Session 3: The Global Effort to Immunize

All Children

This session highlights global efforts and initiatives to immunize all children, as well as the disparities
that still exist.

Overview
The provision of a primary series of vaccines in the first year of life, referred to as "routine
immunization," is viewed as the cornerstone of all immunization and other primary health care
efforts.

Assuring that children and women receive all necessary doses of potent vaccines in a safe and
effective manner on a continual basis is essential.

Immunization services must be provided throughout the year, every year, to enable each new cohort
of newborns and women of childbearing age to become adequately protected as early as possible.

Realizing the potential of immunization requires a commitment from a broad coalition of partners. A
coalition of this kind involves everyone from the village health worker to the research scientist, from
the national Expanded Program on Immunization (EPI) manager to the global policy maker, from the
donor agency health officer to the Minister of Health.

At the national level, the majority of countries have formally established independent groups to guide
immunization policies. These groups are commonly referred to as National Immunization Technical
Advisory Groups or NITAGs. NITAGs serve to guide countries in the development of immunization
standards, guidelines, and policies and inform decision-making on the introduction of new vaccines
and immunization schedules. In addition to a NITAG, Interagency Coordinating Committees (ICCs)
are established to improve partner coordination. These groups provide critical support to the
ministries of health for immunization planning and programming. 

Highlights
As a proven, cost-effective intervention, immunization prevents more than two million deaths per year and
prevents millions more from suffering illness and disability.

Global Vaccine Alliance (Gavi)

In 2000, the Global Vaccine Alliance (Gavi) was established to revitalize immunization and create
the massive financing mechanism needed by low-income countries. In 2016, 52 of the world’s
poorest countries were eligible for Gavi funding.

Gavi’s strategic goals for 2016-2020 include a focus on coverage and equity, working to ensure
more equitable access to vaccines, supporting countries to build comprehensive immunization
programs that also strengthen health systems, and shaping markets for vaccines, including reducing
prices for new vaccines such as those for rotavirus and pneumococcal disease.

For more information on Gavi, please view the animation video below or visit their website(link is
external)(link will open new window).

The Decade of Vaccines: The Global

Vaccine Action Plan (2011-2020)
 The Global Vaccine Action Plan (GVAP)(link is external)(link will open new window) is a framework
designed to deliver universal access to immunization, thereby improving the health of all people by
the year 2020. 

GVAP has six strategic objectives for achieving its goals. These objectives, outlined below, provide
guidance to the global community for how to achieve universal access to immunizations.

1. All countries commit to immunization as a priority.

2. Individuals and communities understand the value of vaccines and demand immunization as both
their right and responsibility.
3. The benefits of immunization are equitably extended to all people.
4. Strong immunization systems are an integral part of a well-functioning health system.
5. Immunization programs have sustainable access to predictable funding, quality supply, and
innovative technologies.
6. Country, regional, and global research and development innovations maximize the benefits of
immunization.
However, halfway through the decade of vaccines, five of the six GVAP targets are off track and
additional strategies are needed if the goal of universal immunization is to be realized.
As part of this effort, Gavi has put out its newest strategy for 2016-2020(link is external)(link will
open new window) that aligns with the GVAP and focuses on improving the equity of access to
vaccines. 

Did you know?

Health system issues constrain many low- and middle-income countries that are trying to increase or
maintain high immunization coverage.

To help address this, Gavi(link is external)(link will open new window) has committed US $862.5
million in health system strengthening (HSS) grants from 2007 through 2017. 

Highlights
There are a number of key players working in immunization, including Gavi, the World Health
Organization (WHO), UNICEF, the Center for Disease Control & Prevention (CDC), the World Bank, the
Bill & Melinda Gates Foundation, and the United States Agency for International Development (USAID). 

Accelerated Disease Control Initiatives

Ac
celerated disease control initiatives focus on controlling, eliminating, and eradicating priority
diseases by using routine immunization services and supplementary delivery strategies.
 These intensive strategies seek to reduce childhood morbidity and mortality of specific diseases by
reaching all children with life-saving vaccines.

Accelerated disease control initiatives differ by disease, but have several common features:

 Specific targets set at the global or regional level

 Routine immunization
 Supplementary immunization activities (SIAs) that reach expanded target groups
 Special surveillance activities
Accelerated disease control initiatives (e.g., polio eradication, measles and rubella mortality
reduction, and maternal and neonatal tetanus elimination) have played a significant role in
increasing and maintaining the visibility of immunization and mobilizing communities. It is important
to remember, however, that accelerated disease control initiatives are time-limited and resource-
intensive efforts that must rely on a strong routine immunization system to sustain high immunization
coverage.

Please note
Supplemental immunization strategies should not replace routine immunization services. As soon as
they are eligible, children should be vaccinated for ALL vaccine-preventable diseases through regular
immunization services. More information on supplementary immunization activities (SIAs) is presented
in Session 4(link will open new window).

Global Polio Eradication Initiative

Since the Polio Eradication Initiative (PEI)(link is external)(link will open new window) was launched
in 1988, there has been a 99% decrease in the number of polio cases. In 1988, 350,000 cases were
reported, compared to 74 reported in 2015. The number of polio-endemic countries has dropped
from 125 in 1988 to two at the beginning of 2016 (Pakistan and Afghanistan).

Accelerated disease control strategies are sometimes applied to eradicate or eliminate

certain diseases.
 For polio, population immunity levels must be increased quickly to interrupt chains of poliovirus
transmission.

 In the few remaining polio-endemic countries, National Immunization Days (NIDs) are held two or
more times annually to vaccinate everyone in the target population (usually children under age
five) over a one- to three-day period.
 In non-endemic countries with low population immunity, NIDs are needed approximately every
three years.
 In addition to NIDs, polio eradication planners use sub-national immunization days (SNIDs) and
even local immunization days (LIDs) to reach children who were missed in previous campaigns
and are not reached by routine services.
In April 2016, a globally coordinated switch from trivalent OPV (tOPV) to bivalent (bOPV) took place.
The switch is part of the polio eradication and endgame strategy, with the goal of reducing the
possibility of vaccine-derived poliomyelitis due to vaccine poliovirus type 2 (which is contained in
tOPV). The wild polio virus type 2 has not been seen since 1999 and was certified eradicated in
September 2015. In coordination with the switch, inactivated polio vaccine (IPV) is being introduced
globally to help reduce risks associated with withdrawal of OPV type 2 and to boost immunization for
types 1 and 3.

Did you know?

Multiple rounds of NIDs help displace the virulent form of poliovirus from the environment and increase
the likelihood that every child is vaccinated multiple times with OPV.

Polio Endgame
 The Polio Eradication and Endgame Strategy (link is external)(link will open new window) has four
main objectives:

1. Polio virus detection and interruption

2. Immunization system strengthening and OPV withdrawal
3. Contain the poliovirus and certify that transmission has been interrupted
4. Transition planning for polio lessons learned and resources
As the world edges closer to polio eradication, planning is underway to transition the vast resources
that have been allocated for polio eradication. Countries will be expected to continue to utilize IPV
and to integrate polio surveillance into national mechanisms. The focus on legacy planning is to
protect a polio-free world and to ensure that investments from 20 years of GPEI contribute to
broader goals within the health community. 

Measles and Rubella Elimination

Measles
Globally, death due to measles has been reduced by 79% from 2000 to 2014. While great progress
has been made in the control of measles, the disease continues to pose a major threat to children’s
health. Measles is a highly contagious virus that spreads quickly and can result in massive
epidemics. Progress has stalled globally, with an estimated 115,000 children dying from the disease
in 2014.
More than 60% of the 21.5 million children who did not receive one dose of measles vaccine in 2013
came from only six countries: India, Nigeria, Pakistan, Ethiopia, Indonesia, and the Democratic
Republic of the Congo. 

Rubella
Rubella can have serious consequences for pregnant women and their children. Each year, more
than 100,000 children are born with Congenital Rubella Syndrome (CRS), which can cause lifelong
complications and disabilities.  

The Measles & Rubella Initiative(link is external)(link will open new window) is working to reduce
measles deaths and prevent newborns from contracting congenital rubella syndrome.