There’s a “paradox” at work in global health, as the philanthropist Bill Gates wrote last week. Even as funding for global health is declining, the science that supports those efforts is accelerating. And nowhere is that divergence more apparent than in the most important tool in public health: vaccines.
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Earlier this week Gavi, the Vaccine Alliance — a public-private partnership that does more than any other organization to get vaccines to people in poor countries — reported that its vaccines saved a record-breaking 1.7 million people in 2024. That’s 400,000 more lives saved than in 2023, enough to produce some $20 billion in economic benefits through reduced health care costs and healthier, more productive populations.
In total 72 million children were vaccinated through Gavi last year, with large gains in routine vaccine coverage against diseases like polio, measles, pneumonia, and yellow fever. Vaccination rates improved in some of the most fragile and conflict-ridden countries in the world, like Mali, Haiti, and Syria. And in 2024, 17 African countries received the first routine vaccinations against malaria, a disease that still kills an estimated 600,000 people each year, primarily in the world’s poorest countries.
Beneath the headlines, this is the story we should be paying attention to: the quiet, compounding power of vaccines — still the best, most effective bargain in global health — doing what they do.
The first vaccine was given on May 14, 1796, when English physician Edward Jenner scratched material from a cowpox lesion onto the arm of 8-year-old James Phipps to protect him from smallpox, a disease that killed hundreds of millions of people before it was finally eradicated in the 20th century. For the first time, doctors had a way not just to treat disease, but to prevent it altogether. In the time since, the number of diseases that can be prevented or blunted by vaccines has only grown — and with it, the number of lives saved.
For centuries, though, it was rich nations who reaped most of the benefits of vaccines. But in 1974, the WHO launched the Expanded Programme on Immunization (EIP), a global effort with the initial goal of vaccinating all children against smallpox, tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, and measles by 1990. In the years since, several other diseases like rotavirus were added, and the program became the cornerstone of global routine vaccination efforts.
A 2024 study published in The Lancet tried to gauge just how effective the EIP has been, and the numbers are remarkable. Over the first 50 years of its existence, the program’s vaccines have saved around 154 million lives, almost all of them young children, and delivered an estimated 10.2 billion years of healthy life. One single shot — the suddenly controversial measles vaccine — has been responsible for 60 percent of those lives saved.
As I’ve written before, the decline in infant and child mortality in recent decades is the single best reason to be hopeful about the state of the world. Since 1974, vaccines explain roughly two-fifths of the global decline in infant deaths, and they are responsible for over half the decline in Africa specifically.
That makes vaccines the single biggest driver of improved infant survival in the modern era. Tens of millions of adults today would have been snuffed out as children without vaccines.
While tried and true vaccines still provide the bulk of the benefits, both in rich countries like the US and in the Global South, a new class of vaccines are providing protection against diseases that seemed invulnerable.
Chief among them is malaria. As long as that ancient killer has existed, the only way to prevent it has been to not get bitten by mosquitos carrying the malaria parasite. In the US, as my colleague Umair Irfan wrote recently, that meant a long-term effort to wipe out malaria-carrying mosquitoes, and continual work to keep the country safe. In the poor tropical areas of sub-Saharan Africa and South Asia, where those mosquitoes are far more prevalent, however, the best defense has been insecticide-treated bednets that prevent bites at night. Such bednets have saved millions of lives, and have been so effective that they’re considered the gold standard for effective philanthropy.
But even better would be a vaccine that prevents or reduces transmission of the disease altogether. Two new vaccines — RTS,S and R21 — have shown the ability to reduce clinical cases of malaria by around 50 percent in the first year after vaccination. That isn’t perfect, but it’s a huge step forward at a time when climate change and urbanization have amplified the threat of vector-borne illnesses. So far, more than 12 million doses of the vaccine have been delivered since 2023.
It’s not lost on me that all this good news comes at a time when vaccines are more controversial than ever, thanks to the global spread of anti-vax sentiment. If you want to see where those attitudes can lead, just look at the US, where the drop in measles vaccination rates has directly led to the worst measles outbreak in the country in 30 years. Or Europe, which in 2024 experienced the highest number of measles cases in 25 years. The Trump administration’s moves to slash funding for mRNA research risk cutting off one of the most promising areas for future vaccines.
In rich countries, turning away from vaccines is a perversely self-inflicted wound, one that can be afforded only because vaccines have allowed us to forget the toll of these dieseases. But in the poorest countries in the world, many children aren’t getting vaccinated not because they won’t, but because they can’t. Over 14 million infants in 2024 received no vaccines whatsoever, an increase of 1.4 million from 2019.
Progress is precarious. Holding the miraculous gains made by vaccines will require reaching those zero-dose infants, tamping down measles outbreaks where coverage slipped, and resisting political moves to defund mRNA vaccine research that speeds responses to new threats. If we can do that, this year’s record will be next year’s baseline.
A version of this story originally appeared in the Good News newsletter. Sign up here!
