Immunization highlights: 2012
Supporting countries in evidence-based decision-making
Vaccine and immunization policy-making
Evidence-based immunization policy recommendations are formulated through the regular consultation of experts from around the world. SAGE ― established in 1999 by the WHO Director-General ― is the principal advisory group to WHO for vaccines and immunization. It is charged with advising WHO on overall global policies and strategies, ranging from vaccine technology and research and development, to delivery of immunization and its linkages with other health interventions. SAGE is concerned with vaccines and immunization for all age groups.
In 2012, three SAGE meetings were held, including an extraordinary meeting in February to discuss the Decade of Vaccines -- Global Vaccine Action Plan and the Global Polio Eradication Emergency Action Plan for 2012-2013. At the February meeting, SAGE members were presented with the latest version of the Global Vaccine Action Plan, together with feedback from consultations with countries and stakeholders, projected costs and financing as well as the accountability framework. SAGE endorsed the Decade of Vaccines vision in which all individuals and communities enjoy lives free from vaccine-preventable diseases. SAGE called for a clearer definition of the roles and responsibilities of WHO, UNICEF and the GAVI Alliance in the further development and implementation of the plan. At the same time, SAGE emphasized the need for firm WHO leadership and coordination at all levels.
At the April meeting, SAGE was seriously alarmed by the polio eradication funding gap for 2012-13. SAGE welcomed the Global Polio Emergency Action Plan and notes the progress made in developing and implementing the national plans for Afghanistan, Nigeria and Pakistan, aimed at reaching missed children with polio vaccines and in articulating the accountability processes at all levels. SAGE discussed seasonal influenza vaccination and recommended pregnant women as the most important risk group for seasonal influenza vaccination. On the topic of hepatitis A vaccine, SAGE concluded that while a two dose regimen of hepatitis A vaccines is currently in use in some countries, national immunization programmes may consider the use of single dose inactivated hepatitis A vaccines for inclusion in immunization schedules.
At the November meeting, the draft strategic plan and current status of the global polio eradication programme were presented to SAGE. SAGE endorsed the four major objectives and milestones in the new strategic plan. SAGE also reviewed and endorsed the monitoring and evaluation/accountability framework for the Decade of Vaccines Global Vaccine Action Plan. A SAGE working group will be established to review progress in rolling out the GVAP and will submit annual reports to SAGE. Following SAGE’s input, the report will then be submitted to the WHO Executive Board and the World Health Assembly for discussion.
Three new WHO position papers on vaccines published
Three new or updated position papers were published in the WHO Weekly Epidemiological Record — on hepatitis A, influenza and pneumococcal. As with all WHO position papers on vaccines, prior to publication, the papers were reviewed by experts within and outside WHO and follow the recommendations of SAGE on immunization.
Substantive supporting material — a summary, grading tables of scientific evidence on which the paper is based, key references and presentation slides — is posted with all new and updated position papers.
Updated WHO recommendations for routine immunization
Immunization is not limited to the classic six vaccines for children. New products, including for adolescents, adults and seniors, are available to prevent disease, disability and death. To assist countries in creating optimal immunization schedules, WHO has updated tables summarizing its current recommendations on routine immunization. Details on the recommended timing of routine immunization of children are also included. In addition, a short orientation guide has been developed as a companion piece to facilitate the use of the WHO summary tables. By consolidating its many recommendations into summary tables, WHO hopes to provide easy access to its policy advice and support national immunization programmes to critically examine, and possibly modify, their schedules.
Progress in establishing and strengthening National Immunization Technical Advisory Groups
In partnership with the Supporting National Independent Immunization and Vaccine Advisory Committees Initiative and other partners, WHO continued its efforts to assist countries in establishing and strengthening their National Immunization Technical Advisory Groups (NITAGs).
NITAGs advise governments, policy-makers and programme managers on technical issues related to national immunization programmes and on the formulation of national immunization policies and strategies.
To enable systematic global monitoring of the existence and functionality of NITAGs, in 2010, WHO and UNICEF included process indicators related to NITAGs in the 2010 WHO–UNICEF Joint Reporting Form.
Although 115 countries (64% of responders) reported having a NITAG in 2010, only 50% of countries reported the existence of a NITAG with a formal administrative or legislative basis.
However, substantial progress has been achieved globally with 43 committees reporting affirmatively on six NITAG process indicators, compared with 23 in 2008. Impressive progress has been observed in the proportion of countries reporting NITAGs with formal terms of reference (24% increase), a legislative or administrative basis (10% increase), and a requirement for members to disclose their interests (14% increase). Some of the poorest developing countries now enjoy support from a NITAG which meet all six process indicators. These may serve as examples for other countries.
New WHO Collaborating Centre
In December 2012, the Health Policy and Institutional development (HPID) Unit of the Agence de Médcine Preventive, which hosts the SIVAC project, was designated as a WHO Collaborating Centre for evidence-informed immunization policy-making. This designation is the result of the close collaboration between SIVAC, WHO and HPID in the last three years.
The initial period of designation is five years and the work plan for that period includes: contributing to WHO’s promotion of a systematic use of evidence informed policymaking processes in immunization; collaborating with WHO to scale up initiatives to improve the use of evidence informed policymaking processes in immunization, in particular through the creation and strengthening of NITAGs; and to facilitate the exchange of information within the immunization community.