SAGE assessment reports

Immunization has proven the test of time as one of public health’s most cost effective interventions. In 2017, the number of children immunized – 116.2

million – was the highest ever reported. The Region of the Americas achieved

maternal and neonatal tetanus elimination, leaving only 15 countries yet to

achieve elimination. Since 2010, 113 countries have introduced new vaccines,

and more than 20 million additional children have been vaccinated.

Nevertheless, this year starkly illustrates how easily hard-won gains are lost.

Because of low coverage nationally, or pockets of low coverage, multiple WHO

regions have been hit with large measles and diphtheria outbreaks causing

many deaths. The continued detection of circulating vaccine-derived poliovirus is further evidence that national immunization programmes are not achieving the goal of reaching every child.

To spur action, the Global Vaccine Action Plan set ambitious goals, and it

remains the case that most targets will not be met by the end of the Decade of Vaccines in 2020. DTP3 and first-dose measles vaccine coverage have

plateaued globally at 85%. Progress towards the eradication of wild poliovirus and the elimination of measles, rubella, and maternal and neonatal tetanus

is currently too slow to be achieved by the end of the decade.

This picture provides a backdrop for discussions of the future of immunization

after 2020, the final year of the Decade of Vaccines. The next decade is likely

to be volatile and uncertain. Continuing mass urbanization and migration,

population growth, geopolitical uncertainty and conflict, and natural disasters and environmental disruption will present major challenges to national

immunization systems.

To meet these challenges, the immunization community must seek to maintain its hard-won gains but also aim to do more and to do things better, which

may involve doing things differently. Equity must continue to be a strong driver, to ensure that everyone enjoys the benefits of immunization, including the most

disadvantaged, marginalized and hard-to-reach populations, particularly those

displaced or otherwise affected by natural disasters and conflict.

Integration will be central to achieving future goals. Partnerships have been

key to the successes of the Global Vaccine Action Plan, and will be critical to the future. Immunization is a central pillar of universal health coverage, providing an infrastructure on which effective and equitable health systems can be constructed. Through this integration, immunization can contribute to multiple Sustainable Development Goals as well as global health security and the battle against antimicrobial resistance.

Countries will be at the heart of a future immunization strategy. Regions will have a key role to play in supporting the development of national immunization systems, while global immunization partners will continue working together

to create an enabling environment for immunization.

As attention now turns to strengthening immunization post-2020, 2017’s outbreaks are a sobering reminder that no country can take its eye off the ball:

effective national immunization systems require ongoing nurturing, political commitment and public support. All countries need to see immunization systems as core to their health systems, and all citizens need to see immunization as a basic human right. In their absence, countries, regions and the world as a whole are less healthy, less safe and less prosperous. We become complacent at our own peril.