Navigating the Evolving Landscape for Next-Generation Vaccines: Enhancing Proven Strategies to Build Confidence and Drive Vaccination Equity and Uptake

Navigating the global vaccine landscape is becoming increasingly complex, shaped by growing vaccine hesitancy driven by persistent misinformation, shifts in policies dictating access to preventive services, and growing uncertainty around the long-term financing of immunization programs. In low- and middle-income countries, declining donor support and constrained national budgets threaten the sustainability of routine immunization and the introduction of newer vaccines. Meanwhile, high-income countries, while typically self-financing, are grappling with rising program costs due to the introduction of high-value vaccines (e.g., RSV, next generation HPV), growing demands for life-course immunization, and challenges reaching underserved populations through fragmented delivery systems. Across all contexts, these intersecting pressures are reshaping how vaccines are prioritized, funded, and delivered.

Despite being one of the most cost-effective tools for preventing disease and saving lives, vaccines face increased skepticism from the public and declining prioritization by some governments and donors. This is especially concerning given that over the past 50 years, global immunization efforts are estimated to have saved at least 154 million lives and have contributed to a 40% reduction in infant mortality. Yet today, public trust in vaccines is being eroded not only by misinformation but also by some health care professionals who publicly question their value. When individuals with medical credentials cast doubt, intentionally or not, it amplifies confusion and skepticism, especially among communities already wary of health systems.

The ripple effects of misinformation or disinformation are far-reaching: lower immunization rates, re-emergence of preventable diseases, and deepening inequities in global health outcomes. In 2025, measles has resurged both in the United States and globally, with the U.S. reporting over 600 cases (more than double the total in 2024) while countries such as the UK, Australia, and several across the WHO European Region are also experiencing outbreaks. Even localized epidemics like these can strain health systems, as resources are redirected toward outbreak response, which often leads to deprioritizing of other critical health services, such as routine immunizations, maternal care, and chronic disease management.

At the same time, changes in global financing – such as the recent decision by the U.S. to withdraw funding from Gavi, a global initiative to purchase and distribute vaccines that has immunized more than 1 billion children since its launch in 2000 – are weakening the multilateral system that many low- and middle-income countries rely on for vaccine access. Disrupting Gavi’s funding base could affect global supply chains, delay the development and rollout of new vaccines, and create gaps that even well-resourced high-income countries may experience.

Without sustainable funding commitments, these systems may struggle to maintain routine immunization, as well as take on the introduction of new vaccines.

These shifts don’t just threaten health outcomes; they also undermine economic resilience. Under vaccination could impact the health and lifespans of nearly 100 million children and adolescents worldwide, weakening the future labor force. As these cohorts age into working adulthood, avoidable illness and disability could reduce productivity, strain health systems, and increase dependency ratios. Protecting this group through strong immunization programs is not only a public health priority but a long-term economic imperative.

These developments underscore the urgent need for renewed investment, coordinated action, and bold advocacy to protect and advance vaccine equity – not just in low-and middle-income countries, but also in high-income settings, where declining childhood immunization rates, growing vaccine hesitancy, underinvestment in immunization platforms beyond infancy (such as for adolescents, adults, and pregnant women), and widening access gaps are exposing health system to preventable risks. According to a 2023 UNICEF report, confidence in childhood vaccines declined in 52 out of 55 countries surveyed, with particularly sharp drops in high-income countries like Japan and the United States, underscoring growing global hesitancy and the urgency of rebuilding trust in immunization.

Vaccine introduction in a shifting immunization landscape

Within this already challenging landscape, introducing a new vaccine (defined as those that have received regulatory approval and /or have been introduced into the population within the last decade) – like those for respiratory syncytial virus (RSV), human papillomavirus (HPV), mpox, malaria – is even more complex. Unlike traditional childhood immunizations, which benefit from decades of trust, routine use, and institutional support, introducing new vaccines like HPV and RSV is not just a matter of navigating a challenging environment; it also requires grappling with unique delivery and systems challenges that differ significantly from traditional childhood immunization.

For example, HPV vaccines are often administered through school-based programs, which effectively reach adolescents enrolled in schools. However, this approach means access depends on the strength of the education systems and may inadvertently exclude out-of-school adolescents. On the other hand, RSV vaccination is complicated by its seasonal nature and the diverse target groups, including pregnant women, newborns, and older adults. Rolling them out requires more than just logistics; it demands that countries create new delivery systems, update policies, train health care professionals, raise public awareness, and determine financing pathways.

While established strategies such as transparent communication, culturally relevant engagement, and partnerships with trusted community actors remain vital, introducing vaccines like RSV and HPV necessitates an evolved approach that views these introductions as opportunities to strengthen health systems. This means designing vaccine delivery around the people and platforms that communities already trust. For RSV, that might include training midwives to administer vaccines during routine check-ups or leveraging traditional birth attendants and community health workers to raise awareness of new vaccines – an approach that builds on existing relationships and effectively reaches pregnant women who may not otherwise access immunization services. It could also involve exploring delivery mechanisms through pharmacies, mobile clinics, or integrated with other services, such as maternal/child health services, adolescent health visits, or family planning visits.

Introducing new vaccines is not only an opportunity to protect people today, but also a catalyst for strengthening immunization systems for the future. Each new vaccine prompts systems to evolve, driving investments in delivery platforms, improving cold chain infrastructure, health worker training, and refining outreach strategies. These enhancements extend far beyond a disease area; they contribute to more resilient health systems, capable of delivering a broader range of health services and adapting to future public health needs and challenges.

Confidence: Building trust in a new era of immunization

New vaccines face a higher bar for public trust. Concerns about safety, accelerated development timelines, and widespread misinformation – often amplified through social media – fuel skepticism, particularly for vaccines not included in traditional childhood immunization schedules.

For vaccines like RSV, the use of multiple tools (maternal vaccines, monoclonal antibodies) targeting different age groups increases the complexity of messaging and delivery, which can create confusion or reluctance to adopt. These challenges are heightened by limited public understanding of the virus and its health risks.

Health equity: Ensuring no one is left behind

In high-income countries, inequities in access and uptake are driven by policy variations, including inclusion in national strategies and vaccine reimbursement, and disparities across race, geography, and socioeconomic status. For instance, in rural areas of the U.S. and Europe, uptake for newer vaccines is often lower, not necessarily because communities lack awareness, but because trusted sources of information often lie outside traditional health systems. When guidance from neighbors, faith leaders, or community groups differs from official recommendations, people naturally follow the voices they trust most. Combined with limited health workforce capacity and fewer vaccine access points, these trust dynamics contribute to coverage gaps. This is especially critical for RSV, where at-risk populations such as infants in underserved communities are most in need of protection.

Meanwhile, in low- and middle-income countries, potential reductions in U.S. funding for Gavi threaten the sustainability of immunization programs that reach the most vulnerable populations. Without this support, vaccine access could be delayed or disrupted, especially for newer vaccines like RSV that are not yet integrated into national plans, further widening global equity gaps.

RSV also presents unique delivery issues, particularly around deciding whether to prioritize immunizing pregnant women or newborns. Choosing between these approaches required countries to assess the strength of their antenatal care platforms versus their newborn delivery infrastructure. In settings with low ANC attendance, newborn immunization may offer more reliable coverage. Financial considerations are also a critical factor. Governments must weigh not only delivery feasibility but also the implications for reimbursement and cost containment. Maternal immunization may align more easily with existing public financing mechanisms, such as maternal health packages, while monoclonal antibodies may require separate reimbursement pathways or fall outside of routine immunization budgets. These choices can shape which populations get prioritized based on what’s more affordable to pay for within a country’s health financing structure.

Uptake: From innovation to impact

The path from vaccine approval to widespread adoption is often long and uneven. Even in well-resourced settings, systemic barriers, such as fragmented delivery systems, inconsistent provider recommendations, and complicated access pathways, can hinder uptake.

For RSV, missed opportunities are already visible. In the United States, many hospitals do not administer RSV immunizations to infants at birth, despite the fact that about 70% of U.S. infants receive the hepatitis B vaccine at birth. This gap highlights the importance of integrating new vaccines into standard care practice from the start.

HPV vaccines face different but equally important barriers. Despite being widely available and often covered by national immunization programs, uptake remains uneven due to stigma around sexual activity, inconsistent school-based delivery policies, and provider discomfort discussing the vaccine with parents and adolescents. In some countries, HPV uptake among boys also lags behind, in part due to outdated messaging that frames the vaccine as “only for girls.”

We are at a turning point. The introduction of new vaccines and the global conversation around vaccine trust offers a moment to reset, recommit, and reimagine how we protect health for all. We help our clients navigate this complexity by designing strategies that go beyond approval and supply. We support vaccine introduction through trust-building approaches rooted in clear, tailored audience communication, stakeholder engagement, and community insight. We work with clients to identify and close health equity gaps, ensuring access isn’t limited by geography, income or health system variation. Whether developing country-level rollout strategies in both high- and low-income settings, generating demand-side insights or building the case for investment, we help clients position vaccines for success in today’s dynamic and evolving global health landscape.