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Keyword: dovc

By Orin Levine

This week in Geneva, health ministers from governments around the world will meet at the 65th World Health Assembly (WHA) for their annual meeting to discuss health issues that affect everyone everywhere. For those of you unfamiliar with this assembly, it’s a bit like a parliament of health ministers. They meet, discuss pressing health issues, put resolutions to the floor and vote. Among the resolutions they will consider is one supporting the Global Vaccine Action Plan, a road map to ensure that by the end of this decade, every child, everywhere enjoys the full benefits of immunization.

The plan is the cornerstone of work to date of the Decade of Vaccines Collaboration, sponsored by the Bill & Melinda Gates Foundation and chaired by global health leaders Ciro de Quadros (Sabin Vaccine Institute), and Pedro Alonso (Universidad de Barcelona). This impressive document is the result of an 18-month consultation involving more than 1,100 stakeholders from 142 countries. The plan sets ambitious new goals for the decade, establishes strategic objectives and identifies the actions that will support their achievement. Perhaps most importantly, it puts developing countries at the center of the plan and stresses country and community ownership of immunization programs as a key pillar for success in the decade ahead.   

As a member of the DoV Collaboration’s Steering Committee, I’m pleased to see the plan reaching the WHA this week. It represents a huge collective effort. But it is also important to remember that global health is full of plans for this and plans for that. The endorsement of the plan by the WHA should be viewed as the beginning, not the end of our work. Turning the document into actions that move the needle on research, vaccine access, and ultimately, child survival will require continued investment and commitment of everyone from lab scientist to front line health worker and from head of state to head of household.

As Save the Children notes in a paper published this month, we’ve succeeded in delivering a full package of most basic childhood vaccines to four out of five children born on the planet, but nearly 20 million children remain incompletely immunized. Children whose mothers have received no formal education are only half as likely to get vaccinated as those whose moms have a secondary education, for example, and rural children are just under half as likely to get immunized as those living in urban areas. In an era where cell phones, soft drinks and Facebook are ubiquitous in every corner of the world, we can and should work to overcome inequalities to ensure that the same can be said for life-saving vaccines. 

The plan outlines clearly the ambitious but achievable goals of the Decade of Vaccines: achieving a world free of polio; meeting all global and regional disease elimination targets; meeting vaccination coverage targets in every region, country and community; developing and introducing new and improved vaccines and technologies, and exceeding the Millennium Development Goal 4 target for reducing child mortality.

We have our work cut out for us, to be sure – and achieving these goals will require that we all do our part, and that we go beyond even Ministers of Health to engage other stakeholders and communities.  Specifically:

  • Countries must commit to immunization as a priority, and work to strengthen their immunization systems
  • Families must understand the value of vaccines, and demand immunization as both their right and responsibility
  • Manufacturers must continue to innovate and deliver quality supply at affordable prices
  • Donors and governments must ensure funding for immunization programs is predictable and consistent, and
  • We must all work together to ensure that the benefits of immunization are equitably extended to all people.

I’m hopeful the ministers present at the WHA will approve Global Vaccine Action Plan this week in Geneva. But I’m even more focused on what happens when the Ministers go home and how the effort engages stakeholders beyond national governments. In a world where corporations, foundations, and non-governmental organizations can be as powerful as some governments, a winning plan for the Decade of Vaccines will require including all the players who can help to achieve this common goal. With all the players involved, and a sustained team effort, it should be a winning game plan. 

Dr. Orin Levine is the Executive Director of the International Vaccine Access Center.

Cross-posted at The Huffington Post.

By David R. Curry

WHO Vaccination Clinic

Villagers line up to be vaccinated against Smallpox at an outdoor clinic, Côte d'Ivoire, 1970s. From the WHO Archives.

In February, 2012, I participated in the WHO Extraordinary SAGE meeting in Geneva, called to review the Global Vaccine Action Plan (GVAP) being developed by the Decade of Vaccines Collaboration (DoVC). On the flight back to the U.S., I was reflecting on the continuing challenge of identifying and scoping "game changers" in the GVAP to help realize the DoV’s ambitious vision: 

The vision for the DoV is a world in which all individuals and communities enjoy lives free from vaccine-preventable diseases. Its mission is to extend, by 2020 and beyond, the full benefits of immunization to all people, regardless of where they are born, who they are, or where they live.

We need “game changers” because of the scale of the challenge, to be sure. But I was also reflecting on the history of global immunization strategies and that we have faced the same core challenges for generations.

Having arrived early for the SAGE meeting, I spent a day in the WHO Archives pursuing the broad question of when the WHO first considered anything like a global immunization strategy, and at least one other reference point for perspective. Two original documents caught my attention.

The first was a report from what appears to be the first expert consultation on this theme: the first session of the Expert Committee on Maternal and Child Health, Geneva, January 1949. The session title was Immunization Against Principal Communicable Diseases of Childhood - Plan for an International Program (WHO/MCH/5).

The meeting report surveys the then-current knowledge on immunization – informed by WWII – and includes a key recommendation for convening an "international expert conference on immunization procedures as soon as possible. This conference should bring together epidemiologists, paediatricians, heads of child-health services, and experts responsible for the preparation of vaccines in state and other official laboratories and institutes. The conference should discuss the use of the newer techniques for producing the more effective vaccines (e.g. pertussis vaccine) and plans for their widespread application in immunization programs..." The proposed conference was later convened as a result of a resolution adopted at the Second World Health Assembly.

But in the meeting report, the assessment of immunization and its challenges in 1949 (as thinking about an international program was just underway) was alarmingly "current":

"Where immunization programmes have failed, the main reasons for such failure have been 1) a false sense of security when the incidence of these diseases happened to be low, although the population has not yet been adequately immunized; 2) Lack of adequate health education of the public; 3) Insufficient information among the medical professions as regards new immunization procedures; 4) Reluctance to use auxiliary personnel for mass immunization; 6) Lack of appropriate immunization agents [vaccines]; and 7) Lack of appropriate legislation and funds for immunization programmes."   

A companion recommendation was the release of a circular letter by WHO to all WHA members surveying "active immunization" programmes, including an inventory of which diseases and what age groups might be involved in either "advocated" or "compulsory" immunization, whether the country's programme was "assisted by an organized public information campaign," and whether the public is "generally eager for immunization, passive, or reluctant..."

The second reference point comes from a 1974 Consultation on the WHO Expanded Programme on Immunization held at Geneva (VIR/74.15), obviously very early in the EPI era. The report notes:

"...most diseases against which vaccines are available are still uncontrolled in virtually all developing countries. The principal problems are a) lack of trained personnel (and often the idea that only physicians or highly trained nurses should administer vaccines); b) use of complicated immunization schedules appropriate to developed countries but which do not recognize the local epidemiological and administrative realities of the developing world; c) the high cost of equipment and difficulties of maintenance of e.g. transport, refrigeration and jet injectors; d) the cost of many of the vaccines, and e) restrictions on the production of some vaccines because vaccine strains or methods have been patented."

Later in the report, two additional factors around "shortcomings in immunization activities" caught my attention: that “cost benefit and cost effectiveness analyses are either not appreciated by health planners and administrators, or have not been undertaken...” and that “illiteracy and poorly developed public information media result in the lack of public understanding of the need for immunization..."

Finally, this 20-page analysis concludes with a series of recommendations for the year ahead, asserting: "Immunization must be recognized as an essential and permanent programme for the control of communicable diseases and must be a primordial responsibility of the country concerned. The role of the WHO is to stimulate countries to set up immunization programmes and to assist them in doing so..."

These two reference points – from over 60 years ago and almost 40 years ago – are, in a sense, humbling. But they also are a fresh call-to-action. Now is the time to focus our energies and stretch our collective imagination to complete the GVAP with critical game changers, and boldly implement it in the decade-plus ahead. Now is the time for us all to commit our generation to realize the DoV vision.

David R. Curry is Executive Director of the Center for Vaccine Ethics and Policy, a joint program of the Penn Center for Bioethics, the Wistar Institute Vaccine Center, the Vaccine Education Center of the Children’s Hospital of Philadelphia.