Kate O'Brien, Director of the Department of Immunization, Vaccines and Biologicals at WHO
WHO, along with the IA2030 partners, has established 2023 as an intensified year of action on immunization. This call to action recognizes the importance for country immunization programmes to assess the impact of the pandemic on their programme performance and course correct where needed. This may involve the need to catch-up the accumulated zero-dose children through a variety of programmatic approaches; to recover the programmatic performance of DTP1 coverage to at least the levels of 2019 (pre-pandemic); and to strengthen the immunization programme so that DTP1 coverage is better than the pre-pandemic levels and, on a trajectory, to achieve 2025 and 2030 zero-dose goals (i.e., half the number of 2019 zero-dose children by 2030). Harnessing the political leadership and prioritization of immunization resulting from the COVID pandemic experience is an opportunity to save millions of lives. The ambition to save 50 million lives in the IA2030 decade depends on this concerted action.
Together with our members states and key partners, WHO has been uncompromising in our commitment to get vaccination on global agendas, to enhance political dialogue and engagement, and to leverage the resources needed to implement. The COVID pandemic put the spot-light on the value of vaccines, and demonstrated what could be achieved with concerted, aligned effort. This year we are not only continuing the work to protect the high priority populations with COVID vaccine but are also intensifying our efforts on routine immunization, aiming to claw back what was lost on programmatic performance and push to reduce the number of zero-dose children.
With this as our overarching priority so as to address the worst continued decline in routine immunization coverage in 30 years, together with the IVB Leadership Team, I recently visited our Africa Regional Office and three priority country offices, the Democratic Republic of Congo (DRC) and Mozambique.
The visits were supporting the Essential Immunization Recovery Plan in the African Region that has been developed in partnership with UNICEF and Ministries of Health to ensure that countries get back on track to reach the Immunization Agenda 2030 (IA2030) goals. Our visit included strategic dialogue and alignment with our regional office for 2023 catch-up-recovery-strengthening planning and action; country office and field visits in DRC; and understanding the polio outbreak response approach in Mozambique for identifying Zero-Dose children.
Getting concrete on the synergies that EPI can leverage from the polio vaccine approaches is a key action to gain efficiency and have greater impact. We have further visits planned to our regions and country offices in this year of intensified action on immunization.
Last week, the Executive Board (EB) of WHO reviewed progress towards implementation of the Global Roadmap to Defeat Meningitis by 2030. Member States highlighted the importance of collaboration between regions and member states to defeat meningitis and the need for technical guidance. In view of the impact of COVID and insufficient funding, Member States highlighted the following key priorities to support implementation of the roadmap: encouraging the mobilization of funding; stepping up efforts to boost trust and confidence in vaccines; fostering cooperation between regions and providing opportunities for PHC reinforcement and integration; and for surveillance enhancement and early detection. Further, coordinated action at country level was highlighted with required links to PHC, Immunization, Global Health Security and Disability efforts/initiatives.
Today, more than 1.2 million children have been reached with the first malaria vaccine, RTS,S/AS01 (RTS,S), in Ghana, Kenya and Malawi through national immunization programmes as part of the WHO-coordinated Malaria Vaccine Implementation Programme (MVIP). Pilot introductions have resulted in substantial reduction in deadly severe malaria - a drop in child hospitalizations for malaria and reduction in child deaths. There is unprecedented demand for the life-saving vaccine: at least 28 countries in Africa plan to apply for Gavi funding support to rollout the malaria vaccine as part of their national malaria control strategies (13 countries applied for Gavi funding in the January 2023 application round).
Supply, although limited in the short term, has been secured for wider malaria vaccine use. The initially limited supply will be allocated to children living in areas of highest need across endemic countries, with phased expansion to other countries as supply increases. Increasing supply is a priority for WHO, Gavi and partners so Africa can reap the benefits of the additional malaria prevention tool. A second malaria vaccine (R21/Matrix-M) is in late stage clinical development, and if recommended for use, could increase global supply and access. A joint working group of the Strategic Advisory Group of Experts on Immunization (SAGE) and the Malaria Programme Advisory Group (MPAG) will be reviewing available data from the ongoing phase 3 trial on R21 to understand the vaccine's safety and efficacy in different malaria transmission settings (year-round and seasonal). The pilots will continue through 2023 to help us understand the added value of the 4th vaccine dose and to measure the impact of the vaccine introduction on lives saved.
Another area of our intensified focus is on building demand for immunization. This is key to ensuring the use and impact of any new vaccines. With 80% of vaccines in development focused on adults, ensuring uptake among this group is vital. With that in mind we are intensifying our work to advance new TB and RSV vaccines, which are at different stages in the development value chain but are both diseases which significant burden for which vaccines would have a significant impact. The WHO Director General announced on 16 January 2023 at the World Economic Forum that he would be initiating a TB Vaccine Acceleration Council in order to increase momentum for the development of a vaccine to combat the world's most deadly infectious disease. This will be an important means to accelerate the development of TB vaccines that are much more impactful on TB disease and transmission than the tools in hand presently. WHO looks forward to expanding partnerships and working with political leaders, advocates, academics, research institutions, communities and many other stakeholders to advance this critical area of innovation and development.
