Working towards vaccine equity to leave no one behind
Country and community perspectives on realising the targets of the Immunisation Agenda 2030.
- 11 May 2021
- 7 min read
- by Elo Otobo
Last month, immunisation experts came together to discuss which strategic shifts in immunisation are needed to realise the goal of Immunization Agenda 2030: “a world where everyone, everywhere, at every age, fully benefits from vaccines to improve health and well-being” and enhance equity in immunisation access for zero-dose, under immunised and missed communities.
In a discussion chaired by Dr Vineeta Gupta, ACTION Secretariat Director USA, participants heard from:
- Dr Chizoba Wonodi, Nigeria Country Director at the International Vaccine Access Centre, Founder of the Women Advocates for Vaccine Access, and Secretariat for the National Platform Expanded Civil Society Initiative for Immunization.
- Dr H.M Agus Samsudin, Chairman of COVID-19 Command Centre, Muhammadiyah, Indonesia.
- Mirafe Solomon, Health and Nutrition Specialist, Save the Children Ethiopia.
- Maki Igarashi, Regional Representative and Health Coordinator IFRC Regional Office, Middle East and North Africa (MENA).
- Dr Ephrem Lemango, WHO Regional Office for Africa EPI-Essential Programme on Immunization.
- Dr Peter Singer, Special Advisor to the Director General and Assistant Director General of the World Health Organization (WHO).
Setting the agenda for immunisation
Dr Chizoba Wonodi opened the webinar by stating that leaving no one behind was the ultimate focus of IA2030. She touched on the core principles of the strategy, highlighting that it was designed to be country-owned and developed through multiple consultations with stakeholders that fed into this new strategy. IA2030 was officially launched on the 26 April, during World Immunization Week, “to maximise the lifesaving impact of vaccines over the next decade”. She also stressed that the success of IA2030 relies on engaging with communities and sensitising stakeholders at national and subnational level, thus allowing them to own and elevate this global strategy to the level of the Sustainable Development Goals (SDGs).
Vaccine equity in practice – country and community perspectives
Mirafe Solomon offered the CSO perspective and described some of the challenges to immunisation services in Ethiopia – where equity is one of the health sector’s transformation priorities. Immunisation is a high impact intervention praised with contributing to Ethiopia’s overall reduction in mortality in children under five over the last decade. However, she noted that variation in health access has led to varied health outcomes. In the Afar Region, where most people are pastoralist and semi-pastoralist, under-five mortality is 125 per 1000 live births compared with 39 per 1000 live births in Addis Ababa. Vaccination coverage in Afar is 26% whilst in Addis Ababa it is 96%. These challenges are exacerbated by Ethiopia’s poor infrastructure, which has hindered vaccine access, and the COVID-19 pandemic, which has interrupted routine immunisation programmes. She highlighted Save the Children’s initiatives to maintain immunisation during the pandemic, including support for solar driven vaccine transportation systems, engaging community leaders and driving health budget advocacy to increase resources for immunisation in Ethiopia’s hard-to-reach areas.
Dr H.M Agus Samsudin shared that enhancing demand for immunisation, ensuring vaccine availability, and sustaining immunisation services during the COVID-19 pandemic have been major challenges in Indonesia. Dr Agu Samsudin’s organiaation Muhammadiyah has been mobilising communities to maintain immunisation services within the country, including by using its own school and office facilities as centres for vaccination. Muhammadiyah has also been encouraging community leaders, like teachers to become vaccinated to set an example for the population. Interfaith vaccinations and vaccinations in the local districts are also popular approaches to scale up vaccine uptake in Indonesia.
Maki Igarashi, who leads efforts by the International Federation of Red Cross and Red Crescent Societies (IFRC) to support child health interventions in conflict-affected regions in the Middle East and North Africa, provided insights into the delivery of vaccines for vulnerable populations within protracted crises and conflict. She described the challenges facing 20 million people in the region, who make up almost one third of the global displaced population, including limited technology and poor health coverage.
Highlighting the need for community participation, Maki Igarashi described IFRC’s strategy to build trust within marginalised communities by acting as an independent and neutral player. The trust built through community engagement enables IFRC to ensure coordination with partners and speak with one voice and with one approach.
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WHO’s role in supporting integration of immunisation with primary health care
Dr Ephrem Lemango said that WHO had a role in supporting integration of IA2030 into regional and national operational plans, citing ongoing work by the WHO AFRO Regional Committee. He warned against the repurposing of essential health workers to COVID-19 response, which risks overwhelming health systems and skilled birth attendants, negatively impacting immunisation and antenatal health. In his view, strong immunisation, due to its reach, is the key to creating strong primary health care systems that can identify and reach missed and under-served communities with essential health services. Integration with antenatal, nutrition and other maternal and child health campaigns would help reach missed populations with immunisation services.
Dr Peter Singer identified equity as the major lesson from the COVID-19 pandemic. He stated “Vaccine equity is probably the defining challenge of 2021. Of the millions of vaccines that have been rolled out there is almost a 500-fold difference between high- and low-income countries. If the pandemic is raging anywhere, it also hinders global trade.”
He further observed that investment in primary health care is necessary to drive an equitable recovery back from the pandemic and towards realising the Sustainable Development Goals. Calling for investments to close the US$ 22 million gap in ACT-A, he noted that investments needed are much lower compared to the global stimulus spend to mitigate the financial impact of COVID-19. COVAX is the best mechanism to close the vaccine equity gap and has been able to distribute doses to countries that would never have had access to them. He also highlighted domestic manufacturing as a critical lever towards equity, especially as countries must become self-reliant. WHO has launched a call for messenger ribonucleic acid (mRNA) technology transfer to help decentralise vaccine manufacturing. WHO also supports calls for a temporary suspension of patents attached to lifesaving vaccines.
What actions will enhance equity in immunisation?
During the discussion, speakers identified urgent actions governments and other stakeholders can take to scale up access and equity to vaccines, such as:
- Increased financing for immunisation.
- Improved integration of immunisation within primary health care services and prioritisation of health workers (including timely pay, training and access to personal protective equipment (PPE).
- Integration of outreach services to enhance efficiency and meet comprehensive needs of missed communities.
- Enhanced coordination and equitable partnership with multiple development stakeholders with consensus on the roles and responsibility of all partners to drive action.
- Empowering communities to enhance demand generation – improving health literacy, building trust and empowering communities to hold governments accountable in the delivery of immunisation services.
- A clear and concise strategy for action that aligns with IA2030.
How has IA2030 been impacted by COVID-19?
As an overarching, flexible umbrella strategy IA2030 is equipped to support the COVID-19 response, with a defined strategy for responding to pandemics. Importantly, there was consensus amongst speakers that the COVID-19 response must be in alignment with wider immunisation priorities and essential health challenges. It was noted that the pandemic had facilitated a level of global collaboration and innovation that has not been seen before. Under WHO leadership, there is a need now to leverage some of the systems put in place for the COVID-19 response to drive innovation for routine immunisation systems. Through the ACT Accelerator, new financing modalities and discussions on technology transfer could help build resilient immunisation systems that will allow countries to be better prepared for the next pandemic.