Getting back on track to meet global anaemia reduction targets: a Lancet Haematology Commission

Anaemia, a condition affecting more than 1·9 billion people worldwide, disproportionately affects children, adolescent girls, and women. Despite longstanding interventions and guidelines, most countries are not on track to meet global anaemia reduction targets, and cuts in global health funding in 2025 further threaten progress. This Lancet Haematology Commission aims to reinvigorate efforts to prevent and control anaemia by addressing key gaps in data, evidence, implementation, governance, and target-setting approaches.
For many countries, there is a paucity of reliable data on anaemia prevalence, especially for populations beyond young children and women of reproductive age, and only a 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, data periodically. We also recommend better integration of data across several sources, including household surveys, and the 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 considering potential reductions in USA funding for global data initiatives.
The causes of anaemia are multifactorial and include iron deficiency, other micronutrient deficiencies, infection, inflammation, blood loss, and inherited blood disorders. We identify crucial knowledge gaps in the complex interactions between these risk factors across life stages in different populations. We recommend targeted research to elucidate underlying mechanisms, improve tools for assessing anaemia determinants, advance nutritional interventions, and integrate infection control with nutrition programmes. 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, infection control, and management of heavy menstrual bleeding and postpartum haemorrhage. We also emphasise the need to address environmental factors contributing to anaemia, such as air pollution and climate change.
Effective implementation of anaemia control programmes requires tailored, multisectoral strategies and ongoing monitoring. Our key recommendations are developing clear governance structures at global, national, and subnational levels to ensure proper oversight and accountability; broadening national nutrition plans to incorporate cross-sector coordination and efficient management of anaemia-related strategies; and placing social equity and fundamental human rights at the centre of anaemia-focused policies and interventions.
This Commission critically evaluates the process by which the 2030 anaemia targets were set and proposes a more evidence-based, context-specific approach to them. Key limitations of the current 50% anaemia reduction targets are that they do not account for country-specific contexts, they focus on overall prevalence instead of anaemia disease burden, and the reduction target for magnitude is unachievable using available interventions, even if maximally deployed. We propose 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 applications of this method suggest a global summary target of 12–22% reduction in anaemia prevalence by 2030—which is substantially lower than the current 50% target—with marked variation in country-specific targets. We advocate for a participatory, iterative target-setting process that aligns with local priorities and resources.
Reducing the burden of anaemia requires a comprehensive, multisectoral approach that considers its complex causes and varied effects 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 towards meaningful anaemia reduction. 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.