Global vaccination targets are ‘off-track’

The progress made to achieve the 2015 global vaccination target is still off-track with one in five children still missing out on routine life-saving immunisations that could avert 1.5 million deaths every year from preventable diseases, a World Health Organization (WHO) report says.

In a bid to set things right, WHO has called for renewed efforts to get immunisation back on track in view of the World Immunization Week 2015 (24–30 April).

“World Immunization Week creates a focused global platform to reinvigorate our collective efforts to ensure vaccination for every child, whoever they are and wherever they live,” Flavia Bustreo, WHO assistant director-general, family, women’s and children’s Health, said.

In 2013, nearly 22 million infants missed out on the required three doses of diphtheria-tetanus-

pertussis (DTP3) immunisation coverage. Many of these infants were from poor countries. According to Hayatee Hasan, technical officer (immunisation), vaccines and biological at WHO, close to 70 per cent of these children live in 10 countries. The countries are— Democratic Republic of the Congo, 

Ethiopia, India, Indonesia, Kenya, Mexico, Nigeria, Pakistan, Vietnam and South Africa.

The reasons for low immunisation co  verage rates are lack of access to health services, insufficient number of health care workers to deliver vaccinations, inadequate supply of vaccines, insecurity caused by civil strife and conflict and insufficient financial resources for programme to manage the increasing complexity of immunisation programmes, Hasan told Down To Earth.

The health organisation is calling for an end to unnecessary disability and deaths caused by vaccination failures.

“It is critical that the global community now makes a collective and cohesive effort to put progress towards our targets back on track,” Bustreo added.

 

In 2012, all 194 WHO member states endorsed the Global Vaccine Action Plan (GVAP) at the World Health Assembly. This was a commitment to ensure that no infant misses out on the vital immunisation dose.

However, a recent independent assessment report on the GVAP progress has sent the alarm bells ringing. It warns that vaccines are not being delivered equitably or reliably and that only one out of the six key vaccination targets set for 2015 is currently on track–the introduction of under-utilised vaccines.

According to Hasan, under-utilised vaccines refer to those such as Haemophilus Influenzaetype b (Hib), pneumococcal, rotavirus, human papillomavirus (HPV), rubella and Inactivated Polio Vaccine (IPV).

Many countries have experienced large measles outbreaks in the past year, thus threatening efforts to achieve the GVAP target of eliminating measles in three WHO regions by the end of 2015.

These three regions are the eastern Mediterranean, Europe and the western Pacific. Of these, the eastern Mediterranean and European regions are markedly off-track, Hasan added.

According to an assessment report, GVAP has two aims. The first is to deliver vaccination to all. The second plan is to unleash vaccines’ vast future potential. With these two great ambitions, GVAP aims to make 2011-2020 the ‘Decade of Vaccines’.

Though targets relate to different types of vaccines and diseases, a common thread runs throughout. This is the failure to extend vaccination services to those who cannot currently access them and the inability to strengthen the healthcare system so that all doses of vaccine are reliably provided.

A global collaborative drive for immunisation started in the mid-1970s with the establishment of the Expanded Programme on Immunization. It achieved dramatic results in many countries, raising vaccination levels from as low as 5 per cent to more than 80 per cent by 2013.

 

According to WHO estimates, immunisation prevents between two and three million deaths annually and protects many more people from illness and disability. In 2014, WHO declared two Public Health Emergencies of International Concern–the Ebola crisis in West Africa and the international spread of polio virus. Both are communicable diseases. Polio is vaccine-preventable and Ebola may soon become so.

Although the progress has somewhat stalled in recent years, early success stories demonstrate the potential of vaccines, which are now being increasingly extended to adolescents and adults as well to provide protection against influenza, meningitis and cervical and liver cancers.

Jean-Marie Okwo-Belé, director of immunisation, vaccines and biologicals at WHO, said the organisation would work to increase its support to all countries that were still lagging behind in meeting their targets. In May this year, WHO will bring together high-level representatives of 34 countries with routine vaccination (three doses of DTP3) coverage of less than 80 per cent to discuss the challenges faced by countries and to explore solutions on how to overcome them.

Although many countries are vaccinating four out of five children with DTP3, a full one-third of the countries are still struggling to reach the ‘fifth child’, meaning that millions of children are at risk of illness, disability or death.

“There is no one centralised approach that can ensure vaccines are delivered and administered to each child. Vaccination plans on the ground need to be adapted not just to countries, but to districts and communities,” Okwo-Belé added.

A truly concerted effort and much stronger accountability is required so that each one of the key players involved fulfills its mandate and helps close the immunisation gap, Okwo-Belé said. Earlier this year, donor countries and institutions pledged to meet the funding needs of Gavi, the Vaccine Alliance that brings together public and private sectors to create access to new and underused vaccines for children in poor countries. DOWN TO EARTH