Global immunization: status, progress, challenges and future

Vaccines have made a major contribution to public health, including the eradication of one deadly disease, small pox, and the near eradication of another, poliomyelitis.Through the introduction of new vaccines, such as those against rotavirus and pneumococcal diseases, and with further improvements in coverage, vaccination can significantly contribute to the achievement of the health-related United Nations Millennium Development Goals.The Global Immunization Vision and Strategy (GIVS) was developed by WHO and UNICEF as a framework for strengthening national immunization programmes and protect as many people as possible against more diseases by expanding the reach of immunization, including new vaccines, to every eligible person.This paper briefly reviews global progress and challenges with respect to public vaccination programmes

Decomposing the gap in missed opportunities for vaccination between poor and non-poor in sub-Saharan Africa : a multicountry analyses

Understanding the gaps in MOV between poor and non-poor in sub-Saharan Africa (SSA) would enable an understanding of factors associated with interventions for improving immunization coverage to achieving universal childhood immunization. We aimed to conduct a multicountry analyses to decompose the gap in MOV between poor and non-poor in SSA. We used cross-sectional data from 35 Demographic and Health Surveys in SSA conducted between 2007 and 2016. Descriptive statistics were used to understand the gap in MOV between the urban poor and non-poor, and across the selected covariates. Out of the 35 countries included in this analysis, 19 countries showed pro-poor inequality, five showed pro-non-poor inequality and remaining 11 countries showed no statistically significant inequality. Among the countries with statistically significant pro-illiterate inequality, the risk difference ranged from 4.2% in Congo DR to 20.1% in Kenya. The important factors responsible for the inequality varied across the countries. In Madagascar, the largest contributions to the inequality in MOV was media access followed by number of under-five children and maternal education. However, Liberia media access narrowed the inequality in MOV between poor and non-poor households.The findings indicate that in most SSA countries, children belonging to poor households are most likely to have MOV and that socio-economic inequality in missed opportunities for vaccination is determined not only by health system functions, but also by factors beyond the scope of health authorities and care delivery system. Suggesting the the importance of addressing the social determinants of health, particularly education

A mid-term assessment of progress towards the immunization coverage goal of the Global Immunization Vision and Strategy (GIVS)

BACKGROUND: The Global Immunization Vision and Strategy (GIVS) (2006-2015) aims to reach and sustain high levels of vaccine coverage, provide immunization services to age groups beyond infancy and to those currently not reached, and to ensure that immunization activities are linked with other health interventions and contribute to the overall development of the health sector. OBJECTIVE: To examine mid-term progress (through 2010) of the immunization coverage goal of the GIVS for 194 countries or territories with special attention to data from 68 countries which account for more than 95% of all maternal and child deaths. METHODS: We present national immunization coverage estimates for the third dose of diphtheria and tetanus toxoid with pertussis (DTP3) vaccine and the first dose of measles containing vaccine (MCV) during 2000, 2005 and 2010 and report the average annual relative percent change during 2000-2005 and 2005-2010. Data are taken from the WHO and UNICEF estimates of national immunization coverage, which refer to immunizations given during routine immunization services to children less than 12 months of age where immunization services are recorded. RESULTS: Globally DTP3 coverage increased from 74% during 2000 to 85% during 2010, and MCV coverage increased from 72% during 2000 to 85% during 2010. A total of 149 countries attained or were on track to achieve the 90% coverage goal for DTP3 (147 countries for MCV coverage). DTP3 coverage ≥ 90% was sustained between 2005 and 2010 by 99 countries (98 countries for MCV). Among 68 priority countries, 28 countries were identified as having made either insufficient or no progress towards reaching the GIVS goal of 90% coverage by 2015 for DTP3 or MCV. DTP3 and MCV coverage remained < 70% during 2010 for 16 and 21 priority countries, respectively. CONCLUSION: Progress towards GIVS goals highlights improvements in routine immunization coverage, yet it is troubling to observe priority countries with little or no progress during the past five years. These results highlight that further efforts are needed to achieve and maintain the global immunization coverage goals

Rural-urban disparities in missed opportunities for vaccination in sub-Saharan Africa : a multi-country decomposition analyses

Background In this study, we aimed to explore the rural-urban disparities in the magnitude and determinants of missed opportunities for vaccination (MOV) in sub-Saharan Africa. Methods This was a cross-sectional study using nationally representative household surveys conducted between 2007 and 2017 in 35 countries across sub-Saharan Africa. The risk difference in MOV between rural or urban dwellers were calculated. Logistic regression method was used to investigate the urban-rural disparities in multivariable analyses. Then Blinder-Oaxaca method was used to decompose differences in MOV between rural and urban dwellers. Results The median number of children aged 12 to 23 months was 2113 (Min: 370, Max: 5896). There was wide variation in the the magnitude of MOV among children in rural and urban areas across the 35 countries. The magnitude of MOV in rural areas varied from 18.0% (95% CI 14.7 to 21.4) in the Gambia to 85.2% (81.2 to 88.9) in Gabon. Out of the 35 countries included in this analysis, pro-rural inequality was observed in 16 countries (i.e. MOV is prevalent among children living in rural areas) and pro-urban inequality in five countries (i.e. MOV is prevalent among children living in urban areas). The contributions of the compositional ‘explained’ and structural ‘unexplained’ components varied across the countries. However, household wealth index was the most frequently identified factor. Conclusions Variation exists in the level of missed opportunities for vaccination between rural and urban areas, with widespread pro-rural inequalities across Africa. Although several factors account for these rural-urban disparities in various countries, household wealth was the most common

Addressing the persistent inequities in immunization coverage.

A key focus of the health-related sustainable development goal (SDG) 3 is universal health coverage (UHC), including access to safe, effective, quality, and affordable essential medicines and vaccines. However, the challenges to achieving UHC are substantial, especially with increased demands on the health sector and with most budgets being static or shrinking. Immunization programmes have been successful in reaching children worldwide. For example, 86% of the world’s infants had received three doses of diphtheria-tetanus-pertussis (DTP3) vaccine in 2018. The experiences from such programmes can contribute to UHC, and as these programmes strive to adapt to new global strategic frameworks, such as Gavi, the Vaccine Alliance’s strategy Gavi and the World Health Organization’s (WHO) Immunization Agenda 2030, these efforts can inform the progressive realization of UHC. Immunization programmes that can sustain regular levels of contact between health providers and beneficiaries at the community level have enabled new vaccines to be added to routine immunization schedules and other interventions to be delivered to children and their families. In addition, experiences from both polio campaigns and the child health days strategy show that incorporating additional interventions into campaigns can increase coverage of these interventions as well as of vaccinations

Recommandations et politiques vaccinales mondiales : le rôle de l’OMS

Cet article fait le point du rôle normatif de l’organisation mondiale de la santé (OMS) en matière de vaccins et vaccinations, de son importance, de son impact, et de ses limites. Il présente aussi les défis à relever pour favoriser l’introduction rapide des nouveaux vaccins dans les pays en développement et s’ajuster à la nouvelle vision et stratégie de l’OMS et de l’UNICEF - qui vise à faire bénéficier l’ensemble des classes d’âge de la totalité de l’éventail vaccinal et de son potentiel de réduction de la mortalité dans un contexte intégré avec les autres interventions de santé. Au niveau global, trois comités ont un rôle prépondérant dans le domaine normatif : le Groupe stratégique consultatif d’experts sur la vaccination ; le Comité consultatif mondial de la sécurité vaccinale ; et le Comité d’experts de la standardisation biologique. Les recommandations de l’OMS en matière d’utilisation des vaccins sont publiées comme notes de synthèse dans le Relevé Épidémiologique Hebdomadaire. Des efforts sont en cours pour accélérer les processus de mise à jour des recommandations, et améliorer la transparence et la communication autour du rôle normatif de l’OMS