Strengthening global immunization efforts to leave no-one behind

WHO Executive Board
Strengthening global immunization efforts to leave no-one behind
The Seventy-third World Health Assembly,
Having considered the report on the global vaccine action plan,1

Recalling resolutions WHA65.17 (2012) and WHA68.6 (2015) on the global vaccine action plan (2011–2020); resolution WHA67.23 (2015) on health intervention and technology assessment and WHA70.14 (2017) on strengthening immunization; and the global vision of defeating meningitis by 2030;

Recognizing the important contribution of vaccines and immunization to achieve the Sustainable Development Goals and that immunization contributes directly or indirectly to 14 of the 17 Goals;

Recalling the Political Declaration of the High-level Meeting on Universal Health Coverage “Universal health coverage: moving together to build a healthier world,” and its commitment to improve routine immunization and vaccination capacities as a fundamental contribution to universal health coverage;

Recalling the Global Vaccination Summit jointly organized by the European Commission and the WHO (2019), which identified 10 Actions Towards Vaccination for All, and set out priority areas for future collaboration;

Appreciating the contribution of the global vaccine action plan in galvanizing global immunization efforts to allow individuals to live free from vaccine-preventable diseases;

Noting with concern that despite the progress made during the past decade, 8 of the 9 goals of the global vaccine action plan will not be achieved by 2020, which underscores the need and urgency to set a new global vision and strategy for vaccines and immunization for the next decade, to accelerate progress and ensure a smooth transition away from global vaccine action plan, reflecting lessons learned;

Recognizing that although the introduction of new vaccines has contributed to reducing morbidity and/or mortality from vaccine-preventable diseases, significant barriers to timely and equitable access to vaccines remain, with significant variations of vaccine coverage and equity both between countries and within countries, including at the subnational level, and with an unacceptably slow pace of progress towards increasing equitable access to life-saving vaccines, ending cholera, and eliminating measles, rubella, and maternal and neonatal tetanus;

Recognizing also the increase in vaccine-preventable disease outbreaks occurring globally, which are stark reminders of backsliding in progress to reduce vaccine preventable disease burden and impact;

Recognizing the role that misinformation and uncertainty play in reducing public trust and confidence in vaccines, despite their proven safety and effectiveness in promoting individual, family and community health;

Noting with particular concern that, although Member States in all six WHO regions have measles elimination goals, and that four regions have rubella elimination goals, measles is undergoing an alarming resurgence with significant outbreaks in all six regions, creating an urgent need for additional efforts in order to reach measles and rubella elimination, through the primary strategy of strengthening routine immunization but also by considering control measures based on the local/regional epidemiology;

Recognizing the significant progress achieved towards polio eradication, but also noting continuing concerns with the persistence of wild-type polio, the rising number of vaccine-derived polio outbreaks, and reiterating the need for strong cross-border cooperation and implementation of necessary requirements concerning vaccination for travellers in accordance with the International Health Regulations (2005), and the need to integrate core polio functions, human resources, and infrastructure into national immunization programmes and health systems as polio eradication goals are met;

Recognizing also that community engagement and integrated, people-centred essential immunization programmes, as a part of a strong health system, are the cornerstones of primary health care and core to achieving immunization goals and targets;

Further recognizing the need for increased investment in research and development and innovation, including to improve timely and expanded access to vaccines of assured quality and diversification of manufacturing sources, including for vaccines such as against malaria that affect specific areas or communities of the world, and for new forms of delivery and service approaches to enhance coverage, equity and efficiency of immunization programmes while meeting the global demand;

Welcoming efforts to promote national and global forecasting, planning and procurement capacities, including through pooled procurement, and recognizing the importance of more accurate vaccine demand and supply forecasting, regular monitoring of vaccine stock levels, measures to assure and maintain supply security, and timely decisions on procurement to address recurrent vaccine shortages and stockouts in the short term,

1. WELCOMES the new global vision and strategy for vaccines and immunization “Immunization Agenda 2030”, recognizing the critical role of vaccines and immunization as a part of primary health care, to achieve universal health coverage and the Sustainable Development Goals, and notes that IA2030 provides the policy and technical framework for vaccines and immunization at the global, regional, and country levels, and looks forward to the operational elements of Immunization Agenda 2030, including its Monitoring and Evaluation Framework, governance mechanism, and operational plans at the regional level;

2. CALLS FOR enhanced cooperation at the global, regional and country levels to strengthen the capacities of countries to integrate their immunization programmes into primary health care and to achieve and sustain the goals of the Immunization Agenda 2030, including efforts to expand equitable access to quality, safe, effective and affordable vaccines and to increase community demand and acceptance for vaccines, and to combat misinformation and promote vaccine confidence;


3. URGES Member States:
(1) to demonstrate stronger leadership and governance of national immunization programmes as a component of strong health systems and towards achieving universal health coverage;
(2) to identify the root causes of low coverage and address inequities, and pockets of susceptible individuals by strengthening routine immunization programmes, vaccine preventable disease surveillance, data systems, and capacity to prepare for, swiftly detect, and respond to outbreaks, while building on the linkages between strong routine immunization programmes and outbreak preparedness and response capacities to decrease the risk of disease outbreaks and strengthen routine immunization recovery post-outbreak as a part of primary health care;
(3) to invest in national and international public awareness efforts to communicate accurate information on the safety, effectiveness, and public health benefits of vaccines, to work with media, including social media, individuals, parents, families and communities to combat misinformation regarding vaccines and vaccine preventable diseases, and by training health workers as part of a comprehensive communications strategy regarding community questions or concerns and engaging individuals, parents, families, communities to build and sustain trust in life-saving vaccines;
(4) to improve community immunization rates thereby protecting vulnerable populations, such as children and immunocompromised individuals at high risk for communicable diseases;
(5) to sustain and redouble efforts to achieve or maintain national measles and rubella elimination targets with the aim of supporting regional elimination goals through the strengthening of routine immunization systems and a range of tailored supplementary immunization activities that will reach the unreached and that also help to strengthen the overall routine immunization system;
(6) to strengthen comprehensive vaccine-preventable disease surveillance, including case-based surveillance and laboratory confirmation capacities, by prioritizing disease detection and notification systems, data analysis and reporting systems to strengthen immunization policies and programmes;
(7) to collect, monitor and use timely and accurate data on immunization coverage and outbreaks to guide strategic and programmatic decisions that protect at-risk populations and reduce disease burden;
(8) to mobilize adequate financing of immunization programmes, including allocation of adequate financial and human resources where appropriate and to sustain the immunization gains achieved, including through technical partners and funding agencies, such as: the Global Polio Eradication Initiative; Gavi, the Vaccine Alliance; WHO and UNICEF; the World Bank; academia; nongovernmental partners; and, in the Americas, through the PAHO Revolving Fund, as appropriate;
(9) to strengthen national processes and advisory bodies for independent, evidence-based, transparent advice and decision-making, both during and outside times of national, regional or global outbreaks, including on vaccine safety and effectiveness, such as health interventions and technology assessments and/or National Immunization Technical Advisory Groups working in collaboration with national regulatory authorities;

(10) to expand, where appropriate, immunization services beyond infancy to include the whole life course, guided by evidence on the burden of disease, the value of vaccines, vaccines’ impact on reducing morbidity and mortality throughout the life course, and system capacities, using the most appropriate and effective means of reaching all age groups and high-risk populations with immunization and integrated health services with special emphasis on “zero-dose” children in order to reduce the burden of disease as much as possible with available resources;
(11) to promote incentives and to create an enabling environment to increase investment in public and private research and development collaborations aimed at diversifying and strengthening the pipeline, improving and increasing vaccine production capacity, and developing new products, services and practices, including for emerging infectious diseases;
(12) to continue to strengthen international cooperation and vaccine supply, including by enhancing and expanding sustainable national and regional manufacturing capacity for affordable vaccines and technologies;


4. INVITES global, regional, and national partners, and other relevant stakeholders:
(1) to continue to support Member States to achieve regional and global vaccination goals and in the development and implementation of national immunization plans, including through contributions to Gavi, the Vaccine Alliance, and other health and development partners;
(2) to increase efforts for multistakeholder and cross-sector coordination toward improved vaccine and immunization programme impact, aiming to avoid duplication and gaps, while leveraging resources more effectively;
(3) to increase efforts and enhance multistakeholder collaboration to develop and apply tools to strengthen immunization, including through coordinated, responsible, sustainable and innovative approaches to research and development, including but not limited to quality, safe, effective and affordable vaccines, and to accelerate innovation to address key programmatic challenges on immunization delivery and services to optimize impact, recognizing the important contribution of the Coalition for Epidemic Preparedness Innovations (CEPI) in this regard;
(4) to consider immunization priorities in funding and programmatic decisions, including innovative ways to mainstream immunization-relevant activities into existing international development financing;
(5) to ensure that robust response plans are in place to tackle misinformation and build community trust, as well as to support social media platforms and actors in addressing incorrect information about vaccination risks that may increase vaccination hesitancy;


5. REQUESTS the Director-General:
(1) to support countries to achieve the goals and strategic priorities outlined in the Immunization Agenda 2030, taking stock of lessons learned from the global vaccine action plan;

(2) to advocate in national, regional and international forums for the need to implement the Immunization Agenda 2030 at regional and country levels, to achieve its goals to accelerate progress on and impact of the global immunization programme;
(3) to support Member States in their efforts to rebuild and sustain trust and confidence in vaccines and immunization services through national communication and education strategies, campaigns to combat misinformation about vaccines, training health workers on communication, providing high-quality integrated services, enhancing education on vaccines and vaccine-preventable diseases to individuals, parents, families, communities, and community influencers to galvanize the public and build trust regarding the value of vaccines including vaccine safety;
(4) to promote and technically support improved surveillance and disease detection notification systems and fully implement accountability mechanisms to monitor global and regional vaccine action plans;
(5) to support Member States to sustain and redouble efforts to achieve national targets on measles and rubella elimination, and to work to ensure that global and regional strategies on these diseases are updated to enable the most effective response at country level, while strengthening routine immunization systems and educating individuals, parents, families and communities on disease detection, notification and reporting;
(6) to strengthen collaboration with all key health and development partners, including civil society organizations and the private sector so that their work better complements national essential immunization and emergency preparedness, detection and response efforts;
(7) to support Member States, where appropriate, in strengthening and promoting innovation through the research and development of vaccines against new and re-emerging pathogens, facilitating linkages with other key research and development stakeholders, as well as continuing to provide technical assistance, including for outbreak response; to address key programmatic challenges, and to continue to promote and facilitate the development of new vaccines delivery and service formats that will make vaccines safer and more accessible;
(8) to continue working with research and development stakeholders to support, especially in developing countries, supply chain innovations and vaccine-administration technologies, to increase the efficiency of vaccine delivery, as appropriate;
(9) to continue to strengthen the WHO prequalification programme and to provide technical assistance to developing countries, working closely with national regulatory authorities, in capacity building for research and development, expanding capacity to produce quality-assured vaccines, and other upstream to downstream vaccine and diagnostic development and manufacturing strategies that foster competition for a healthy, secure vaccine market;
(10) to cooperate with international organizations, in accordance with their respective mandates, health and development partners, vaccine manufacturers and national governments to overcome barriers to timely and equitable access to affordable vaccines of assured quality for all, and to implement effective preventive measures for the protection of health workers, including in public health emergencies and in the context of humanitarian crises;
(11) to report to the Seventy-fourth World Health Assembly, through the Executive Board, on implementation of the Immunization Agenda 2030, including the development of regional
operational plans, an IA2030 governance mechanism and the Monitoring and Evaluation framework;
(12) to continue to monitor progress annually and to report, through the Executive Board, as a substantive agenda item to the Seventy-fifth World Health Assembly on the achievements made towards the global goals of the Immunization Agenda 2030.
Sixth meeting, 5 February2020 EB146/SR/