Vaccination is among the greatest public health achievements of the 20th century, banishing feared diseases from the lives of those fortunate enough to be immunized. But 1.5 million children continue to die each year from vaccine-preventable diseases. The Global Vaccine Action Plan (GVAP) is a framework to end that inequity and extend the benefits of vaccination to everyone, regardless of where they are born.
Approved by the World Health Assembly in May 2012, GVAP is the global vaccine community’s consensus roadmap for the Decade of Vaccines. The plan was supported by multiple stakeholders involved in immunization, including governments and elected officials, health professionals, academia, manufacturers, global agencies, development partners, civil society, media and the private sector.
GVAP set six immunization targets for eradication and elimination of key vaccine-preventable diseases, introduction of new life-saving vaccines and improved immunization coverage. But as of 2015, only one of the objectives is on track. More than 22 million children still remain unvaccinated; measles, rubella and congenital rubella syndrome (CRS) have yet to be eliminated. In 2014, a resurgence of polio prompted WHO to declare a public health emergency; the disease is now limited to Afghanistan and Pakistan, but the GVAP target was no new cases after 2014.
In an assessment of the GVAP published in 2014, the Strategic Advisory Group of Experts on Immunization (SAGE) noted that the six targets may relate to different vaccines and diseases, “but common threads run throughout: failure to extend vaccination services to people who cannot currently access them at all, and failure to strengthen the healthcare system so that all doses of vaccine are reliably provided.”
Without increased focus on assisting countries to improve and expand their vaccination systems, we will fail to ensure that children around the world receive the basic, inexpensive, life-saving vaccines that parents in other parts of the world take for granted.
GVAP’s guiding principles of country ownership, shared responsibility, equity, integration, sustainability and innovation inform its strategic objectives. These objectives include countries committing to immunization as a priority and legally guaranteeing financing for immunization; fostering strong immunization systems as an integral part of a functioning health system; and ensuring programs have predictable funding and access to a quality supply of vaccines and innovative technologies.
The Sabin Vaccine Institute’s Vaccine Advocacy and Education program assists selected national vaccine programs at the country level through several initiatives:
Sabin’s Sustainable Immunization Financing (SIF) program works with lower and lower-middle income countries to establish sustainable, predictable financing of their immunization programs – a goal which corresponds to GVAP strategic objectives. Countries achieve sustainable immunization financing by developing new domestic funding sources, implementing budget line items for immunization, improving immunization budget management and enacting new laws assuring public funding for immunization programs. SIF documents and disseminates data on countries’ progress in prioritizing immunization and establishing predictable funding for programs as part of a broader GVAP support strategy. SIF also organizes high-level GVAP briefings in SIF countries and encourages immunization managers to integrate the GVAP objectives into annual program work plans.
The International Association of Immunization Managers (IAIM), founded in 2013, provides a forum for immunization managers to share best practices, participate in peer-to-peer learning and develop their managerial and leadership capacity in order to improve the performance of immunization programs.
Sabin’s meningococcal, rotavirus, rubella and pneumococcal advocacy activities encourage accelerated vaccine introduction within countries, leverage new research to improve disease estimates and convene stakeholders around the world to discuss relevant research that will inform public health agendas — all with the aim of delivering universal access to these vaccines.
Several new vaccines have been introduced in recent years and coverage grew rapidly without having any ill effect on basic vaccination rates. Pneumococcal was the most common vaccine introduced. GVAP calls for at least 90 low- or middle-income countries to introduce one or more under-utilized vaccines by 2015. Although some programs have found it difficult to finance the purchase of new vaccines, this is the sole GVAP target that remains on track but clearly more remains to be done.
In addition, the Dengue Vaccine Initiative (DVI) is working to expedite new vaccine introduction by laying the groundwork in endemic areas so that, once licensed, vaccines to prevent dengue will be swiftly adopted. The Coalition against Typhoid (CaT) is addressing global policy barriers by providing evidence for the use of licensed Typhoid conjugate vaccines and generating discussions for epidemiological research and vaccine development for salmonella paratyphi and non-typhoidal salmonella infections. Sabin is also working to assess and strengthen the laboratory capacity for diagnosis of pertussis. And Sabin advocates for policies and resources to support effective measles and rubella immunization programs and practices as a member of the Measles and Rubella Initiative.
Extending the benefits of immunization to everyone, everywhere begins with building political will. Civil and political society must marshal the resources to strengthen immunization systems. Vaccines are essential to not only maintaining the health progress of the last century, but controlling epidemics and future outbreaks. Vaccine science has enormous potential now and for future generations.