SAGE April 2022 meeting highlights – WHO

SAGE April 2022 meeting highlights – WHO
11 April 2022
SAGE Meeting of 4-7 April 2022
(Full report will be published in the Weekly Epidemiological Record on 10.06.2022, and only
the wording of the full report should be considered as final)


Session 1 – Global & Regional Reports
Report from the WHO Department of Immunization, Vaccines & Biologicals
• The speed of the COVID-19 vaccine rollout has been unprecedented with nearly every country
introducing the vaccine in under 12 months.
• Available data of COVID-19 vaccine effectiveness against the Omicron variant generally show
waning immunity against infection but high and more sustained effectiveness against severe
disease and death, especially after booster doses. Data remain very limited for some of the WHO
EUL vaccines.
• To date, 21 countries remain below 10% population coverage, leaving at high risk the most
vulnerable populations. Among countries eligible for support through the COVAX Advance
Market Commitment (AMC) strategy at least 43 have set population targets at 70% or higher
and only a small number have targets below 40% of their population.
• However, available data indicate that coverage among the high priority groups is insufficient to
provide the needed protection against severe disease and death. Health worker coverage is 65%
overall, with coverage below 50% in some regions (Non-AMC member states), and coverage of
older adults is 69% going as low as 24% in some regions.
• Disruptions to routine immunization programmes persist, including the ongoing delay of at least
one campaign in 37 countries as of 10 January 2022, putting millions of children at risk of disease
outbreaks. Large and disruptive outbreaks of measles have occurred in at least 19 countries
during the past 12 months.
• COVID-19 vaccination response and investments offer important opportunities that are being
leveraged to restore and strengthen immunization programmes and enhance their resilience.


WHO Regional Updates
• National immunization programmes in all six WHO regions were adversely impacted by the
COVID-19 pandemic through declining immunization coverage and surveillance quality, though
the magnitude of the impact varied between and within regions.
• The European region is also facing a challenge due to the ongoing war in Ukraine and the
resulting large population displacement. The WHO Regional Office and partner agencies are
taking measures to mitigate the risks of vaccine-preventable disease outbreaks such as measles,
polio, and COVID-19, while also ensuring continued delivery of critical medical supplies and
• All countries are implementing measures to restore vaccination coverage, with several having
identified innovative strategies for catch up vaccination.
• The rollout of COVID-19 vaccination is progressing in all regions, though vaccine uptake varies
between and within regions and disproportionately lower vaccination coverage has been
observed in low- and low-middle income countries. Vaccine hesitancy and low risk perception
are further affecting the uptake of COVID-19 vaccination in several countries.


Gavi report
• Reaching the zero-dose children through the building of resilient health systems remains a top
priority of the Alliance in the Gavi strategy 2021-2025 (Gavi 5.0) and is estimated to account for
over half the incremental impact of Gavi investments during the strategy period.
• A funding window for the rollout of malaria vaccines will be opened in the second half of 2022 to
enable initial vaccine introductions in 2023.
• Gavi expressed concern over the 13% decline of global HPV vaccine coverage in 2020 due to
COVID-19 disruptions, attributing this issue primarily to school closures and limited supply. It
was acknowledged that a recommendation for a single dose regimen has the potential to
accelerate introductions and reduce operational costs and complexity.
• The COVAX facility has sufficient supply available for all AMC countries to achieve the WHO 70%
coverage target by June 2022. The COVAX Vaccine Delivery Partnership is supporting countries
to overcome barriers and to achieve national coverage targets.


Session 2 – Immunization Agenda 2030 and catch-up vaccination
• SAGE was presented with evidence of the impact of the COVID-19 pandemic on national
immunization programmes mainly due to service delivery disruptions.
• The urgent need to close resulting immunity gaps was recognized, as was the importance of
supporting the recovery and resilience of immunization programmes and mitigating the risk of
vaccine-preventable disease outbreaks.
• SAGE recommended that countries use the COVID-19 pandemic and COVID-19 vaccination
rollout as a transformative opportunity to establish resilient immunization programmes and
strengthen primary health care. Among the specific areas identified were health worker
vaccination, immunization logistics and registries, surveillance, data and communications.
• The document “Guiding Principles for recovering, building resiliency, and strengthening of
immunization in 2022 and beyond” was endorsed and recommended for dissemination to
regional and national immunization technical advisory groups so that it may be adapted and
used for their local context.

[The full summaries for the sessions below are available at the PDF link above]
Session 3 – Hepatitis A vaccination


Session 4 – COVID-19 vaccines

Session 5 – Typhoid conjugate vaccination


Session 6 – Human Papillomavirus vaccination

Session 7 – Poliovirus vaccines



One-dose Human Papillomavirus (HPV) vaccine offers solid protection against cervical cancer
11 April 2022
News release
The 4-7 April convening of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) evaluated the evidence that has been emerging over past years that single-dose schedules provide comparable efficacy to the two or three-dose regimens.

SAGE’s review concluded that a single-dose Human Papillomavirus (HPV) vaccine delivers solid protection against HPV, the virus that causes cervical cancer, that is comparable to 2-dose schedules.  This could be a game-changer for the prevention of the disease; seeing more doses of the life-saving jab reach more girls…

“The HPV vaccine is highly effective for the prevention of HPV serotypes 16 & 18, which cause 70% of cervical cancer,” said Dr Alejandro Cravioto, SAGE Chair. “SAGE urges all countries to introduce HPV vaccines and prioritize multi-age cohort catch up of missed and older cohorts of girls. These recommendations will enable more girls and women to be vaccinated and thus preventing them from having cervical cancer and all its consequences over the course of their lifetimes.”


SAGE recommends updating dose schedules for HPV as follows:
one or two-dose schedule for the primary target of girls aged 9-14
one or two-dose schedule for young women aged 15-20
Two doses with a 6-month interval for women older than 21.

Immunocompromised individuals, including those with HIV, should receive three doses if feasible, and if not at least two doses. There is limited evidence regarding the efficacy of a single dose in this group.

WHO’s recommendations will be updated following further consultation across stakeholders…

Globally, the uptake of the life-saving vaccine has been slow, and coverage in countries much lower than the 90% target. Consequently, in 2020 global coverage with 2 doses was only 13%.  Several factors have influenced the slow uptake and low coverage of HPV vaccines including supply challenges, as well as the programmatic challenges and costs related to delivering a two regimen to older girls who are not typically part of childhood vaccination programs. Added to this has been the relatively high cost of HPV vaccines, particularly for middle-income countries…

The option for a single dose of the vaccine is less costly, less resource intensive and easier to administer. It facilitates implementing catch-up campaigns for multiple age groups, reduces the challenges link ed to tracing girls for their second dose and allows for financial and human resources to be redirected to other health priorities.”