2017 Assessment Report of the Global Vaccine Action Plan
In 2016, some progress was made towards the goals set out in the Global Vaccine Action Plan (GVAP). The year saw the fewest number of cases of wild poliovirus ever reported, and three more countries were certified as having achieved maternal and neonatal tetanus elimination. Nine additional countries have introduced new vaccines. Overall DTP3 vaccination coverage increased, but by only 1% to 86%. Progress therefore still remains too slow for most goals to be reached by the end of the Decade of Vaccines in 2020. Furthermore, multiple global, regional and national issues threaten further progress, and have the potential to reverse hard-won gains. Economic uncertainty, conflicts and natural disasters, displacement and migration, and infectious disease outbreaks all pose major challenges to immunization programmes. At the same time, there are concerning signs of complacency and inadequate political commitment to immunization – as well as a global lack of appreciation of its power to achieve wider health and development objectives. Additional risks include growing levels of vaccine hesitancy and the worrying rise in stockouts disrupting access to vaccines – related primarily to shortcomings in vaccine procurement and distribution but also to some extent to vaccine production. The continued marked underperformance of certain countries relative to others within their region – ‘outlier’ countries – remains of grave concern. The potential impact of the phase-out of funding for polio eradication is also of concern. It is vital that the polio transition remains sufficiently flexible that it does not jeopardize ongoing outbreak control efforts or critical surveillance activities and post-eradication certification processes. Furthermore, there is a significant risk that wider surveillance activities and routine immunization programmes, and hence global health security, could be compromised during the polio transition. The potentially simultaneous phasing out of polio and Gavi funding and technical support is of further concern. These risks threaten to slow the extension of vaccines to neglected populations and heighten global inequalities in vaccine access. As the Decade of Vaccines draws to a close, there is a need to intensify global efforts to promote immunization and to address the systemic weaknesses that are limiting equitable access to life-saving and life-changing vaccines, particularly in outlier countries and middle-income countries. The recommendations made in the Strategic Advisory Group of Experts on Immunization (SAGE) 2016 Assessment Report informed the development of World Health Assembly Resolution WHA70.14, approved in May 2017, and remain a high priority. In light of the risks highlighted, SAGE also calls for a broadening of the dialogue, to align immunization with emerging global health and development agendas, including the sustainable development goals, global health security and International Health Regulations, health systems strengthening and universal health coverage, and the battle against antimicrobial resistance. A concerted effort is also required to address outlier countries, through a multidimensional, system-wide approach, recognizing that complex issues require multifaceted solutions and that civil society organizations have important contributions to make. Through these and other measures, progress can continue to be made towards GVAP goals and the ground laid to exploit the full potential of immunization post-2020.