This study examines the strategic directions for the development of vaccination programs in Romania in the context of declining vaccination coverage and public confidence. The research was based on a complex methodology that included literature review, quantitative analysis of the perspectives of 1,162 family physicians (71% response rate) and qualitative research through expert interviews and consultative webinars. The results highlight important challenges: vaccination coverage below the European average, disruptions in the supply chain, insufficient financial motivation for health professionals, lack of consistent public information and an incomplete legislative framework. The SWOT analysis identified Romania's immunization tradition and existing structures as strengths and political commitment and multi-sectoral interest as opportunities. The study defines six strategic areas for intervention: clear public policy, adequate financing, institutional capacity, operational management, research and public awareness. The report points out that vaccine hesitancy has increased due to stock discontinuity and ineffective communication, recommending a comprehensive approach to restore public confidence.