We’re at the midpoint of the Decade of Vaccines — an intense period marked by efforts to ramp up and extend the benefits of immunization to all people, everywhere. Unfortunately, despite much progress, the world has fallen short. But there is still time to re-think our strategy.
It was with this goal in mind that PATH recently joined Health Affairs at the launch of its February issue on Vaccines, which includes a series of articles on global immunization. I moderated a thought-provoking panel of experts from various US agencies to discuss how the US government—as a leader in global immunization—can help accelerate action in the second half of the decade, and beyond.
The US has a long history of leadership and success in global immunization and played an important role in shaping the Global Vaccine Action Plan (GVAP), which was endorsed in 2012 by 194 countries at the World Health Assembly. The GVAP provides a framework for achieving the vision of a Decade of Vaccines. It includes very specific goals and targets on vaccine issues ranging from achieving equitable coverage to improving delivery systems and developing new vaccines.
Many of the GVAP goals overlap with US global immunization goals. At the panel discussion, we discussed recommendations for how the US can take advantage of this moment to strengthen its policies, improve coordination and leadership, and sustain financing to maximize efforts.
Evaluating The Global Vaccine Action Plan
During the discussion, Rebecca Martin of the Centers for Disease Control and Prevention (CDC) noted that pockets of progress do exist. But as demonstrated in a recent assessment of the GVAP, provided by the World Health Organization, the world is far off track, and if immediate action is not taken we will continue to fall further behind. Promising gains have been made in the introduction of new vaccines, but we are falling short on all other targets, including overall immunization coverage and disease elimination goals. Accomplishments like India’s elimination of maternal and neonatal tetanus and Nigeria being taken off the list of polio-endemic countries are remarkable, but these successes need to become the norm to achieve the GVAP goals.
Like many global plans, the GVAP goals were aspirational, but the key to leveraging them to make an impact is follow through. The GVAP, according to Dr. Lee Hall from the National Institute of Allergy and Infectious Diseases, was designed with accountability in mind. Ambassador Jimmy Kolker, from the Office of Global Affairs at US Department of Health & Human Services (HHS), added it “was developed by scientists but had political steam behind it.” Yet, with progress lagging, it raises the question of whether sufficient political attention is being placed on accountability.
Looking at how global immunization efforts are coordinated across US agencies—a challenge identified in PATH’s policy report—panelists highlighted areas of success. Hall noted that there is effective coordination across the government on vaccine research and development, particularly between the Food and Drug Administration (FDA), the National Institutes of Health (NIH), and CDC, and that these groups come together regularly to address barriers. On collaboration in the field, Susan McKinney of the US Agency for International Development (USAID) echoed the value of interagency coordination, sharing an example of how USAID and CDC work in lockstep in Nigeria to maximize investments.
Country ownership is a key tenet of the GVAP. Panelists noted that it takes close partnership to help countries identify and address their greatest needs. Bruce Gellin from the National Vaccine Program Office at Department of Health and Human Services described the technical assistance provided by a variety of US agencies to countries around the world, helping countries strengthen surveillance, cold chain and logistics, regulatory capacity-building, and health information systems.
However, the degree to which countries feel ownership and engagement in the GVAP is uncertain. McKinney noted that in her experience working with country health systems, political and technical leaders do not often address GVAP commitments or focus their priorities around meeting the targets. Ambassador Jimmy Kolker from the Office of Global Affairs at HHS suggested that increasing “collective accountability,” between the US and partner countries is essential to accelerating progress.
Reflecting on the remarkable accomplishments we have made in nearly eradicating polio, Martin noted that polio efforts have strengthened systems and taught us how to truly reach every child. Once the job is done, the human capacity, assets, and knowledge gained through polio efforts must be transitioned to other disease elimination efforts, such as measles. She noted that the resources the US contributes to polio must continue to be leveraged to detect, prevent, and respond to a broader array of diseases.
Countries not only have many ongoing competing health priorities, but their health systems are also faced with new outbreaks, as we’ve seen most recently with the spread of the Zika virus in the Americas. Panelists reflected on how the systems supported by routine immunization programs have provided know-how, staff, and infrastructure that has helped stop the spread of diseases like Ebola. Investments in immunization have proved to have a high return on investment for addressing both existing and new challenges.
Tremendous efforts are taking place within individual agencies and frequently in partnerships that span multiple agencies. Still, the world is off track and will not reach the GVAP goals without a course correction, and the US could play a significant role in catalyzing that shift. An overarching US plan to unify efforts across agencies, double down on support to partner countries, and ensure that immunization is prioritized for both political and technical decision-makers can ensure that US investments and leadership are maximized to accelerate impact.
PATH is deeply committed to advancing global immunization. In our work developing new vaccines, partnering with companies to bring them to market, and collaborating with governments and partners worldwide to strengthen delivery systems, we see the challenges firsthand. Urgent action is needed by all players in the global health community to accelerate progress toward global immunization goals and prevent millions from suffering and dying from vaccine-preventable diseases.
We hope the global health community will use the midpoint to assess what has worked and reinvigorate our collective commitment to reach the goal line.