As we approach the end of the Decade of Vaccines and with just a couple of years remaining on the Global Vaccine Action Plan (GVAP 2011-2020), a new Immunization Agenda 2030 is needed for the entire health and development community – one that re-affirms the benefits of vaccines and immunizations for a healthier, more secure and prosperous world through their contributions to the achievements of Universal Health Coverage (UHC) and Sustainable Development (SDG). An initial attempt to assemble ideas, thoughts and content for an Immunization Agenda 2030 is now available for broad review. It is being shared as a ‘draft zero’ and is offered as a starting point for further co-creation and co-development with immunization specialists, broader health experts, and wider health stakeholders at country, regional and global levels. We welcome your reactions and views on this document by 14 June 2019 either by:  • Providing quick feedback via an online survey: https://www.surveymonkey.com/r/IA2030 • Sending written comments to: immunizationagenda2030@who.int or • Posting comments online directly on the document at: https://drive.google.com/file/d/1Ct0Q1X7ZZch17EWdB5tnVM_qae17hTIx/view?usp=sharing - To do so, please select a word/sentence/paragraph, then click on the "+" on the right hand side of the page.  This document will continually evolve over the coming months based on you feedback. In addition, several dedicated regional consultations will be organized to ensure the voices of regional and country stakeholders are heard and that a bottom up process in co-developing the Immunization Agenda 2030 is implemented. For any queries, please send an email to: immunizationagenda2030@who.int 

Friends and Family of Immunization, I hope you will join me over the next six weeks before the TechNet Conference in Portugal to debate important futures for the vaccine supply chain. Each week, I will start a discussion on a topic and ask for your reactions. If you participate, you will also have the chance each week to respond to an online survey, just one or two questions, to express your agreement, interest or despair! The choice of topics is mine, not necessarily shared with any organization or individual. I chose them because they seem to respond to the changing needs of the vaccine cold chain and, collectively, they respond to most of the important challenges and opportunities that are on the horizon. They are: Merging vaccine and medicine distribution Advancing technologies of cooled-distribution Changing vaccines and their administration Introducing data-driven, remote oversight Addressing safety to maintain acceptance At the end of these discussions, it may become clear whether collectively we are aligned towards this view of immunization futures or towards a different course. I will present the results of the survey in a summary posted before Technet. We expect to organize an event at the TechNet Conference to give a further chance to discuss these topics with other participants.   Topic one: Merging vaccine and medicine distribution In the late 1970s, the vaccine supply chain was deliberately separated from other medical distribution systems. It was recognized at that time that vaccines occupied a small storage volume compared to that of medicines. Vaccines were different from medicines. They required special cooled handling procedures, a higher frequency of distribution and more timely arrival of fresh supplies.   Increased need for cooling of medicines The volume of cooled medicines (+2/8C & +20/25C) is likely to be in the order of twenty times that of vaccines within the next few years. The demand for certain temperature products, such as insulin, is increasing and international standards (EU, US) have recently been established for handling all medicines. This is provoking extensive re-equipping of stores and re-mapping of transport. Ministries of Health are recognizing the economies of merging the distribution of vaccines with pharmaceuticals. WHO expressed the goal of integration in the Global Vaccine Action Plan 2011-2020 (GVAP) and many countries have already moved to integrate specific components of the supply chain. The volume of cooled medicines (+2/8C & +20/25C) is likely to be in the order of twenty times that of vaccines within the next few years. The demand for certain temperature products, such as insulin, is increasing and international standards (EU, US) have recently been established for handling all medicines. This is provoking extensive re-equipping of stores and re-mapping of transport. Ministries of Health are recognizing the economies of merging the distribution of vaccines with pharmaceuticals. WHO expressed the goal of integration in the Global Vaccine Action Plan 2011-2020 (GVAP) and many countries have already moved to integrate specific components of the supply chain.   Rationalization of the distribution network So many countries have now choosen to establish para-statal organizations that handle the distribution of vaccines, medicines and supplies. The process of integrating warehousing and distribution needs for medical products compels Ministries of Health to reconsider the network of intermediate stores linking districts with the central, national store. Instead of 40m3 ready-made, ‘plug-and-play’ cold rooms that are fitted into spare storage spaces, large-scale 5000m3 cold-room facilities are planned for large countries on the basis of efficient use of the road network and optimizing storage sites. Discussion point #1: Do the existing primary stores and transport infrastructure provide the most efficient network for future distribution of temperature-sensitive medicines and vaccines?   Vaccine volumes now require refrigerated vehicles Cold boxes or vaccine packaging cooled by ice-packs are typically loaded onto trucks and used for most journeys between stores. Frozen ice-packs increase the risk of freezing in transport and a high level of compliance is needed to reduce the risk. The increased volume of vaccines to be transported is becoming unmanageable. Hundreds of packs are loaded into 25l insulated boxes that occupy six times the storage volume of vaccines to be transported and exceed the capacity of trucks.   Integrated transport by refrigerated vehicle Refrigerated vehicles are efficient in the use of transportable volume per km. They require less re-packing time and staff resources and most already carry temperature-recording devices that will soon be merged with the monitoring equipment standardized for vaccine refrigerators. In addition, satellite-positioning systems in the trucks will enable LMIS systems to automatically track distribution timeliness and arrival at each delivery point on optimized road circuits. Refrigerated vehicles will improve the timeliness of the delivery system and will raise the standard of vaccine handling. Refrigerated vehicles are the mode of choice for store-to-store pharmaceutical distribution and will replace passive cooling at central and intermediate stores. Icepack freezing will still remain an important option at the level of service delivery. Discussion point #2: When planning transport for store-to-store delivery of vaccine, do country managers evaluate the costs and benefits of sharing refrigerated vehicles and integrating with supply of temperature controlled medicines?   Please click this link to complete a short questionnaire: https://www.surveymonkey.com/r/3F6K5TL I will return the analysis to you at the end of this week and the results will be posted before TECHNET for all five topics. Thank you!  

Since it seems that this got lost during the TechNet-21 hack, I am reposting. This was published in the Global Immunization Newsletter, January 2017:http://www.who.int/immunization/gin/en/ Last year, we saw great data visualisations, including an animated map showing the reduction in the number of unvaccinated children overtime, and the report of the Global Vaccine Action Plan (GVAP) was more interactive than ever (see: dynamic graphs of GVAP indicators in TechNet-21 ). WHO country profiles and the app were revamped to include more information and graphs. In October 2016, partners gathered in Kigali, Rwanda, at the “Meeting on Improving the Availability, Quality and Use of Immunization Data at all levels” to agree on the WHO/UNICEF Join Reporting Form and to jointly discuss strategies for improving the quality and use of immunization data, and to discuss ways to collaborate across partners to reach common data quality objectives. A framework to think about Systems and Data Quality was proposed and presented in meetings organized by the African and the Eastern Mediterranean Regions, it is illustrated here In 2016, the Health Data Collaborative was also launched, representing an important opportunity to coordinate our work on immunization data with the broader health data and M&E agenda. From WHO/HQ, draft guidance on information systems assessment and data desk review, field data quality reviews and data quality improvement plan (DQIP… a new acronym to remember) was drafted and circulated for feedback, and should be ready in 2017. Also, work on vaccination coverage surveys took place with a training for statisticians and several surveys starting to use the new WHO Vaccination Coverage Survey Manual; all or some of the recommendations. Vaccination survey tools, resources and guidance were also added to TechNet-21. Along with implementing quality surveys, dialog is ongoing on defining when is worth investing in a survey and when other methods can be used to inform decision-making. Finally, the working group on home-based records (HBR) continued to work towards ensuring that HBRs are of quality and available in the right place, at the right time and in the right quantity in countries. JSI was engaged in the redesign and promotion of HBRs in Ethiopia and Madagascar; and those experiences and lesson learned are highlighted in two case studies. An updated map with the estimated prevalence of home-based vaccination cards – from DHS and MICS surveys – was produced and an article on reported HBR stock-outs was just published. The WHO webpage on HBRs with all these resources is available at http://www.who.int/immunization/monitoring_surveillance/routine/homebasedrecords/en/.

Dear viewers In-spite of rapid progress in e-media, offline Home Based Record (HBR) has an important role in all the countries. WHO supports local innovation for sustenance as 6th and 5th principles of GVAP (Global Vaccination Action Plan). After reading the outcome indicators of a project, we developed a user-friendly card. Service providers at the field level can easily document the essential data of two mothers in the front page, compile and transmit in the monthly report for performance review. This card acts as a dual checklist: a) service providers to provide essential services timely, b) beneficiaries to avail the service timely. This greatly minimizes the fatigue of grass-root level service providers and the time saved can be devoted for providing quality service. Expertise in this field is free to contribute additional points for further fine tuning. On the back page of the card, additional lines are provided for writing important notes / instructions / advices and also the vaccination status of their child(ren) - not meant for issuing to the beneficiary. Warm regards Holla and team

Dear members and viewers of technet For the successful implementation of routine immunization, country should have a specific IMMUNIZATION SCHEDULE. Members of National Technical Advisory Group on Immunization periodically meet and review the progress involving the collaborative development partners and major stakeholders. Generally, there will be one National Immunization Schedule (NIS) so that all the beneficiaries will get the vaccines as per schedule even if they move out of regular residential area or visit different facilities irrespective public sector or private sector within the country. NIS expands to meet the goals and objectives of Global Vaccination Action Plan (GVAP). There can be delay in communicating the revised schedule to all service providers especially to private sector. In India, Indian Association of Pediatricians (IAP) has always played an important role in the immunization programme. However IAP recommended immunization schedule has not one but multiple versions, some times in the same facility especially private Medical Colleges. Often, both, the parents and the facility that provided vaccination service found it very difficult to decipher the vaccines administered. Parents are provided with the “Tayicard”, MCP card and the equivalent by the Govt and the private card with IAP schedule; parents get totally confused and lose faith with both the sectors. ANMs provide vaccination services at the outreach and at planning units (PHC/CHC/Govt Hosp). They expressed that there should be only one immunization schedule for all the vaccines supplied by the Govt which we call as “ESSENTIAL VACCINES – Part A” and other vaccines available in the private sector which we call as “OPTIONAL VACCINES – Part B” as one “combo-card”. This will strengthen the Routine immunization programme of the country and promote child’s health. Keeping this in mind, we critically reviewed the revised IAP schedule, shared our “Draft” observations with a few pediatricians, IAP and local development partners for additional inputs and further revision. The same is attached for sharing with the technet community and viewers for valuable inputs. Regards Holla and the team

The SAGE October 2016 meeting report has been published in the WHO Weekly Epidemiological Record. SAGE reviewed relevant data and evidence, advised and made recommendations on various complex and critical issues including: Global Vaccine Action Plan: 2016 mid-term review of progress and recommendations Maternal and neonatal tetanus elimination (MNTE) and broader tetanus prevention Measles and rubella elimination Hepatitis B vaccination Schedules and strategies for human papillomavirus (HPV) immunization Yellow fever Polio eradication The meeting report can be downloaded at http://apps.who.int/iris/bitstream/10665/251810/1/WER9148.pdf?ua=1

Every year, the Decade of Vaccines secretariat[1] prepares a report which summarizes the progress against each of the GVAP goals (coverage, disease elimination, vaccine prices, NITAGs…). This report is the best source of information available to have a clear picture of the situation in all the areas of work of the Immunization world (research, procurement, logistic, delivery, demand…). This year, the GVAP Secretariat report 2016 is composed of several pieces: 1) The usual GVAP secretariat report (all Goals and Strategic Goals indicators) 2) Six regional progress reports 3) Seven priority countries progress reports 4) The Score Cards for Immunization summarizing the immunization coverage for all antigens and for all countries from 2000 to 2015 All those documents serve as the basis for the independent review conducted by the Strategic Advisory Group of Experts on immunization (SAGE). SAGE GVAP Assessment report will be published soon and will then be discussed at the World Health Assembly. The SAGE Decade of Vaccines (DoV) Secretariat Report 2016 and the National Immunization Coverage Scorecards estimates 2016 are now available and can be accessed from the WHO GVAP web page To facilitate the exploration of the data, some data visualizations that measure progress against the goals and strategic objectives of the GVAP have been made available on the TechNet-21.org website. We encourage you to share your opinions or ask questions about these visualizations on the TechNet-21.org forum. For further information on the Decade of Vaccines and the Global Vaccine Action Plan please see the GVAP webpage or email the DoV Secretariat (dovsecretariat@who.int). [1] The Decade of Vaccines secretariat comprises the Bill & Melinda Gates Foundation, Gavi the Vaccine Alliance, UNICEF, the US National Institute of Allergy and Infectious Diseases and the World Health Organization (WHO).

Dear all We are presenting this post for inputs from the viewers which will help us in critically reviewing the programme as an exercise for the post graduates. This may indierectly help in reaching the goals and objectives of GVAP by 2020. Context: Government of India (GOI) has launched Mission Indradhanush (MI) – a flagship programme of the country on good governance day: 25th Dec 2014 - as a new initiative for ambitiously improving vaccination coverage @5% per year to reach ≥90% by 2020 from 65% as per Rapid Survey of Children (RSOC) 2013-14. It is stated that in 5 years, coverage had increased @1% per year from 61% as per Coverage Evaluation Survey (CES) 2009 to 65.2% in 2013-14. We have the dubious distinction of being “highest in the world” as an estimated 8.9 million children do not receive all vaccines that are available under UIP - launched in 1985. This gap is further accentuated by iatrogenic widening as the children of elite population avail vaccination services from the private sector including Medical Colleges administering vaccines with no known potency and practicing whimsical schedule incompatible with National Immunization Schedule (NIS) – hampering Full Immunization Coverage (FIC), reporting through MCTS & HMIS with resultant accumulation of covert susceptible. This situation often becomes news when antibody for rubella during the routine ante-natal checkup in the developed countries was not found among those who received MMR by the private sector in India. Management techniques play an important role in the effective implementation of a health programme. MI - launched as a special drive qualifies to be reviewed using VMOSA of business management; assigned to the Post graduates doing MD in community Medicine – who would be programme officers in future. MI is compared with the success story of planning units supported by the Department of Community Medicine – KVG Medical College which attained and sustained very high vaccination coverage both quantitatively and qualitatively much before the launch of MI (March 2013). As a guesstimate, a few thousands of planning units in the country may be already enjoying high coverage through dedication and commitment. What is VMOSA? It is the acronym for Vision, Mission, Objectives, Strategies and Action plan. The Vision is simply a “dream” for realizing in the future. Philosophers, successful managers often iterated that everyone should know how to dream and the life will be successful for those who can / do dream: even day dream with open eyes. Who has (have) to dream / visualize? The smallest ‘Unit’ is one person who is dedicated, having in depth experience in the programme, has adequate knowledge starting from the grass-root service provider to national level, believes in learning by doing & working together empathetically, does pilot study, provides: supportive supervision / technical assistance / timely feed-back & forward / appreciates and rewards the good performers; develops successful template for replication. Vision statement by such person(s) will develop operable user friendly tool for fatigue free process, can be managed with available budget and dramatically realizes the dream hence it has long term sustainability. Such experienced person(s) may or may not have the authority or in the development organization. On the contrary, vision statement from less experienced but authorized persons from higher formation with ivory tower approach, necessitating too much dependency on technical consultants whose support is not easily accessible and or available only for short duration being dependent on heavy budget, lack of operational clarity among the service providers at different level etc may not fetch the expected results timely and may revert back to ‘status-co’ as happened in the past and at present – the coverage is 62.6% as per NFHS4 (2015-16); 15.4% lower than 78% of CES 2009 inspite of operating Intensified Routine Immunization (IRI) 2012-13 and MI since April 2015. Why VMOSA? VMOSA is for making a useful journey in the right direction for achieving the set objectives by these ‘Missioners’ (those who work in mission mode), preferably through the tested strategies and user-friendly practically workable sustainable comprehensive action plans with minimal fatigue and marginalized finance. The action plan should provide tool(s) for the team to self supervise and monitor the outcome as per the critical programme indicators provided in the guideline, helping in programme sustainability. If the outcome is dramatically / visibly / higher, needs to be shared concurrently with the community. Perceiving and appreciating the positive outcomes by the community through regular sharing will voluntarily promote utilization. The process is expected to reorient, build the capacity, perpetuation through peer education for long term sustenance and better the quality of the programme compared to the ongoing. Programmatically, Decade of Vaccines (2011–2020) made the decadal vision statement as a world in which all individuals and communities enjoy lives free from vaccine-preventable diseases. GVAP also expressed to realize this dream by delivering universal access to immunization. Between 1971 and 2016 the WHO region America has become disease free for 4 VPDs – smallpox in 1971, poliomyelitis in 1994, and rubella and congenital rubella syndrome in 2015 and now for Measles in 2016. The Mission being action / outcome oriented, the statement describes why and what are to be done by the RI players to achieve the vision. The 'Missioners' work on a war-foot like the commandoes - stop not till they accomplish the "MISSION". Core value as to how the partners, stakeholders, service providers at different levels and the beneficiaries believe needs to be considered and respected. Goals as a general statement as to what needs to be accomplished and the specific Objectives with specific milestones and specific timeline for achieving the goal are to be clearly defined. How much of what is to be accomplished with specific measurable results by when are to be drawn. The objectives of MI are to be achieved at community level. Though the ultimate ownership lies with the Govt, for timely reaching the national and international goals, collaborating and coordinating with all stake holders is mandatory. Pro-activeness by the latter is probably welcome. Strategies are to be made to use the mission statement to achieve the vision statement, tested ones are preferable. Replicating the success stories will save time money and lives. Finally the Action plan – the detailed blueprint in the form of specific micro-plan for: quantifying / reaching / service providing / recording / reporting / measuring the outcome / sharing / operational research etc can help in culminating the journey of realizing the dream – THE VISION.

The final report of the “Briefing on WHO Tools and Guidance on Immunization Data Quality and Vaccination Coverage Survey” that took place in Istanbul in December 2015 is now available. The Executive summary is pasted below. Please feel free to share. Executive Summary From 1 to 4 December 2015, 68 representatives of Ministries of Health, National Statistics Offices and national institutes from five regions of the World Health Organisation (WHO), UNICEF, scientific institutions, independent consultants, non-governmental organisations and partners met in Istanbul, Turkey, with the objective to Present new tools developed by WHO on immunization data quality and the new Vaccination Coverage Cluster Survey Reference Manual Train participants, including potential consultants or academic or similar organizations able to provide technical assistance, on one of the following tracks: immunization data quality and vaccination coverage survey planning and implementation. In recent years, the importance of using high quality data both to improve immunization programme performance and to monitor the results has been highlighted, for example following the roll-out and annual assessments of the Global Vaccine Action Plan (GVAP). Also, Gavi, the Vaccine Alliance, now requires countries applying for all types of Gavi support to conduct: an annual desk review of immunization data periodic in-depth assessments of routine administrative vaccination coverage data and periodic nationally representative vaccination coverage surveys. Given this background, over the next few years, it is expected that there will be an increased need for guidance and technical assistance to assess the quality of country immunization data and produce actionable data improvement plans, as well as to implement vaccination coverage surveys using the revised WHO Vaccination Coverage Cluster Survey Reference Manual. This Briefing was the first of such activities and aimed at sharing the new materials and tools, seeking expert advice to complete those materials related to data quality, sharing best practices among participants and thinking critically about the design of a vaccination coverage survey in a given country, from survey protocol design, to implementation and interpretation of results.

Dear colleagues, On 27 February, the Cameroon Inter-ministerial Committee, authorized by the Health Minister of Cameroon to facilitate the production of a joint HIV/immunization law and accompanying Special Appropriation Account, scheduled a study tour in Costa Rica to observe the country's law and EPI performance, and one to nearby Gabon to learn from their HIV fund. The planning session was well-attended, with representatives from parliament, ministries of Health and Finance, and international partners all actively participating. Please find a brief report attached. Warm regards, Andrew Carlson

We are pleased to inform you that several publications featuring the Decade of Vaccines Global Vaccine Action Plan (GVAP) Assessment report 2014 are now available for dissemination. - WHO Executive Board 136 report on GVAP: http://apps.who.int/gb/e/e_eb136.html The document (EB 136/25) will be discussed at the upcoming Executive Board meeting in January 2015 and is available in all 6 official languages. - The Strategic Advisory Group of Experts (SAGE) on immunization October 2014 meeting report is now available in the Weekly Epidemiological Record (WER): http://www.who.int/wer/2014/wer8950.pdf. The report includes a summary of the GVAP session. - The SAGE GVAP Assessment Report 2014: http://www.who.int/immunization/global_vaccine_action_plan/en/ The 2014 report is available for download in English, French, Russian and Spanish languages. Hard copies will be disseminated to Member States. Please feel free to share these materials with your networks. Let us know what you think about the report! Kamel Senouci

The Global Vaccine Action Plan (GVAP) sets out an array of targets for a world in which all individuals and communities enjoy lives free from vaccine-preventable diseases. As requested by Member States at the World Health Assembly in 2012, an annual review of the progress with the implementation of the GVAP goals and indicators is done by the Strategic Advisory Group of Experts (SAGE) based on a technical report prepared by the GVAP Secretariat. To access in full both the GVAP Secretariat and the SAGE assessment reports please visit http://who.int/immunization/global_vaccine_action_plan Progress against the GVAP goals and strategic objectives are shown in the following data visualizations on the GVAP indicators page on TechNet-21. http://www.technet-21.org/resources/gvap-indicators These visualizations were created by David Oh, Daniela Urfer, Laure Dumolard, Thomas Cherian, and Kamel Senouci from data available in the public domain. A special thanks to Daniel Brigden for his help with sharing the materials on the web. Please share your thoughts and opinions on these visualizations by replying to this post!

by Magda Robert and Laurie Werner, Decade of Vaccines Collaboration Over the past year, the Decade of Vaccines (DoV) Collaboration has been developing a Global Vaccine Action Plan (GVAP). The plan is now being finalized and will be presented for endorsement at the 65th World Health Assembly, to be held in Geneva on May 21–26, 2012. One of the recommendations made is the need to improve immunization delivery systems, and the importance of innovation in achieving this. The GVAP outlines how best to provide lifesaving vaccines to those who need them most, how to maintain a strong pipeline of new vaccines, and how to strengthen public support for vaccination efforts. By 2020, the plan aims to meet the following goals: • Achieve a world free of polio. • Meet global and regional elimination targets. • Meet vaccination coverage targets in every region, country, and community. • Develop and introduce new and improved vaccines and technologies. • Exceed the MDG 4 target for reduction in child mortality. The GVAP proposes that these ambitious goals be met through six strategic objectives: 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 programmes have sustainable access to predictable funding, quality supply, and innovative technologies. 6. Country, regional, and global research & development (R&D) innovations maximize the benefits of immunization. For those working in the field of vaccine supply chains, strategic objective 4 is particularly important, as it emphasizes the importance of innovation in the supply chain. Establishing and improving information systems, cold chain capacity and logistics, and waste management is also highlighted as critical for the next decade. The GVAP was initially developed through the work of stakeholders across the immunization spectrum, with input from eight working groups composed of more than 100 core members. Starting in November 2011, the DoV Collaboration shared the draft GVAP with stakeholders around the world. Over the ensuing months, the DoV Collaboration held approximately 20 consultations with stakeholders in Asia, Africa, the Americas, Europe, the Middle East, and Western Pacific regions. Overall, more than 1,100 stakeholders from the working groups and global consultation process, representing more than 140 countries and 290 organizations, provided ideas, feedback, and comments on the GVAP. They represented governments, policy makers, elected officials, civil society, health professionals, global development organizations, the research community, manufacturers, and other experts. Emerging from the consultation process, certain critical components of the World Health Organization/ UNICEF Global Immunization Vision and Strategy have been given greater emphasis in the GVAP. This includes amplifying the emphasis on country ownership, generating demand for immunization, having a comprehensive strategy for vaccination (from research and development to delivery, access, and public and political support), and strengthening comprehensive disease prevention and control. The GVAP also proposes: • A high-level monitoring and evaluation framework with defined indicators and stakeholder responsibilities. • Innovation as a guiding principle. • Recasting the Reaching Every District strategic approach as “Reaching Every Community.” • Adding supply-side interventions to ensure sustainable access to vaccines. • Broader stakeholder participation in the planning and implementation process, including a larger group of actors from across the immunization spectrum. We hope the GVAP will be endorsed by the World Health Assembly in May. Once endorsed, we will have a plan that looks at the discovery, development, and delivery of immunization, and provides a strategy for country ownership, demand generation, equity, health systems strengthening, financing, supply, and research and development that needs to be translated at the regional and country levels. It will also set the foundation for a monitoring and evaluation framework for implementation of the plan over the decade. We now have a strategy for the next ten years and, once approved, the decade-long task of implementing such an ambitious plan will begin. For more information on the DoV Collaboration, visit the DoV Collaboration website or email Laurie Werner (lwerner@path.org). To comment, make sure you are logged in and click Reply.”

Here is a summary of interventions made by country delegations during the GVAP discussion at the WHO Executive Board on 21 January. - A number of delegations mentioned the importance of including measles elimination as part of the GVAP (there was some discussion as to whether it should be eradication). - EU delegation: welcomes the GVAP, expects that governments will be given guidance and country-level road maps on how to operationalize it. Calls for WHO to play a lead role in drafting and implementing the GVAP. Welcomes the establishment of a Vaccine Access Forum. Encourages a GVAP that is operational, not conceptual. Highlights the importance of an accountability framework for the GVAP. - China: suggests a strong role for health education and promotion in the GVAP. Introduces the importance of "risk communications" to address misperceptions around immunisation. Says that it is important to prioritize immunisation *within* a primary healthcare approach. Calls for a disease surveillance component to the GVAP. Asks how DoV will communicate with all stakeholders. Mentions importance of technology transfer and calls for GVAP to support countries to develop their Health Information Systems. - USA: Encourages member states to support the GVAP, mentions the need to stimulate demand for immunisation in high-income countries as well. Defines immunisation as a development challenge, not just a health challenge. Says that GVAP insufficiently addresses the *use* of vaccines (focus is on access, to detriment of use)-- recommends plugging in "access and use" wherever "access" is mentioned in the plan. Says that it is unclear who will take the GVAP forward-- requests clarification. Requests clarification on the vaccine access forum-- what is it? Mentions lagging coverage of measles vaccine-- US does not accept measles eradication language, instead prefers elimination. - Japan: supportive of GVAP, but says it is vital that it coordinates with existing immunisation strategies and programmes to avoid confusion, especially at the field level. - Ecuador: speaking on behalf of UNASUR (Union of South American countries): supports measles elimination-- not eradication. - India: highlights the need to focus on increasing community awareness within the GVAP. - Timor Leste: GVAP should give priority to developing countries, resource constraints should be taken into consideration. - France: requests information on the relationship between GAVI and the GVAP. - Sierra Leone: speaking in behalf of West African states: request that the GVAP prioritizes research into new vaccines, enhancing regional advocacy. Strongly supports GVAP, calls for states to increase domestic funding for immunisation. Medecins de mundo also made an NGO statement calling for: -WHO to play a leading role in GVAP roll out - Asking how conflicts of interest will be managed - Stating that immunisation should not take the place of wider primary health care. - Senegal following NGO/CSO statements: proposed that where the GVAP refers to "states", this term be changed to reflect the inclusivity of a wide variety of country-level actors.