – including those with more direct relevant expertise. Otherwise, ACIP’s recommendations could be viewed with skepticism, which will work against the success of this Administration’s efforts.”

Image Credits: GAVI/2013/Adrian Brooks.