<p>Vaccination is widely considered to be the pre-eminent public health achievement of modern history, but declining coverage resulting from vaccine hesitancy and from interruptions in immunization campaigns in geopolitically unstable regions threatens progress against vaccine-preventable diseases. The global burden of vaccine-preventable neurological diseases is substantial, resulting in acute and chronic complications as well as high case fatality rates. In recent years, outbreaks of dengue, poliomyelitis, measles, pertussis, meningococcal disease and Japanese encephalitis virus have been linked to lack of access to vaccines, overwhelmed health-care systems, misinformation and disinformation regarding vaccine safety, and gaps in vaccination coverage caused by environmental factors and geopolitical conflicts. Coordinated global strategies, including addressing barriers to vaccination and ensuring equitable access; targeted health education about vaccine benefits and risks; integration with other public services; and advances in next-generation vaccine technologies to tackle antimicrobial resistance and non-vaccine serotype replacement, will be crucial to prevent a resurgence of vaccine-preventable neurological diseases, especially in vulnerable populations, to maintain global health security.</p>