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After the resounding success of last month’s Global Vaccine Summit, at which more than US$ 8.8 billion was pledged in support of Gavi, the Vaccine Alliance for the next five years, we find ourselves at a pivotal moment for immunisation. These new commitments are meant to enable Gavi to accelerate the roll-out of life-saving vaccines in developing countries by 2025 and contribute to saving 8 million more children’s lives. But with COVID-19 currently stifling routine immunisation campaigns, what will it take to ensure that every child is reached with effective vaccines?

On 30 June, representatives of civil society organisations (CSO), in conversation with Gavi and UNICEF, convened to discuss what routine immunisation looks like in the time of COVID-19. Chaired by Dr Endie Waziri, National Coordinator of the National Stop Transmission of Polio Program (NSTOP) at the African Field Epidemiology Network (AFENET) office in Nigeria, the discussion addressed the risk COVID-19 presents to sustaining routine immunisation, the opportunity we have to redress global inequalities in access to life-saving vaccines, and the critical role played by civil society in ensuring accountability for and quality of health services.

Discussion panel

The Challenge

As Dr Robin Nandy, Chief of Immunization at UNICEF, reminded us from the outset, even prior to COVID-19, global immunisation rates had stagnated, with around 20 million children still missing out on the full complement of vaccines. Dr Alina Akhyar, Health Coordinator, International Rescue Committee, Pakistan and CEO and Founder of Ronaq-e-Qainatt, outlined the further detrimental impact COVID-19 is already having on immunisation services. Large-scale immunisation campaigns have been put on hold. In Pakistan alone, 40 million children have missed polio vaccines in April 2020, and the number of measles cases is already increasing. Not only does COVID-19 present a risk to the delivery of vital services, but also to public trust. Dr Chimère Diaw, Chief of Party at Save the Children Democratic Republic of the Congo (DRC), warned that the fear of COVID-19 had reduced the number of people accessing life-saving childhood immunisation services in DRC, including established vaccinations against measles, cholera and pneumonia.

The Opportunity

Building on the successes of the Global Vaccine Summit 2020, Thabani Maphosa, Managing Director of Country Programmes at Gavi, thanked stakeholders for helping to raise vital funds to immunise 300 million children and support the global fight against COVID-19, while reminding us “Gavi 5.0 – Gavi’s next five year strategic period, 2021–2025 – is about reaching the last child first.” He also underscored that “we are here to fight vaccine-preventable diseases and prepare ourselves against novel diseases that might come our way.”

Dr Nandy described the opportunity ahead to increase the efficiency and equity of immunisation by harnessing new partnerships and using the experience of COVID-19 to “reimagine immunisation services with a higher quality”. The creation of a strong health system has been proven to mitigate the impact of disease outbreaks and build the resilience needed to mitigate the impact of future health threats. Reflecting on the experiences of the DRC response to the Ebola outbreak, Dr Diaw told how the health architecture developed in response to Ebola has left the country: “DRC is better prepared and more experienced in tackling epidemics.” These important lessons learnt could set the precedent for how the global community responds and builds from COVID-19.

According to Dr Akhyar, integrated approaches that place immunisation alongside other key health interventions, such as nutrition, will be integral to building the primary health care (PHC) systems needed to improve the effectiveness of immunisation. Dr Nandy agreed that a non-siloed approach with immunisation as a key driver to strengthen PHC and building more resilient health systems are at the core of the reimagined immunisation infrastructure.

The Role of Civil Society Organisations (CSOs)

Immunisation community champion Dr Mbianke Livancliff who works for Value Health Africa, a Cameroonian health advocacy organisation, brought attention to the critical role of CSOs reaching under-served communities. Dr Livancliff highlighted the need to empower CSOs to enhance their abilities to provide hard-to-reach communities with immunisation services.

Mbianke Livancliff

We also heard that solutions to immunisation challenges are often devised from grassroots initiatives. Dr Diaw explained that in the DRC, women’s groups are playing a pivotal role in immunisation at community level, identifying issues, supporting in health education, and taking a leading role in developing context-specific solutions to improve vaccine access and uptake. Civil society action is critical for restoring public trust in immunisation. Maphosa outlined the role of CSOs in tackling misinformation about vaccines and ensuring the right messaging is delivered at the community level, and emphasised that civil society will be fundamental to holding governments to account on their commitments and investments in immunisation.

Re-emerging from the pandemic with a stronger immunisation infrastructure is simply unachievable without the local expertise, reach and dedication of civil society and community-based organisations. Whilst we must be mindful of the risks COVID-19 presents to immunisation, we must also take the opportunity to rebuild with a renewed and reinvigorating approach to improving equitable access to immunisation.

With only ten years remaining to 2030 to achieve the Sustainable Development Goal of ending deaths from vaccine-preventable diseases, our actions in response to COVID-19 will set the precedent for this decade of immunisation delivery, and for many years to come.

This blog is a summary of an online conversation hosted by the Gavi CSO Constituency in partnership with ACTION, Gavi, the Vaccine Alliance, RESULTS UK & Save the Children.

Watch the recording of the event here

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