Milestones :: Perspectives
2018 Assessment Report of the Global Vaccine Action Plan – IMMUNIZATION TODAY AND IN THE NEXT DECADE
SAGE/WHO | November 2018 :: 36 pages
[Selected excerpts; Text bolding from original]
Immunization has proven the test of time as one of public health’s most cost-effective interventions. In 2017, the number of children immunized – 116.2 million – was the highest ever reported. The Region of the Americas achieved maternal and neonatal tetanus elimination, leaving only 15 countries yet to achieve elimination. Since 2010, 113 countries have introduced new vaccines, and more than 20 million additional children have been vaccinated.
Nevertheless, this year starkly illustrates how easily hard-won gains are lost. Because of low coverage nationally, or pockets of low coverage, multiple WHO regions have been hit with large measles and diphtheria outbreaks causing many deaths. The continued detection of circulating vaccine-derived poliovirus is further evidence that national immunization programmes are not achieving the goal of reaching every child.
To spur action, the Global Vaccine Action Plan set ambitious goals, and it remains the case that most targets will not be met by the end of the Decade of Vaccines in 2020. DTP3 and first-dose measles vaccine coverage have plateaued globally at 85%. Progress towards the eradication of wild poliovirus and the elimination of measles, rubella, and maternal and neonatal tetanus is currently too slow to be achieved by the end of the decade.
This picture provides a backdrop for discussions of the future of immunization after 2020, the final year of the Decade of Vaccines. The next decade is likely to be volatile and uncertain. Continuing mass urbanization and migration, population growth, geopolitical uncertainty and conflict, and natural disasters and environmental disruption will present major challenges to national immunization systems.
To meet these challenges, the immunization community must seek to maintain its hard-won gains but also aim to do more and to do things better, which may involve doing things differently. Equity must continue to be a strong driver, to ensure that everyone enjoys the benefits of immunization, including the most disadvantaged, marginalized and hard-to-reach populations, particularly those displaced or otherwise affected by natural disasters and conflict.
Integration will be central to achieving future goals. Partnerships have been key to the successes of the Global Vaccine Action Plan, and will be critical to the future. Immunization is a central pillar of universal health coverage, providing an infrastructure on which effective and equitable health systems can be constructed. Through this integration, immunization can contribute to multiple Sustainable Development Goals as well as global health security and the battle against antimicrobial resistance.
Countries will be at the heart of a future immunization strategy. Regions will have a key role to play in supporting the development of national immunization systems, while global immunization partners will continue working together to create an enabling environment for immunization.
As attention now turns to strengthening immunization post-2020, 2017’s outbreaks are a sobering reminder that no country can take its eye off the ball: effective national immunization systems require ongoing nurturing, political commitment and public support. All countries need to see immunization systems as core to their health systems, and all citizens need to see immunization as a basic human right. In their absence, countries, regions and the world as a whole are less healthy, less safe and less prosperous. We become complacent at our own peril…
More people than ever before benefited from immunization in 2017. Although the world remains off track to reach many of the goals set out in the Global Vaccine Action Plan, these were designed to be ambitious and stretching, and it is important not to lose sight of the great progress that has been made. Even so, the consequences of not achieving global goals have been vividly illustrated with the resurgence of measles and diphtheria and the persistence of poliovirus and maternal and neonatal tetanus.
The final years of the Decade of Vaccines provide us with an opportunity to drive forward immunization in pursuit of the Global Vaccine Action Plan goals. Past successes illustrate what can be achieved by countries prioritizing immunization, producing integrated development plans, and working with national, regional and global partners on their implementation. Despite many challenges, between 2011 and 2017, an additional 20 million children were vaccinated – but we can do even better.
Now is the time to learn the lessons from the Decade of Vaccines to shape a post-2020 strategy that enables the world to sustain its hard-won gains and expand the benefits of immunization to those currently missing out and to older age groups. The next chapter of immunization must also be one of integration, with immunization consolidating its position as a pillar of universal health coverage and primary healthcare, and contributing to the safer, healthier and more prosperous world envisioned in the Sustainable Development Goals.
Countries, regions and global immunization partners should commit to developing an integrated post-2020 global immunization strategy:
:: A comprehensive review should be undertaken of progress, impact and implementation of the Global Vaccine Action Plan to inform a post-2020 strategy.
:: The monitoring and evaluation framework for the Global Vaccine Action Plan should be reviewed to inform the development of a revised framework for a post-2020 strategy.
:: A post-2020 strategy should build on the lessons learned during the Decade of Vaccines and draw upon the key themes identified in this 2018 Assessment Report.
Global Vaccine Action Plan priorities, adapted to reflect changing contexts and lessons learned, should drive immunization activities until the end of the Decade of Vaccines:
:: A major focus should be tailored country support to build and sustain robust and effective national immunization systems aligned with national plans for achieving universal health coverage.
:: A best practice framework should be developed to ensure equitable access to immunization services for migrant, displaced and disadvantaged populations, including those affected by humanitarian emergencies.
:: Nurturing individual and community demand for immunization should be given high priority within countries.
The contributions of research to immunization should be enhanced and expanded:
:: Vaccine research and development (R&D): Connections between vaccine R&D and implementation communities should be further strengthened to ensure close collaboration in new product design, development and evaluation.
:: Immunization systems: More use should be made of implementation, operational and other research to improve the performance of national immunization systems, and to evaluate innovations in service delivery to reach underserved populations.
:: Immunization research capacity in low- and middle-income countries should be developed across all these areas.