What the World Health Assembly had to say about immunization supply chains

As you may know, immunization was on the agenda at the World Health Assembly in May.

This year, PATH listened specifically for references to immunization supply chains and logistics. A few official statements mentioned supply chain, cold chain or logistics, but usually in a list of issues to be addressed, and not as a primary focus nor associated with any concrete strategies.

We also conducted interviews with policymakers, country leaders and immunization experts to gain greater insight into what is needed get immunization on track, or as Dr. Chris Elias puts it, “build a new track,” to reach the unreached with lifesaving vaccines. Watch video highlights from these interviews on Vaccines Work.

FOR DISCUSSION: How do we put supply chain and logistics on the agenda of national policy-makers so it gets the attention it deserves?

For a summary of immunization items discussed at the World Health Assembly, please read on…

IMMUNIZATION AT THE WORLD HEALTH ASSEMBLY 2015

At the 68th World Health Assembly, held in Geneva, Switzerland from May 21 – 28, 2015, two official agenda items focused on immunization as well as two side sessions. A summary follows, courtesy of PATH.

Official Session: Global Vaccine Action Plan

During the official GVAP session, countries read statements into the record on their progress on achieving the goals of the Global Vaccine Action Plan. Overall, statements were brief and general. Many of the statements addressed a proposed resolution by Libya, which was ultimately adopted, on the issue of affordable vaccine prices and financing.

Additional themes included:

• Wide support for immunization as the one of the most cost-effective tools for global health, and a cornerstone of strong health systems;
• Recognition of progress made globally, but serious concern for low-performing countries where routine immunization coverage is below 80%;
• Particular disappointment from a number of higher-income countries that called the Strategic Advisory Group of Experts on Immunization’s (SAGE) assessment of GVAP a “wake-up call” to the plan’s lack of impact to reach the world’s most vulnerable children;
• Consensus that achieving the GVAP is core business for WHO and countries as public health authorities;
• The need to address anti-vaccine sentiments that are emerging in new parts of the world;
• Consistent alarm raised for immunization systems that are disrupted and threatened by public health emergencies and conflicts – so vaccines are not reaching many who need them most; and
• The lack of adequate data and monitoring systems to inform better vaccine delivery.
• An overall summary of statements given will become available from WHO in the coming weeks.

Official Session: Polio

Country statements during this official session focused on implementation of the End Game Strategy. Member States made clear that this is still an international public health emergency and we need to stay the course to complete eradication. With the exception of Indonesia, most countries expressed support for the current timeline of transition to IPV. Other themes addressed included increasing surveillance and strengthening investigation and response to outbreaks, as well as ensuring country plans for transition. Comments were also made about the importance of routine immunization, the need for robust health systems to deliver these vaccines, and how polio legacy assets may be used for this purpose.

Side Session: “Achieving the Global Vaccine Action Plan Objective for Routine Coverage: What can be done to get back on track?”

This technical meeting was convened at the recommendation of the Strategic Advisory Group of Experts on Immunization (SAGE) in its 2014 Assessment Report of the Global Vaccine Action Plan (GVAP). It was co-sponsored by the Democratic Republic of Congo, Thailand and the United States, and chaired by WHO Assistant Director-General Dr. Flavia Bustreo.

The SAGE Assessment reports that progress on GVAP goals is far off track and lays out recommendations for improvements. Only one of the six targets set to be achieved in 2014 or 2015 is on track. The side session focused on the 34 countries with routine vaccination (DTP3) coverage of less than 80%.

It was an open discussion about the challenges of reaching the final 20% -- including migrant populations and other pockets of geographically hard-to-reach communities. It was a wide-ranging and frank discussion about the challenges countries are facing and solutions to overcome them. Innovative ways to finish the last mile of immunization coverage was a key theme: how we reach this last 20% of unprotected children will be more challenging and demand new problem-solving to achieve the vision of immunization for all by 2020.

Participants included ministers and senior ministry staff from those countries, WHO Director-General Dr. Margaret Chan, WHO immunisation department staff, Seth Berkley from Gavi, the Vaccine Alliance, Chris Elias, from the Bill and Melinda Gates Foundation, senior officials from UNICEF and other civil society and health partners.

PATH interviewed technical experts, country leaders and policymakers to learn more about challenges in routine coverage. See video highlights of what they had to say in a PATH blog on Vaccines Work. WHO used this session to launch National Immunization Coverage Scorecards 2015, using DPT1 and DPT3 as coverage indicators by country. See the WHO news release for more information.

Side Session: “Polio Eradication: Status, Lessons Learned and the way forward in Africa”

Much of this event focused on the great successes in Nigeria – nearly ten months without a case of wild poliovirus – as well as good results to control outbreaks in the Horn of Africa. There has been progress toward eradication, but polio-free certification will take three years and will be evaluated regionally – so outbreaks in every country will needed to be investigated closely. There are still challenges to finishing the job in Africa at large, including switching to a new vaccine, how to sustain gains with routine immunizations, and costs and political will to do so before eradication is achieved.

Key to progress will be political will for funding and oversight for sustained polio immunization and efforts to generate demand for the vaccine. Legacy planning is ongoing, and stakeholders are taking inventory of polio assets to determine how to best use these resources to benefit other public health efforts – including routine immunization.