Document resource
Over the past 40 years, immunisation programmes in low-income and middle-income countries, particularly in Africa, have seen significant growth in development assistance through bilateral cooperation and multilateral mechanisms. 1 2 For example, the United States Agency for International Development’s investment in global immunisation efforts began in the 1980s, and Gavi, the Vaccine Alliance, was founded in 2000.1 2 However, in recent years, the Official Development Assistance for Health has steadily declined due to shifting geopolitical priorities, with 2025 marking a crucial inflexion point as major high-income countries announced substantial and sudden cuts.3 4 This comes at a time when many African nations face a ‘polycrisis’ of interconnected challenges, including rising external debt, economic uncertainty, war, conflict, epidemiological transitions and climate change, all competing for limited domestic resources. Given this array of complex challenges, it is unlikely that governments will be able to make special concessions for immunisation programmes to cover the resulting financing gaps in the near future. Furthermore, the contributory health insurance schemes in most African countries do not yet generate sufficient revenue to serve as a viable stopgap for the financing shortfalls created by these drastic cuts.5