Getting back on track to meet global anaemia reduction targets: a Lancet Haematology Commission.
Atkinson SH., Suchdev PS., Bode M., Carducci B., Cerami C., Mwangi MN., Namaste S., Winichagoon P., Leung S., Mutua AM., Abuga KM., Angeles-Agdeppa I., Blythe R., Carvalho N., Cepeda-Lopez A., Cross JH., de Pee S., Di Ruggiero E., Fanzo J., Gentilini U., Gichohi-Wainaina WN., Glover-Wright C., Gomes F., Hess S., Holloway-Brown J., Joof F., Karakochuk C., Kassebaum NJ., Larson L., Mettananda S., Muriuki JM., Mwangome M., Ohuma EO., Oliver V., Perumal N., Phiri K., Samuel F., Sinharoy S., Tizifa T., Valleriani G., van Zutphen-Küffer KG., Vasta F., Verhoef H., Wang Y., Yadav K., Yang Z., Young M., Zimmermann MB., Pasricha S-R.
GLOBAL BURDEN AND DATA GAPS: Many countries lack reliable data on anaemia prevalence, especially for populations beyond young children and women of reproductive age. Few national surveys measure both anaemia and its underlying causes. We call for the creation of a standardised global data repository and the development of a harmonised micronutrient survey platform to collect comprehensive, periodic data. We also recommend better integration of data across sources, including household surveys and other health data sources, and inclusion of haemoglobin assessment in existing survey platforms that already collect venous blood. Continued financial support and coordination of demographic and health surveys are crucial, especially in light of potential reductions in U.S. funding for global data initiatives. ANAEMIA AETIOLOGY AND MANAGEMENT: The causes of anaemia are multifactorial including iron deficiency, other micronutrient deficiencies, infections, inflammation, blood loss, and inherited blood disorders. We identify critical knowledge gaps in the complex interactions between these risk factors across life stages in different populations. We recommend targeted research to elucidate underlying mechanisms, improved tools for assessing anaemia determinants, advanced nutritional interventions, and integration of infection control with nutrition programs. Specific areas highlighted for further research include optimising iron dosing and formulations, effective combinations of micronutrients, improving fortification and biofortification strategies, and evaluating non-nutritional interventions such as delayed cord clamping and infection control, and management of heavy menstrual bleeding and post-partum haemorrhage. We also emphasise the need to address environmental factors contributing to anaemia, such as air pollution and climate change. IMPLEMENTATION AND GOVERNANCE: Effective implementation of anaemia control programs requires tailored, multi-sectorial strategies and ongoing monitoring. Our key recommendations for effective implementation of anaemia reduction programmes are: (1) developing clear governance structures at global, national and sub-national levels to ensure proper oversight and accountability; (2) broadening national nutrition plans to incorporate cross-sector coordination and efficient management of anaemia-related strategies, and (3) placing social equity and fundamental human rights at the centre of anaemia-focused policies and interventions. REDEFINING FUTURE ANAEMIA REDUCTION TARGETS: This Commission critically evaluates the process by which the 2030 anaemia targets were set and proposes a more evidence-based, context-specific approach. Key limitations of the current 50% anaemia reduction target are: (1) not clearly accounting for country-specific contexts; (2) focussing on overall prevalence of anaemia rather than anaemia disease burden; and (3) a reduction target for magnitude that was unachievable using available interventions even if maximally deployed. We proposed a novel target-setting framework based on health economic modelling. This approach incorporates national anaemia prevalence, current intervention coverage and effectiveness, potential scale-up costs, and a range of potential country-specific cost-effectiveness thresholds. This approach aims to balance ambition with achievability while maintaining a unified global vision. Preliminary application of this method suggests a global summary target of 12–22% reduction in anaemia prevalence, significantly lower than the current 50% target, with marked variation in country-specific targets. We advocate for a participatory, iterative target-setting process aligning with local priorities and resources. CONCLUSION: Reducing the burden of anaemia requires a comprehensive, multi-sectorial approach that considers its complex aetiology and varied impacts across populations. By adopting the recommendations outlined in this Commission—including improved data systems, more targeted research, integrated programme implementation, and evidence-based target-setting—the global health community can renew momentum toward meaningful anaemia reduction. Achieving progress will require sustained political commitment, increased investment, and coordinated action from governments, international agencies, civil society, and researchers. As the global health agenda evolves beyond the 2030 Sustainable Development Goals, the insights and strategies presented in this Commission offer a roadmap for a more effective, equitable, and sustainable approach to tackling anaemia worldwide.