Milestones :: Perspectives
2017 Assessment Report of the Global Vaccine Action Plan
Strategic Advisory Group of Experts on Immunization
WHO, October 2017 :: 36 pages
EXECUTIVE SUMMARY [text bolding from original]
In 2016, some progress was made towards the goals set out in the Global Vaccine Action Plan (GVAP). The year saw the fewest number of cases of wild poliovirus ever reported, and three more countries were certified as having achieved maternal and neonatal tetanus elimination. Nine additional countries have introduced new vaccines. Overall DTP3 vaccination coverage increased, but by only 1% to 86%. Progress therefore still remains too slow for most goals to be reached by the end of the Decade of Vaccines in 2020.
Furthermore, multiple global, regional and national issues threaten further progress, and have the potential to reverse hard-won gains. Economic uncertainty, conflicts and natural disasters, displacement and migration, and infectious disease outbreaks all pose major challenges to immunization programmes. At the same time, there are concerning signs of complacency and inadequate political commitment to immunization – as well as a global lack of appreciation of its power to achieve wider health and development objectives.
Additional risks include growing levels of vaccine hesitancy and the worrying rise in stockouts disrupting access to vaccines – related primarily to shortcomings in vaccine procurement and distribution but also to some extent to vaccine production. The continued marked underperformance of certain countries relative to others within their region – ‘outlier’ countries – remains of grave concern.
The potential impact of the phase-out of funding for polio eradication is also of concern. It is vital that the polio transition remains sufficiently flexible that it does not jeopardize ongoing outbreak control efforts or critical surveillance activities and post-eradication certification processes. Furthermore, there is a significant risk that wider surveillance activities and routine immunization programmes, and hence global health security, could be compromised during the polio transition. The potentially simultaneous phasing out of polio and Gavi funding and technical support is of further concern.
These risks threaten to slow the extension of vaccines to neglected populations and heighten global inequalities in vaccine access. As the Decade of Vaccines draws to a close, there is a need to intensify global efforts to promote immunization and to address the systemic weaknesses that are limiting equitable access to life-saving and life-changing vaccines, particularly in outlier countries and middle-income countries.
The recommendations made in the Strategic Advisory Group of Experts on Immunization (SAGE) 2016 Assessment Report informed the development of World Health Assembly Resolution WHA70.14, approved in May 2017, and remain a high priority. In light of the risks highlighted, SAGE also calls for a broadening of the dialogue, to align immunization with emerging global health and development agendas, including the sustainable development goals, global health security and International Health Regulations, health systems strengthening and universal health coverage, and the battle against antimicrobial resistance. A concerted effort is also required to address outlier countries, through a multidimensional, system-wide approach, recognizing that complex issues require multifaceted solutions and that civil society organizations have important contributions to make.
Through these and other measures, progress can continue to be made towards GVAP goals and the ground laid to exploit the full potential of immunization post-2020.
RECOMMENDATIONS IN BRIEF
See page 29 for more detailed versions of these recommendations.
 Broadening the dialogue: The immunization community should ensure that immunization is fully aligned and integrated with global health and development agendas, including global health security and International Health Regulations, health systems strengthening and universal health coverage, and the battle against antimicrobial resistance
 Funding transitions: Until polio eradication is achieved, financial and technical support should be maintained in at least the 16 polio priority countries to ensure the success of eradication efforts and to mitigate the risks to infectious disease surveillance, routine immunization and global health security more generally
 Polio and communicable disease surveillance: Countries in all regions should ensure they maintain effective poliovirus surveillance capacities through the polio endgame and beyond, and build on the polio surveillance platform to strengthen communicable disease surveillance systems, especially for measles and rubella, and other vaccine preventable diseases
 Outlier countries: WHO regional offices should work with countries experiencing the greatest difficulties in achieving GVAP goals to develop and implement multidimensional remediation plans, integrating existing national improvement plans
 Maternal and neonatal tetanus: The immunization community should make concerted efforts to achieve elimination by 2020, in particular by exploiting compact pre-filled auto-disable devices to extend the reach of immunization
 Displaced, mobile and neglected populations: WHO should synthesize existing knowledge on reaching displaced and mobile populations – including individuals escaping conflict zones or natural disasters, economic migrants, seasonal migrants, those moving to urban centres, and traditional nomadic communities – and other neglected populations to identify good practice and gaps in knowledge
 Acceptance and demand: Each country should develop a strategy to increase acceptance and demand for vaccination, which should include ongoing community engagement and trust-building, active hesitancy prevention, regular national assessment of vaccine concerns, and crisis response planning
 Civil Society Organizations: Countries should broaden and deepen their engagement with CSOs to enhance the performance and reach of their national immunization programmes
 Technical capacity-building: WHO regional offices should work with regional and global partners to support national technical capacity-building, adopting a multidimensional approach and leveraging regional and national institutional capacities and expertise as well as global tools and resources
 Vaccine access: WHO regional offices and UNICEF should work with countries to identify and systematically address procurement and other programmatic issues affecting vaccine access
 Vaccine supply: UNICEF, WHO and global partners should continue and expand efforts to map current and anticipated vaccine supply and demand for routinely used vaccines, with a particular focus on vaccines most at risk of supply shortages
 Middle-income countries: WHO regional offices should support middle-income countries in their regions by leveraging all opportunities to promote the exchange of information, the sharing of lessons learned and peer-to-peer support