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Together we can close the immunization gap

Dr Jean-Marie Okwo-Bele, Director of the Department of Immunization, Vaccines and Biologicals

Commentary
22 April 2015

Dr Jean-Marie Okwo-Bele, Director of the Department of Immunization, Vaccines and Biologicals
WHO

Sixty years ago this month, the results of extensive field trials of Jonas Salk’s polio vaccine were published. The trials, which had involved a total of 1.8 million children, had been a resounding success. Later that year the vaccine was licensed for manufacture and the US launched the world’s first mass vaccination campaigns.

By 2014, WHO had certified 4 of its 6 regions polio-free and 80% of the world’s population now lives in countries where this highly infectious and devastating disease has been eradicated.

As a young medical student in the Democratic Republic of the Congo (DRC) in the late 1970s, I knew I wanted to focus my efforts in an area that could bring the greatest benefits to the greatest number of people. I feel very fortunate that this ambition took me straight into the field of vaccinations and to the work of the Expanded Programme on Immunization (EPI), a global, collaborative drive for immunization that began in 1974.

When EPI was first launched, only about 5% of the world’s children were protected from 6 diseases (diphtheria, measles, pertussis, polio, tetanus and tuberculosis). By 2013, that figure had risen to more than 80% in many countries and the number of vaccines used had almost doubled.

Stopping vaccine-preventable diseases

In DRC, I saw vaccination rates increase from less than 10% to around 60% in the course of just a few years. That we could achieve these results in a country such as DRC, which is the size of western Europe but faces immense challenges in terms of infrastructure and health systems, should give us all hope that we can now take immunization to the next level where no child, regardless of where they live or their economic status, is left vulnerable to vaccine-preventable diseases.

"There are still around 1.5 million deaths each year as a result of vaccine-preventable diseases. We are way off-track to meet our end-2015 targets set out in the Global Vaccine Action Plan, which was endorsed by all Member States."

Dr Jean-Marie Okwo-Bele, Director of the Department of Immunization, Vaccines and Biologicals

At WHO, we estimate that between 2 and 3 million deaths are prevented each year through immunization. Work in vaccine development means protection is increasingly being extended beyond the original 6 diseases. Many countries now vaccinate against Haemophilus influenzae type b, a bacteria responsible for severe pneumonia and meningitis in children, hepatitis B, and pneumococcal disease. This list will only continue to grow.

Yet, tragically, there are still around 1.5 million deaths each year as a result of vaccine-preventable diseases. We are way off-track to meet our end-2015 targets set out in the Global Vaccine Action Plan, which was endorsed by all Member States at the World Health Assembly in 2012. In figures that means 1 in 5 children are missing out on life-saving vaccinations. In practice it means millions of families around the world still witness loved ones suffer illness, disability and even death from diseases that we have the knowledge and the tools to prevent.

Tailoring vaccination strategies to meet challenges

Of course there is no one-size-fits-all solution to this global health challenge. Often those infants who are missing out on vaccinations live in rural, isolated communities and urban slums in some of the world’s poorest communities. Many also live in areas that are seriously affected by conflict or insecurity.

We do know what needs to be done and the tools and the capacity do already exist in most countries. We need to work at both global and country levels to mobilize resources and support immunization in each and every community. This involves micro-planning to tailor vaccination strategies to suit the needs of myriad different situations and environments, it involves finding new ways to simplify vaccine processes in the field, and it involves monitoring outcomes, measuring progress and taking collective actions.

The hallmark of successful immunization programmes is their simplicity – they can be adapted to every setting, even where there is conflict or other crises. They work at all different levels of health systems to ensure sustainable delivery of immunization services, be it in fixed health facilities or through outreach and mobile vaccinators, so that each child is reached.

Closing the immunization gap through accountability

At the grassroots level, community leaders have an important role to play in immunization programmes, ensuring that parents and caregivers understand the importance of vaccination. Ensuring accountability at every stage of immunization programmes is critical. In Nigeria, which is on the verge of eradicating polio, local government officials are held accountable for vaccinating children, thus ensuring better management of polio campaigns and of the resources that are allocated to them.

To fulfil our vision of a world free of vaccine-preventable diseases, each key player must fulfil their mandate from parents, to health workers, to programme managers, governments and partners.

Together we can close the immunization gap. When I began my career in public health 34 years ago, I could not have imagined that in my working life I would witness an Africa free of polio. We are so close to achieving this goal now. My dream now is to see much faster improvement in routine immunization coverage so that in 2 years’ time we are not still talking about how to reach that fifth child.