Global vaccination targets ‘off-track’ warns WHO
22 APRIL 2015 | GENEVA – Progress towards global vaccination targets for 2015 is far off-track with 1 in 5 children still missing out on routine life-saving immunizations that could avert 1.5 million deaths each year from preventable diseases. In the lead-up to World Immunization Week 2015 (24–30 April), WHO is calling for renewed efforts to get progress back on course.
In 2013 nearly 22 million infants missed out on the required three doses of diphtheria-tetanus-pertussis-containing vaccines (DTP3), many of them living in the world’s poorest countries. WHO is calling for an end to the unnecessary disability and death caused by failure to vaccinate.
“World Immunization Week creates a focused global platform to reinvigorate our collective efforts to ensure vaccination for every child, whoever they are and wherever they live,” said Dr Flavia Bustreo, WHO Assistant Director-General, Family, Women’s and Children’s Health. “It is critical that the global community now makes a collective and cohesive effort to put progress towards our 6 targets back on track.”
In 2012, all 194 WHO Member States at the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP), a commitment to ensure that no one misses out on vital immunization. However, a recent independent assessment report on GVAP progress rings an alarm bell, warning that vaccines are not being delivered equitably or reliably and that only 1 of the 6 key vaccination targets for 2015 is currently on track – the introduction of under-utilized vaccines.
Many countries worldwide have experienced large measles outbreaks in the past year, threatening efforts to achieve the GVAP target of eliminating measles in 3 WHO Regions by end-2015.
Actions to get back on track
A global collaborative drive for immunization, begun in the mid-1970s — with the establishment of the Expanded Programme on Immunization in all countries — achieved dramatic results, raising vaccination levels from as low as 5% to more than 80% in many countries by 2013. WHO estimates that today immunizations prevent between 2 and 3 million deaths annually and protect many more people from illness and disability.
Although progress has stalled in recent years, this early success demonstrates the potential of vaccines, which are increasingly being extended from children to adolescents and adults, providing protection against diseases such as influenza, meningitis and cervical and liver cancers.
The GVAP recommends three key steps for closing the immunization gap:
:: integrating immunization with other health services, such as postnatal care for mothers and babies;
:: strengthening health systems so that vaccines continue to be given even in times of crisis; and
:: ensuring that everyone can access vaccines and afford to pay for them.
Dr Jean-Marie Okwo-Belé, Director of Immunization, Vaccines and Biologicals at WHO, says the Organization will work to increase its support to all countries that are lagging behind in meeting immunization targets. In May this year, WHO will bring together high-level representatives of 34 countries with routine vaccination (three doses of DTP3) coverage of less than 80% to discuss the challenges faced by countries and to explore solutions to overcome them.
Although many countries are already vaccinating four out of five children with DTP3, a full one-third of countries are still struggling to reach the ‘fifth child’, meaning millions of children remain at risk of illness, disability or death because they are not getting the immunizations they need.
“There is no one centralized approach that can ensure vaccines are delivered and administered to each child. Vaccination plans on the ground need to be adapted not just to countries, but to districts and communities,” said Dr Okwo-Belé.“What is required is a truly concerted effort and much stronger accountability so that each one of the key players involved fulfills its mandate and helps close the immunization gap.”
Critical operational needs to ensure wider vaccination and delivery on the ground, include:
:: finding ways to simplify vaccination procedures in the field;
:: improving vaccination delivery to reach every last child, especially those living in remote and inaccessible areas;
:: ensuring vaccine affordability and strengthening vaccine supply chains;
:: training more health workers, skilled managers and providing supportive supervision;
:: improving the quality of data collected by countries and using this to improve immunization operations;
:: overcoming challenges posed by conflict, natural disasters and other crises;
:: increasing awareness and demand for immunization by communities; and
:: greater accountability linked to micro-planning of vaccination operations and clear lines of responsibility.
Earlier this year, donor countries and institutions pledged to meet the funding needs of Gavi, the Vaccine Alliance that brings together public and private sectors to create equal access to new and underused vaccines for children living in the world’s poorest countries.
Note to editors
The Global Vaccine Action Plan envisions a world where everyone lives life free from vaccine preventable diseases by 2020. It set 6 targets for 2015:
Immunization against diphtheria, tetanus and whooping cough (DTP3)
Target: 90% immunization coverage against diphtheria, tetanus and whooping cough by 2015.
Gap: 65 countries
Introduction of under-utilized vaccines
Target: At least 90 low or middle income countries to have introduced one or more under-utilized vaccines by 2015.
Target: No new cases after 2014
Gap: 3 countries remain polio endemic
Maternal and neonatal tetanus: Global elimination by end-2015
Target: Eliminate maternal and neonatal tetanus
Gap: 24 countries
Target: Eliminate from three WHO regions by end-2015
Gap: 16% of all children are not being immunized against measles
Target: Eliminate rubella from two WHO regions by end-2015
Gap: Half of all children do not receive the rubella vaccine
Together we can close the immunization gap
Dr Jean-Marie Okwo-Bele, Director of the Department of Immunization, Vaccines and Biologicals
22 April 2015
Sixty years ago this month, the results of extensive field trials of Jonas Salk’s polio vaccine were published. The trials, which had involved a total of 1.8 million children, had been a resounding success. Later that year the vaccine was licensed for manufacture and the US launched the world’s first mass vaccination campaigns.
By 2014, WHO had certified 4 of its 6 regions polio-free and 80% of the world’s population now lives in countries where this highly infectious and devastating disease has been eradicated.
As a young medical student in the Democratic Republic of the Congo (DRC) in the late 1970s, I knew I wanted to focus my efforts in an area that could bring the greatest benefits to the greatest number of people. I feel very fortunate that this ambition took me straight into the field of vaccinations and to the work of the Expanded Programme on Immunization (EPI), a global, collaborative drive for immunization that began in 1974.
When EPI was first launched, only about 5% of the world’s children were protected from 6 diseases (diphtheria, measles, pertussis, polio, tetanus and tuberculosis). By 2013, that figure had risen to more than 80% in many countries and the number of vaccines used had almost doubled.
Stopping vaccine-preventable diseases
In DRC, I saw vaccination rates increase from less than 10% to around 60% in the course of just a few years. That we could achieve these results in a country such as DRC, which is the size of western Europe but faces immense challenges in terms of infrastructure and health systems, should give us all hope that we can now take immunization to the next level where no child, regardless of where they live or their economic status, is left vulnerable to vaccine-preventable diseases.
At WHO, we estimate that between 2 and 3 million deaths are prevented each year through immunization. Work in vaccine development means protection is increasingly being extended beyond the original 6 diseases. Many countries now vaccinate against Haemophilus influenzae type b, a bacteria responsible for severe pneumonia and meningitis in children, hepatitis B, and pneumococcal disease. This list will only continue to grow.
Yet, tragically, there are still around 1.5 million deaths each year as a result of vaccine-preventable diseases. We are way off-track to meet our end-2015 targets set out in the Global Vaccine Action Plan, which was endorsed by all Member States at the World Health Assembly in 2012. In figures that means 1 in 5 children are missing out on life-saving vaccinations. In practice it means millions of families around the world still witness loved ones suffer illness, disability and even death from diseases that we have the knowledge and the tools to prevent.
Tailoring vaccination strategies to meet challenges
Of course there is no one-size-fits-all solution to this global health challenge. Often those infants who are missing out on vaccinations live in rural, isolated communities and urban slums in some of the world’s poorest communities. Many also live in areas that are seriously affected by conflict or insecurity.
We do know what needs to be done and the tools and the capacity do already exist in most countries. We need to work at both global and country levels to mobilize resources and support immunization in each and every community. This involves micro-planning to tailor vaccination strategies to suit the needs of myriad different situations and environments, it involves finding new ways to simplify vaccine processes in the field, and it involves monitoring outcomes, measuring progress and taking collective actions.
The hallmark of successful immunization programmes is their simplicity – they can be adapted to every setting, even where there is conflict or other crises. They work at all different levels of health systems to ensure sustainable delivery of immunization services, be it in fixed health facilities or through outreach and mobile vaccinators, so that each child is reached.
Closing the immunization gap through accountability
At the grassroots level, community leaders have an important role to play in immunization programmes, ensuring that parents and caregivers understand the importance of vaccination. Ensuring accountability at every stage of immunization programmes is critical. In Nigeria, which is on the verge of eradicating polio, local government officials are held accountable for vaccinating children, thus ensuring better management of polio campaigns and of the resources that are allocated to them.
To fulfil our vision of a world free of vaccine-preventable diseases, each key player must fulfil their mandate from parents, to health workers, to programme managers, governments and partners.
Together we can close the immunization gap. When I began my career in public health 34 years ago, I could not have imagined that in my working life I would witness an Africa free of polio. We are so close to achieving this goal now. My dream now is to see much faster improvement in routine immunization coverage so that in 2 years’ time we are not still talking about how to reach that fifth child.