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IMMUNIZATION AGENDA 2030
A global strategy to leave no one behind
CONTENTS
At a glance
Introduction
1. The case for immunization
1.1
Saving lives and protecting he health of populations
1.2 Improving countries’ productivity and resilience
1.3 Ensuring a safer, healthier, more prosperous world
2. A strategy for the future
2.1
Lessons from the Global Vaccine Action Plan
2.2 Lessons from disease-specific initiatives
2.3 The changing context and challenges
2.4 What is new on the 2030 agenda?
3. A framework for action
Strategic priority 1.
Immunization programmes for primary health care and
universal health coverage
Strategic priority 2. Commitment and demand
Strategic priority 3. Coverage and equity
Strategic priority 4. Life-course and integration
Strategic priority 5. Outbreaks and emergencies
Strategic priority 6. Supply and sustainability
Strategic priority 7. Research and innovation
4. Impact and strategic goals
5. Operationalization
5.1
Operational plans
5.2 Ownership and accountability
5.3 Monitoring and evaluation framework
References
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Vision Impact goals
A world where everyone,
everywhere, at every age...
Reduce mortality and morbidity from vaccine-preventable
diseases for everyone throughout the life course.
... fully benefits from
vaccines...
Leave non one behind, by increasing equitable access
and use of new and existing vaccines.
... for good health
and well-being
Ensure good health and well-being for everyone by
strengthening immunisation within primary health care
and contributing to universal health coverage and
sustainable development.
AT A GLANCE
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Strategic priorities
Commitment
& Demand
Coverage
& Equity
Life Course &
Integration
Outbreaks &
Emergencies
Supply &
Sustainability
Research
& Innovation
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Core principles
People
Centred
Country
Owned
Partnership
Based
Data
Guided
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Immunization is a success story for global health and development, saving millions
of lives every year. Between 2010 and 2018, 23 million deaths were averted with
measles vaccine alone (1). The number of infants vaccinated annually – more than
116 million, or 86% of all infants born – has reached the highest level ever reported.
More than 20 life-threatening diseases can now be prevented by immunization (2).
Since 2010, 116 countries have introduced vaccines that they did not use previously
(3), including those against major killers like pneumococcal pneumonia, diarrhoea,
cervical cancer, typhoid, cholera and meningitis.
Furthermore, there has been much innovation in vaccine development. There
are now vaccines to protect against malaria, dengue and Ebola virus disease,
and promising vaccines against respiratory syncytial virus, tuberculosis and all
influenza virus strains are in the pipeline. New research on broadly neutralizing
antibodies and therapeutic vaccines is opening fresh horizons. Increasingly,
vaccines are protecting health beyond infancy – in adolescence and adulthood,
during pregnancy and for older people.
Innovative ways are being found to distribute and administer vaccines and to
improve immunization services. Digital tools, new, needle-free techniques for
vaccine administration and more robust vaccine storage and supply chains
promise to transform immunization programmes
1
over the next decade. Timely
access to reliable data will provide new opportunities for national programmes
to monitor and continuously improve their performance, reach and efficiency.
Vaccines are critical to the prevention and control of many communicable
diseases and therefore underpin global health security. Moreover, they are
widely seen as critical for addressing emerging infectious diseases, for example
by containing or limiting outbreaks of infectious diseases or combatting the
spread of antimicrobial resistance. Regional outbreaks (e.g. of Ebola virus
disease), the COVID-19 pandemic and the threat of future pandemics (such as
with a novel flu strain) have and will continue to strain even the most resilient
health systems. A clear risk is a reduction in essential services and particularly
vaccination and prevention of other communicable diseases. Countries should
1. Throughout this document, the term “immunization programme” is used to reflect shifts in both language and thinking. First, as immunization
programmes are only one component of health systems, the term aligns the global vision and strategy with the broader health and
development agenda. Secondly, the term is more comprehensive than the more commonly used “routine immunization,” which does not capture
the full spectrum of an immunization programme’s activities, such as “catch-up” vaccinations, periodic intensification of vaccination activities
or efforts to address missed opportunities for vaccination.
INTRODUCTION
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identify essential services that to be prioritized and maintained during emerging
infectious disease threats and move as soon as feasible to provide missed
vaccinations. In the longer term, intensive, collaborative investments in research
and development and equitable supplies of new vaccines are likely to be part of
the solution to averting recurrences.
Nevertheless, important challenges remain. The benefits of immunization are
unevenly shared: coverage varies widely among and within countries. Some
populations – often the poorest, the most marginalized and the most vulnerable,
in fragile, conflict-torn settings – have poor access to immunization services.
Each year, 20 million infants do not receive a full course of even basic vaccines,
and many more miss out on newer vaccines. Of these, over 13 million receive no
vaccines through immunization programmes – the “zero dose” children.
In some countries, progress has stalled or even reversed, and the risk that
complacency will undermine past achievements is real. Outbreaks of measles
and vaccine-derived polioviruses are stark reminders that strong immunization
programmes and effective disease surveillance are necessary to sustain high
levels of coverage and to eliminate and eradicate diseases. Because measles is
highly infectious, its presence serves as a tracer (the “canary in the coal mine”)
of inadequate coverage and gaps in the health system. Detection of measles
cases through surveillance reveals communities and age groups that are un-
or under-immunized and immunization programmes and overall primary health
care systems that are inadequate, indicating where particular attention and
interventions are needed. High coverage with measles vaccine is an indicator
of a strong immunization programme, which may signal a solid foundation
for primary health care services. The second dose of measles vaccine is an
opportunity to enhance focus on strengthening immunization programmes to
reach children beyond the first year of life and to broaden immunization services
throughout the life-course.
If all people are to access immunization services, vaccines must be delivered
to areas that are isolated geographically, culturally, socially or otherwise and
to marginalized populations such as displaced people and migrants and those
affected by conflict, political instability and natural disasters. The causes of low
vaccine use must be understood and addressed in order to increase people’s
demand for immunization services. Adequate, predictable supplies of appropriate,
affordable vaccines of assured quality must be available at points of service
delivery, and stock-outs must be avoided. Tailored strategies are necessary
for understanding and overcoming barriers to vaccination, particularly gender-
related barriers of caregivers and health workers to accessing immunization
services. New approaches are required to reach older age groups and to deliver
people-centred immunization services, integrated with primary health care.
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The Immunization Agenda 2030 (IA2030) sets an ambitious, overarching global
vision and strategy for vaccines and immunization for the decade 2021–2030.
It draws on lessons learnt, acknowledges continuing and new challenges posed
by infectious diseases and capitalizes on new opportunities to meet those
challenges. IA2030 positions immunization as a key contributor to people’s
fundamental right to the enjoyment of the highest attainable physical and
mental health and also as an investment in the future, creating a healthier,
safer, more prosperous world for all. IA2030 aims to ensure that we maintain the
hard-won gains and also that we achieve more – leaving no one behind, in any
situation or at any stage of life.
IA2030 is intended to inspire and align the activities of community, national,
regional and global stakeholders – national governments, regional bodies,
global agencies, development partners, health care professionals, academic and
research institutions, vaccine developers and manufacturers, the private sector
and civil society. Its impact will be maximized by more effective and efficient
use of resources, innovation to improve performance and measures to attain
financial and programmatic sustainability. Success will depend on building and
strengthening partnerships within and outside the health sector as part of a
coordinated effort to improve access to high-quality, affordable primary health
care, achieve universal health coverage and accelerate progress towards the
2030 Sustainable Development Goals (SDGs).
IA2030 provides a long-term strategic framework to guide a dynamic operational
phase, responding to changes in country needs and the global context over
the next decade. This document is therefore just the beginning. The IA2030
global vision and strategy will be complemented by annexes providing detailed
technical information on the strategic framework, together with new and
existing strategies and immunization plans, including those for disease-specific
programmes to control, eliminate or eradicate disease. IA2030 will become
operational through regional and national strategies, a mechanism to ensure
ownership and accountability and a monitoring and evaluation framework to
guide country implementation.
Through collective endeavour by all stakeholders, we will achieve the vision for
the decade: A world where everyone, everywhere, at every age, fully benefits
from vaccines for good health and well-being.
THE CASE FOR
IMMUNIZATION
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Between 2010 and 2017, the mortality
rate of children under 5 years of age
decreased by 24%, due in large part
to immunization (4).
In countries that have introduced the
vaccine against human papillomavirus
(HPV), after 5–8 years, cancer causing HPV
prevalence was reduced by 83% among
girls aged 13–19, and the prevalence of
precancerous lesions decreased by 51%
among girls aged 15–19 (5).
Vaccines will help keep an estimated
24 million people from falling into
poverty by 2030 (6).
Immunization against measles in 94
low- and middle-income countries
returned an estimated US$ 76.5 for
every US$ 1 invested in vaccination (7).
Immunization reaches more people than any other health or
social service and is a vital component of primary health care. It
benefits individuals, communities, countries and the world. It is an
investment in the future, in three ways.
1.1 Saving lives and protecting the
health of populations
(4–6)
Immunization has reduced the number of deaths from infectious
diseases dramatically. Vaccines also prevent disability, which can
impair children’s growth and cognitive development, so that they
not only survive but also flourish.
Vaccines benefit not only infants and children but also older
people. They can prevent infection-related cancers and protect
the health of the elderly and the vulnerable, allowing people to
live longer, healthier lives. In addition, fewer infections mean less
risk of transmitting disease to relatives and other members of
the community.
In many countries, out-of-pocket payments for health care have a
catastrophic impact on household finances, potentially plunging
households into poverty. Preventing infection by vaccination
can reduce families’ expenditure on health care, contributing
to financial protection, which is a core component of universal
health coverage.
1.2 Improving countries’ productivity
and resilience
(7,8)
Immunization is the foundation of a healthy, productive population.
Preventing infections reduces the burden on health systems, and a
healthier population is a more productive one. Children protected
against infectious diseases have better educational attainment
and contribute more to national development and prosperity.
Halting disease outbreaks is disruptive and costly. Outbreaks
can overwhelm and profoundly disrupt public health programmes,
clinical services and health systems. They may also have adverse
effects on travel, trade and overall development. For seasonal
diseases like influenza, the costs of treatment and lost productivity
are borne repeatedly. Immunized communities are resistant to
infectious disease outbreaks, and strong health systems and
immunization programmes allow rapid detection and response to
limit their impact.
The full economic impact of the 2014–
2016 outbreak of Ebola virus disease in
West Africa has been estimated at US$
53.2 billion (8).
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Climate change between 2030 and
2050 is expected to cause 60 000
additional deaths from malaria per
year (9). This trend may be changed by
use of a malaria vaccine being pilot-
tested in three African countries.
It is estimated that widespread use of
thee pneumococcal conjugate vaccine
(PCV) could reduce the number of days
on antibiotics for pneumonia in children
under 5 years by 47%, equivalent to 11.4
million days on antibiotics per year (10).
A 10% increase in the core capacities
required by the International Health
Regulations (2005) (e.g. surveillance,
risk communication) is associated
with a 19% decrease in the incidence
of cross-border infectious threats (11).
1.3 Enabling a safer, healthier, more
prosperous world
(9–11)
Vaccines are a critical component of the battle against emerging
and re-emerging infections. Pathogens are not bound by national
borders, and local and international movement of people can
rapidly spread infections. Increasing urbanization results in
large, dense populations, raising the likelihood of infectious
disease transmission and outbreaks. In addition, climate change
exposes new populations to vector-borne diseases and may
alter the patterns and intensity of seasonal diseases. Detecting,
preventing and responding to infectious disease threats are
therefore key to global health security.
In all parts of the world, infectious diseases are increasingly
developing resistance to antibiotics and other antimicrobials.
Preventing infection through immunization not only protects
people against drug-resistant infections but also reduces
their spread and the need for and use of antibiotics, thereby
contributing to the battle against antimicrobial resistance.
Immunization and disease surveillance are core capacities
required by the International Health Regulations (2005), as
they contribute to resilient, sustainable health systems that
can respond to infectious disease outbreaks, public health risks
and emergencies (11). Furthermore, the safe management and
disposal of vaccine waste ought to be part of all vaccination
activities, contributing directly to patient safety and quality of
care, while reducing environmental and climate risks.
Immunization plays a critical role in achieving the SDGs,
specifically SDG3, “Ensure healthy lives and promote well-being
for all at all ages”, and also contributes directly or indirectly to
13 other SDGs (Fig. 1).
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Figure 1. Contributions and relevance of immunization to 14 of the 17 SDGs
Immunization plays a key role in
eliminating poverty, by reducing
treatment costs and increasing longer-
term productivity by averting losses due
to disability and death.
Immunization promotes a healthy
and productive workforce, which
contributes to the economy.
Immunization prevents diseases that
aect the most marginalized groups,
especially those in poor urban or remote
rural settings and in areas of conflict.
Immunization protects urban public
health and interrupts disease
transmission, ensuring sustainable
cities and communities.
Immunization is critical to building
people’s resilience to and mitigating
the risk of disease outbreaks linked to
climate change, such as yellow fever,
malaria, meningitis and cholera.
Eective, safe, people-centred health
systems are the backbone of social
institutions, and vaccination is often the
regular point of contact of the population
with the system.
Immunization programmes broaden
partnerships and multisectoral
approaches, ensuring that civil society,
communities and the private sector work
together towards common goals.
Vaccine manufacture contributes to
national industrial infrastructure in
low- and middle-income countries.
Immunization and nutrition go hand
in hand. Malnourished individuals,
especially children, are more likely to
die from infectious diseases such as
diarrhoea, measles and pneumonia.
Immunization increases educational
attainment, as it improves long-term
cognitive development. Children who are
immunized tend to attain more years of
schooling and score higher in cognitive
tests than those who are unvaccinated.
Removal of gender-related barriers
to vaccination contributes to gender
equality, as it supports women’s full
participation and equal opportunities for
accessing health services.
When vaccination is complementary to
clean water, sanitation and hygiene, it
prevents diarrhoeal diseases, which are
the leading cause of child mortality in
low-income countries.
Immunization logistics increasingly
involve use of cleaner, more sustainable
techniques based on solar and other
renewable sources of energy.
Vaccination is one of the most cost–
eective ways of saving lives and
promoting good health and well-being.
Source: reference 12
A STRATEGY
FOR THE FUTURE
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IA2030 envisions
“A world where everyone, everywhere, at every age, fully
benefits from vaccines for good health and well-being.”
To achieve this ambitious vision, lessons have been drawn from the past to
identify factors that contribute to success.
2.1 Lessons from the Global Vaccine Action Plan
The Global Vaccine Action Plan (GVAP) was the global immunization strategy
of the “Decade of vaccines” (2011–2020). Developed through extensive global
consultations, GVAP brought together existing goals to eradicate and eliminate
diseases and set new global goals that accounted for the full spectrum of
functions of immunization programmes. The review of experience with GVAP in
2019 (3) revealed important lessons for the decade to 2030.
GVAP brought together many global, regional and national stakeholders in a
shared vision and strategy for the future of immunization. The health and
immunization community agreed to aspirational goals to catalyse action, and,
although many GVAP goals have not been met, much progress has been made.
GVAP enhanced the visibility of immunization and helped build high-level
political will. It provided a common framework for establishing priorities,
aligning activities and assessing progress, and it created a platform on which
further work can be built. GVAP was a comprehensive strategy, and most of its
goals and objectives remain relevant.
GVAP was to be implemented through national immunization programmes,
with the support of partners; however, GVAP was only partially successful
in influencing national actions, and partner activities were not always fully
coordinated globally or nationally. To enhance country ownership, which is critical
to the success of the IA2030, tailored strategies will be necessary to respond to
the significant differences among countries in size, resources and the conditions
in which people live, with consideration of subnational differences. IA2030 will
strengthen existing partnerships and build new relations, especially at the country
level, such as with a wider range of civil society organizations and the private
sector, under the leadership of national programmes.
During GVAP implementation, regional vaccine action plans were used to
translate global strategies into regional plans. Regional vaccine action plans
will be revised to align with IA2030, as a critical step in operationalization.
GVAP struggled to influence national and global responses to situations that arose
during the decade, such as conflict, climate change, migration and urbanization,
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Disease-specific goal
or initiative
Targets
Polio eradication (GVAP, Polio
Endgame Strategy 2019–2023)
a
Interrupt transmission of all wild poliovirus by 2020.
Stop circulating vaccine-derived poliovirus outbreaks
within 120 days of detection.
Certify eradication by 2023.
Neonatal tetanus elimination (GVAP) Eliminate neonatal tetanus in the remaining 40 countries
by 2015.
Measles and rubella elimination
(GVAP, Global Measles and Rubella
Strategic Plan 2012–2020)
Eliminate measles in at least five WHO regions by 2020.
Eliminate rubella in at least five WHO regions by 2020.
Cholera control (Ending Cholera –
A Global Roadmap to 2030)
Reduce cholera deaths by 90% by 2030.
as well as the spread of misinformation about vaccines. In IA2030, more flexibility
may be required to account for national and subnational circumstances to in order
to respond effectively to emerging challenges.
GVAP established the first global monitoring and evaluation framework for
immunization, defining roles and responsibilities for stakeholders. The framework
provided a wealth of information on progress and raised awareness of the
importance of high-quality data. It was unable to ensure, however, that use of
the data improved the performance or accountability of national programmes,
especially at subnational level.
IA2030 will build on these lessons to further clarify roles and responsibilities,
so that the agenda can be implemented nationally, regionally and globally, and
improving the use of data to prompt action and ensure accountability.
2.2 Lessons from disease-specific initiatives
GVAP drew together existing goals to eradicate polio and to eliminate measles,
rubella and maternal and neonatal tetanus. These disease-specific initiatives
were inspired by the landmark achievement of smallpox eradication. They have
the advantage of focusing on a single, clear objective and agreement on common
approaches and timelines. After the World Health Assembly had endorsed GVAP,
it approved additional disease-specific targets (Table 1).
Table 1. Goals and targets of disease-specific initiatives
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Disease-specific goal
or initiative
Targets
Elimination of viral hepatitis as a
major public health threat (Global
Health Sector Strategy on Viral
Hepatitis 2016–2021)
Reduce new cases of chronic viral hepatitis B infections
by 95% by 2030 (equivalent to 0.1% prevalence for HBsAg
among children).
Reduce viral hepatitis B deaths by 65% by 2030.
Control of vector-borne diseases
(including Japanese encephalitis)
(Global Vector Control Response
2017–2030)
Reduce mortality due to vector-borne diseases by at least
75% by 2030.
Reduce case incidence due to vector-borne diseases by at
least 60% by 2030.
Prevent epidemics of vector-borne diseases in all
countries by 2030.
Elimination of yellow fever epidemics
(Eliminate Yellow Fever Epidemics)
Reduce yellow fever outbreaks to zero by 2026.
Elimination of meningitis epidemics
and reduction of cases and deaths
(Global Roadmap to Defeat
Meningitis)
Eliminate meningitis epidemics by 2030.
b
Reduce the numbers of cases and deaths from vaccine-
preventable bacterial meningitis by 2030.
c
Reduce disability and improve quality of life after
meningitis due to any cause by 2030.
Reduction of seasonal influenza
burden (Global Influenza Strategy
2019–2030)
No disease-specific targets.
Zero deaths from dog-mediated
rabies by 2030 (Zero by 30: The
Global Strategic Plan)
Reduce the number of deaths from dog-mediated rabies
to zero by 2030.
a Target dates depend on the epidemiological situation.
b As of 13 September 2019.
c Targets will be set at regional level.
Although disease-specific goals are enduring global commitments that will
continue to be an important element of IA2030, revisions may be made during
development of the IA2030 monitoring and evaluation framework, especially to
goals for which the target dates have passed.
Polio. Enormous progress has been made towards eradication of polio. Wild
poliovirus is now circulating in only two countries, where conflict, lack of access,
cross-border population movement, insufficient polio vaccine coverage in
immunization programmes, difficulty in sustaining community engagement and
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weak health infrastructure are major obstacles to reaching the polio eradication
goal. The continuing challenges in interrupting the transmission of wild poliovirus
and circulating vaccine-derived poliovirus outbreaks in countries that had
been declared polio-free demonstrate the importance of strong immunization
programmes as part of primary health care in reaching and sustaining global
eradication. In addition, as the world moves closer to global polio eradication, the
decrease in resources provided through the Global Polio Eradication Initiative (GPEI)
is an additional challenge. In many countries, GPEI helped build an infrastructure,
supporting immunization functions beyond polio. Effective planning without such
infrastructure and resources is therefore vital to ensure that functions essential
for shared disease-prevention goals – vaccine-preventable disease surveillance,
strong immunization services and outbreak responses – are sustainably integrated
into national immunization programmes.
Measles. Before measles vaccines were introduced in the 1960s, measles was a
leading cause of child morbidity and mortality worldwide, responsible for more
than 2 million deaths annually. Between 2000 and 2018, stronger health systems
and increased measles vaccination coverage resulted in a 73% global decrease
in mortality. Regional elimination has not, however, been achieved or sustained,
and an alarming resurgence in measles cases and deaths has been seen around
the world in recent years, in some cases with cross-border importations and even
small pockets of immunity gaps leading to large outbreaks. As measles is so
contagious, very high vaccine coverage (95%) with two timely doses of measles-
containing vaccine is required to prevent its spread. Coverage with the first
dose of measles vaccine has plateaued globally at around 85% over the past
decade, and, although coverage with the second dose has increased to 69%,
the percentage is not sufficiently high, and supplementary means of delivering
vaccine are necessary through planned campaigns, periodic intensification of
routine immunization and other strategies. Providing every child with two timely
doses of measles-containing vaccine and effective elimination-standard measles
surveillance are, therefore, critical indicators of a strong immunization programme,
as an integral component of primary health care. Measles cases indicate gaps in
population immunity, signalling inadequate access or uptake. A strong, resilient
immunization programme is essential to respond to this challenge and a powerful,
measurable means of achieving health equity.
Maternal and neonatal tetanus. Three fourths of priority countries have
eliminated maternal and neonatal tetanus; more work is necessary to eliminate
the disease in the remaining 25%. Elimination of maternal and neonatal tetanus
will reduce neonatal mortality, which has decreased more slowly than for children
under 5 years of age. Although current strategies address inequity, they target
only pregnant women and women of reproductive age, leaving older boys and
adult and elderly men unprotected from tetanus. Strategies that include booster
doses for vaccination of whole populations in a life-course approach will help
overcome gender disparities. As maternal and neonatal tetanus is also strongly
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associated with poverty, its incidence can be used as a marker of the quality of
the health services delivered to marginalized and underserved populations and of
their uptake by these populations.
Strengthened systems for integrated disease control. Control of key infectious
diseases equitably, efficiently and sustainably requires both robust immunization
programmes and targeted, disease-specific strategies. Strong disease surveillance
and immunization programmes are integral components of primary health care
and are essential for raising immunity, reducing the risk of disease and preventing
morbidity and mortality. Supplementary immunization activities may still be
necessary, however, to boost immunity quickly in targeted populations. The
mixture and balance of these two approaches depends on disease epidemiology,
the context and the ability of health systems to deliver vaccines to those who
need them most.
Lessons learnt from the past decade demonstrate that it is difficult to eradicate
or eliminate a disease in the absence of an efficient, resilient immunization
programme. IA2030, therefore, emphasizes building a strong national
immunization infrastructure integrated into primary health care services, as a way
to achieve and sustain elimination and eradication goals. To achieve universal
health coverage through primary health care, all aspects of health systems will
need to be strengthened, including immunization and other preventive services,
disease surveillance, regular collection and use of reliable data, emergency
outbreak preparedness and response, a strong workforce, good governance and
social accountability, appropriate budget allocations, financial management and
efficient patient care for existing and emerging diseases.
2.3 The changing context and challenges
IA2030 has been shaped by both lessons from the past decade and the changing
global environment.
Sustaining trust. Uptake of vaccination depends on many factors, from the
convenience and quality of facilities and services to the spread of misinformation
about the safety and effectiveness of vaccines. These considerations must
be understood and addressed to enhance and sustain trust in vaccines and
immunization services in communities, to increase health literacy with a focus on
vaccination at all levels, and to build resilience against misinformation. The harm
being caused by anti-vaccine messaging, especially on social media, should be
addressed by understanding the context and reasons for lack of trust and by
building and keeping trust, especially in the face of fear and distrust in traditional
establishments. Strategic investments to increase trust and confidence in vaccines,
in particular through strong community engagement, would increase community
support for vaccines and ensure that vaccination is viewed as a social norm.
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Inequity. The benefits of immunization are not spread equally, either among or
within countries. In 2018, 70% of unvaccinated children lived in middle-income
countries (13). Reaching all people will require higher national vaccination
coverage, but also less subnational inequity. Success will require interventions
that take into account poverty, education, socioeconomic and cultural factors
and gender-related barriers to access.
Population movements. Continuing urbanization will pose major challenges, as
it results in large, dense populations at high risk of infectious disease. Migration
and cross-border population movements can result in large communities of
unprotected individuals at risk of infection. Migrants and mobile populations are
often difficult to reach or track. As they often move across borders, it is not even
clear who is responsible for vaccinating them, and they may be marginalized
and overlooked.
Ensuring immunization for all ages. Expanding the benefits of vaccination to
all age groups offers tremendous opportunities, but it will require major shifts
in immunization programmes. As more vaccines become available for older age
groups, new methods will be necessary to deliver integrated, people-centred
health services. Programmes will also have to respond to significant global
demographic shifts. Regions such as Africa are undergoing rapid population
growth and a resulting “youth bulge”, while others are experiencing significant
population ageing. These shifts will have a major impact on the design of
immunization services.
Climate change and natural disasters. The world’s changing climate will
have significant implications for the prevalence of infectious diseases. New
populations will be exposed to vector-borne diseases such as malaria and
dengue, and more flooding will increase the spread of waterborne diseases such
as cholera. Climate change is also disrupting seasonal disease patterns, shifting
the timing, duration and pattern of their transmission. It may also alter the
endemicity of infectious diseases. Climate-informed surveillance and response
systems will be an essential part of national preparedness for infectious disease
outbreaks. The environmental impact of vaccine waste, from excess packaging
to the release of harmful pollutants during burning, will have to be addressed
more comprehensively and minimized.
Conflict and political instability. Civil conflict can rapidly lead to loss of
health service infrastructure and shortages of trained health workers, often
for extended periods, thereby disrupting delivery of immunization services. The
affected populations are also frequently at higher risk of infectious diseases
because of the breakdown of national infrastructure and mass displacement
into temporary settlements.
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Outbreaks. The world continues to experience outbreaks of measles, yellow
fever, diphtheria and other vaccine-preventable diseases and also emerging
infections, such as Ebola virus disease. Disease surveillance and immunization
are critical for preventing, detecting and controlling infectious disease
outbreaks. Disease surveillance provides insight into the effectiveness of
immunization programmes, indicates how they can be optimized and provides
early warning of potential outbreaks. Comprehensive preparedness and
response strategies, including research during outbreaks, will limit their impact
on health and national finances.
Optimizing and maintaining supplies. Achieving the IA2030 vision will require
a reliable global supply of appropriate, affordable, innovative vaccines and
other immunization products of assured quality. Every year, many countries
experience disruptions in their supplies of vaccines, often because of a mismatch
between global production levels and needs. Healthy market dynamics must be
achieved and maintained for vaccines and immunization products in the long term,
both globally and regionally. Reliable forecasts of national vaccine requirements
and priorities will continue to ensure healthy market dynamics and improve and
maintain supplies. The price of vaccines is a key barrier to access and can delay
the introduction of new vaccines into low- and middle-income countries. There
are also regulatory, financing and procurement barriers to sustainable vaccine
supplies. For instance, the markedly different procurement processes in countries
might have to be adjusted to respond to changes in the vaccine market and in
quality-assurance requirements.
2.4 What is new on the IA2030 agenda?
These lessons from the past and the changing context make IA2030 different
from its predecessor, GVAP, in several respects.
• Cooperative design from the bottom up. IA2030 was developed
collaboratively with countries, to ensure that the vision, strategic priorities
and goals
2
are aligned with country needs.
• Tailored to the national context. The IA2030 strategic framework is flexible,
allowing countries to adapt the global framework to their local context and
partners to provide differentiated, targeted, customized support.
• Adaptable to changing needs. The IA2030 strategic framework can be
adapted to changing needs and new challenges that may emerge during
the decade.
2. In the context of this document, a “goal” is an ambitious commitment to address a single challenge; an “indicator” is a measure of a goal; and
a “target” is a specific (sometimes time-bound) outcome of achievement of an indicator.
25
• Targeted ways to reduce inequity. IA2030 ensures that the benefits of
immunization are shared equitably among and within countries. It gives priority
to the populations that are not currently being reached, particularly the most
marginalized communities, those living in fragile and conflict-affected settings
and mobile populations, especially those moving across borders.
• Gender-responsive strategies. IA2030 focuses not only on equitable
coverage of boys and girls, but aims at understanding and addressing all
the direct and indirect barriers to access to immunization services, including
those related to the gender of caregivers and health workers, and increasing
women’s full and equal participation in decision-making at all levels.
• Stronger focus on systems strengthening. IA2030 positions sustainable
immunization programmes embedded within primary health care as the
basis for achieving high vaccination coverage and universal health coverage.
Notably, IA2030 builds on the goals of existing disease-specific initiatives,
while at the same time stressing health system strengthening to help achieve
the goals of disease control, elimination and eradication.
• Measles as a tracer. Measles coverage is an important indicator for
attaining SDG3 indicator 3b 1.
3
In IA2030, measles vaccination coverage and
incidence recorded by surveillance are tracers of the strength of immunization
programmes, indicating communities and age groups that are un- or under-
immunized and where more emphasis is required.
• Life-course approach. The growing number of new vaccines administered
after childhood is opening frontiers for national immunization programmes
and will require new methods for delivery. Furthermore, booster doses should
be introduced for lifelong protection against diphtheria, pertussis and
tetanus. IA2030 has a stronger focus on extending the benefits of vaccination
throughout the life-course.
• Strengthening partnerships beyond health. The future of immunization
will increasingly be based on integration and collaboration with stakeholders
within and beyond health. IA2030 proposes closer collaboration with
existing and new partners. Such enhanced collaboration will have mutual
advantages, extending the benefits of immunization while helping others to
achieve their goals.
3. Proportion of the target population with access to measles-containing-vaccine second-dose (MCV2) (%).
26
• Accelerating innovation. A more nimble, robust research agenda offers new
opportunities to meet future challenges. IA2030 focuses on not only the
development of new vaccines but also accelerating innovation to improve
programme performance, surveillance and quality and to increase access to
data, drawing on lessons from other sectors.
• Better use of resources for self-sustainability. IA2030 emphasizes
maximization of the impact to be achieved with existing resources. Efficient,
effective, resilient national immunization programmes delivered within primary
health care, backed by strong political commitment and popular support, hold
the key to progress and long-term sustainability. Partners play a vital role in
supporting countries on the path to self-sustainability.
These shifts in emphasis do not lessen the importance of GVAP priorities that
are still relevant, which are incorporated into the IA2030 framework for action.
A FRAMEWORK
FOR ACTION
3
30
IA2030 is based on a conceptual framework of seven strategic priorities
(Fig. 2). Each strategic priority has defined goals and objectives and key
areas of focus. Action is necessary to achieve these interrelated strategic
priorities to realize the overall vision and goals and to ensure that immunization
fully contributes to stronger primary health care and attainment of universal
health coverage.
Figure 2. The seven strategic priorities of IA2030
Commitment
& Demand
Coverage
& Equity
Life Course &
Integration
Outbreaks &
Emergencies
Supply &
Sustainability
Research
& Innovation
People
Centred
Country
Owned
Partnership
Based
Data
Guided
I
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m
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n
i
s
a
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P
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o
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m
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o
r
P
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i
m
a
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H
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a
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C
a
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31
Figure 3. The four core principles of IA2030
The first, overarching strategic priority is to ensure that immunization
programmes are an integral part of primary health care to achieve universal
health coverage. The second is commitment and community demand. These
two strategic priorities are the basis of an immunization programme and
are essential to deliver people-centred, demand-driven health services to
individuals and communities.
The next three strategic priorities, coverage and equity, life-course and integration
and outbreaks and emergencies, ensure the
delivery of immunization services,
in the face of population growth, continuing urbanization, rising migration,
cross-border movement and displacement of populations, conflict, political
instability, natural disasters and climate change.
The remaining two strategic priorities are
enablers of success. Continued
investment is necessary to combat infections for which there is no vaccine.
Similarly, innovation will improve the performance of immunization programmes
by ensuring the delivery of services to underserved populations. Ensuring a
reliable global supply of affordable vaccines and the sustainability of national
programmes worldwide are also essential for success.
These seven strategic priorities are anchored by
four core principles that
will shape the nature of actions undertaken to achieve each strategic goal
and objective (Fig. 3). These principles are the threads that weave together
the strategic priorities and provide guidance on translating the high-level
strategy into practical actions. They convey the values and guiding principles
for mutually beneficial partnerships and alignment of the activities of all
partners within and outside of the immunization community.
People-centred
Responding to populations needs.
The design, management and delivery of
immunization services should be shaped by
and responsive to the needs of individuals and
communities, including addressing barriers
to access to immunization services due to
age, location, social and cultural norms and
gender-related factors.
Partnership-based
Aligning eorts to maximize impact.
Immunization partners should align and
coordinate their actions to increase efficiency,
build on complementarity and involve sectors
beyond immunization for mutual benefit.
Data-guided
Promoting evidence-based decision-making.
High-quality, “fit-for-purpose” data will be
used to track progress, improve programme
performance and form the basis of decision-
making at all levels.
Country-owned
Driving progress from the bottom up.
Countries should establish targets that
represent the local context and should be
held accountable for achieving them.
32
Immunization programmes for primary health care and universal health coverage
Goal Effective, efficient and resilient immunization services are accessible to all people
as an essential part of primary health care, and thereby contribute to universal
health coverage.
Objectives • Reinforce and sustain strong leadership, management and coordination of
immunization programmes at all levels.
• Ensure the availability of an adequate, effective, sustainable health workforce.
• Build and strengthen comprehensive vaccine-preventable disease surveillance
as a component of the national public health surveillance system, supported by
strong, reliable laboratory networks.
• Secure high-quality supply chains for vaccines and related commodities and
effective vaccine management, within the primary health care supply system.
• Strengthen immunization information within a robust health information system,
and promote use of high-quality, “fit-for-purpose” data for action at all levels.
• Establish and maintain a well-functioning vaccine safety system involving all
stakeholders.
Key areas
of focus
Immunization in primary health care: Ensure that sustainable immunization
programmes are an integral part of the national primary health care strategies and
operations, and of national strategies for universal health coverage.
Leadership, governance and management: Create an environment for effective
coordination, financial management and performance monitoring at every level of
the immunization programme.
Health workforce: Ensure the availability and appropriate distribution of health
workers who are motivated, skilled, knowledgeable and appropriately resourced
to plan, manage, implement and monitor the performance of immunization
programmes at all levels and locations, as part of primary health care.
Supply chain and logistics: Strengthen supply chains to ensure that high-quality
vaccines are always available in the right quantity and form at the right time, in
the right place and stored and distributed under the right conditions. Promote
integration with other supply chains for more effective delivery of primary health
care. Invest in systems and infrastructure to safely manage, treat and dispose of
vaccine waste to help reduce their environmental footprint.
STRATEGIC PRIORITY 1.
33
Immunization programmes for primary health care and universal health coverage
Key areas
of focus
Vaccine-preventable disease surveillance: Increase the efficiency, responsiveness
and comprehensiveness of disease surveillance (including epidemiology and
laboratory capacity) in order to: encourage the introduction of vaccines; optimize
immunization programmes; measure the impact of vaccines; monitor disease
control, elimination and eradication; and detect, investigate and respond to
outbreaks. These activities should be based on existing surveillance infrastructure,
such as that for polio and measles.
Health information systems: Ensure that health information systems allow health
workers and decision-makers to generate and use high-quality, “fit-for-purpose”
data to implement and manage immunization programmes effectively at all levels
and that the data are also integrated into national health information systems.
Monitoring vaccine safety: Ensure that national immunization programmes can
detect and respond to any concern about vaccine safety by continuous monitoring
and coordination among relevant stakeholders.
Disease control initiatives: Ensure that strengthening of national health systems
and initiatives for disease control, elimination and eradication are coordinated for
mutual reinforcement.
Application
of the core
principles
People-centred. Immunization programmes will be designed and tailored to the
needs and social and cultural preferences of people and communities.
Country-owned. National strategies and plans to build and sustain robust
immunization programmes will strengthen health systems and primary health care
in order to attain universal health coverage.
Partnership-based. Public and private partnerships will be formed, including with
partners beyond the health sector, with the private sector and with civil society
organizations, for coordinated strengthening of immunization programmes.
Data-guided. Data, evidence and best practice will guide strengthening of
immunization programmes and improve their design and performance for universal
health coverage.
34
Commitment & demand
4
Goal Immunization is valued and actively sought by all people, and health authorities commit
to ensuring that immunization is available as a key contributor to enjoyment of the
highest attainable standard of health as a fundamental right.
Objectives • Build and sustain strong political and financial commitment for immunization at
all levels.
• Ensure that all people and communities value, actively support and seek out
immunization services.
Key areas
of focus
Commitment: Ensure that key groups, champions and stakeholders advocate for
greater commitment to and ownership of immunization programmes and for sustained
national and subnational financing. Encourage leaders to prioritize immunization in
strategic and operational planning and in policy, fiscal and legislative instruments.
Strengthen evidence-based decision-making, with technical input from bodies such as a
national immunization technical advisory groups (NITAGs).
Subnational support: Build support for immunization and capacity for national and
subnational leadership, management and coordination, especially in large countries
and in those with decentralized health systems. Establish mechanisms for stakeholder
coordination and participation in planning, implementation and monitoring.
Accountability: Establish accountability frameworks for all stakeholders, with
platforms for engagement and dialogue. Ensure that communities and civil society
organizations are equipped to hold national and subnational authorities accountable
for equitable delivery and for the quality of immunization services. Ensure access to
data and information, and develop frameworks for joint monitoring.
Public trust and confidence: Establish an ongoing understanding of all the
behavioural and social drivers to vaccination (including social processes, gender-related
barriers, practical factors and social media) to engage communities and encourage
greater use of immunization services.
4. In the context of this strategic priority, “demand” refers to the actions of individuals and communities to seek, support or advocate for
vaccines and vaccination services. Demand is dynamic and varies by context, vaccine, vaccination services, time and place. It can be fostered
by governments, immunization programme managers, public and private sector providers, local leaders and civil society organizations that
listen and act on the comments of individuals and communities .
STRATEGIC PRIORITY 2.
35
Commitment & demand
4
Key areas
of focus
Public knowledge and understanding: Include the topic of immunization in
education curricula, formulate public education tools (including to meet the needs of
vulnerable and marginalized groups), provide educational opportunities for the health
workforce, and prepare information resources for advocacy groups.
Acceptance and value of vaccination: Use local data to understand and devise
tailored solutions to address the underlying causes of low vaccination rates. Use the
evidence to respond to practical barriers, such as access to good-quality services,
and to support positive attitudes and social influences. Proactively implement plans
to prevent and respond to adverse events, rumours and hesitancy and strengthen
resilience to these influences.
Addressing reluctance to vaccinate: Understand and respond to public concern,
and develop robust, innovative strategies to mitigate vaccine misinformation and
reduce its propagation and negative impact.
Application
of the core
principles
People-centred. Community engagement will be at the heart of building people’s
trust and of their acceptance and use of vaccines. The emphasis is on dialogue,
service quality, effective and respectful provider communication in primary care and
accountability.
Country-owned. Political leaders, civil society and immunization champions will
ensure that countries are committed to ensure the enjoyment of the highest
attainable standard of health and to protection of communities against vaccine-
preventable diseases.
Partnership-based. New partnerships will be built among multiple actors to increase
knowledge and raise awareness of the value of immunization, to build community
trust and to overcome barriers to equity, including gender-related barriers.
Data-guided. Evidence on behavioural and social factors will be obtained locally
and nationally to develop appropriate interventions. Communication technology will
be used to increase commitment to and demand for immunization.
36
Coverage & equity
Goal Everyone is protected by full immunization, regardless of location, age, socioeconomic
status or gender-related barriers.
Objectives • Extend immunization services to regularly reach “zero dose” and under-
immunized children and communities.
• Advance and sustain high and equitable immunization coverage nationally and in
all districts.
Key areas
of focus
Disadvantaged populations: Identify and address low coverage throughout the
life-course of the poorest and most disadvantaged individuals and communities.
Barriers to vaccination: Identify barriers to uptake of vaccination services due to
age, location, social and cultural and gender-related factors, and use evidence-based
approaches to overcome these barriers to achieving high, equitable coverage.
Gender-responsive strategies: Understand the role of gender in accessing
vaccination services, and use gender-responsive strategies to overcome the barriers
faced by recipients, caregivers, service providers and health workers.
Measles as a tracer: Use measles cases and outbreaks as a tracer to identify
weaknesses in immunization programmes, and to guide programmatic planning in
identifying and addressing these weaknesses.
Learning from disease-specific initiatives: Use the experience of disease
eradication and elimination initiatives in reaching the most marginalized
populations, and integrate successful strategies for delivery and accountability into
immunization programmes, with the full integration of disease control perspectives
into primary health care.
Context-specific interventions: Develop, evaluate and scale up innovative, locally
tailored, evidence-based, people-centred approaches to reach poorly served
populations.
Implementation research: Strengthen local capacity to conduct implementation
research to identify factors that affect the equity of immunization coverage,
interventions that enhance coverage and equity and promote use of the results
to implement locally tailored, context-specific interventions and innovations to
address inequities.
STRATEGIC PRIORITY 3.
37
Coverage & equity
Application
of the core
principles
People-centred. Gaps in coverage and equity will be addressed, especially among
marginalized and disadvantaged groups such as mobile and displaced populations,
by actively engaging representatives of local communities and local health
providers in designing interventions for these groups.
Country-owned. To overcome barriers, national immunization programmes will use
strategies based on proven, innovative approaches and local research on effective
ways to deliver services to underserved groups.
Partnership-based. Partnerships will be built with local communities and
representatives of marginalized groups to understand the obstacles to access to
vaccination (including gender barriers faced by recipients, caregivers and health
workers) and to address inequities.
Data-guided. Immunization data systems will be expanded subnationally to map
and track “zero dose” and under-immunized populations and specific marginalized
groups to ensure that they are covered by the immunization programme.
38
Life-course & integration
Goal All people benefit from recommended immunizations throughout the life-course,
effectively integrated with other essential health services.
Objectives • Strengthen immunization policies and service delivery throughout the life-course,
including for appropriate catch-up vaccinations and booster doses.
• Establish integrated delivery points of contact between immunization and other
public health interventions for different target age groups.
Key areas
of focus
Mobilizing support: Raise awareness of the benefits of vaccination beyond early
childhood, through adolescence and in priority adult groups such as pregnant women,
health workers and older adults.
Evidence-based delivery practices: Identify and evaluate new delivery strategies for
increasing coverage of recommended vaccines throughout the life-course.
Missed opportunities: Implement proven approaches to reduce the number of missed
opportunities by integrating immunization into other primary health care planning,
health registers and other record-keeping systems, and streamline use of all encounters
with the health system to verify and provide missed vaccines and other essential
health interventions.
Cross-sector collaboration: Form collaborations to integrate age-appropriate and
catch-up vaccination into public and private health services, emphasizing the reciprocal
benefits of receiving vaccines with other health interventions. Establish collaboration
beyond the health care sector to ensure integration of immunization into context-
specific programmes such as for education, nutrition, water and sanitation, care of
older people and women’s empowerment.
Policy environment: Promote changes in legislation or in the policy of immunization
and other programmes to extend the national focus beyond early childhood
immunization. Form new collaborations and private-sector partnerships to mobilize
financing for vaccination of older age groups.
Tracking vaccination status: Institute policies for monitoring vaccination coverage at
different ages and facilitating administration of vaccines throughout the life-course.
Vaccine development: Generate evidence on the disease burden among older age
groups, the potential of vaccines to decrease it and the programmatic implications for
introducing the vaccines.
STRATEGIC PRIORITY 4.
39
Life-course & integration
Application
of the core
principles
People-centred. Vaccination throughout the life-course is integrated into other
health care services for different age groups, according to the needs of individuals.
Country-owned. National immunization technical advisory groups will guide
country programmes in extending vaccination beyond infancy throughout the life-
course to reflect specific national and subnational contexts.
Partnership-based. Partnerships with other health programmes and with non-health
actors (including in education, water, sanitation and hygiene and nutrition) are
built into comprehensive life-course approaches for disease control and elimination,
including for pneumococcus pneumonia, diarrhoea and cervical cancer.
Data-guided. Implementation and social and behavioural research will be conducted
to generate evidence for effective delivery of integrated, coordinated packages of
vaccination services and to identify new contact points for vaccination throughout
the life course. Research will identify the vaccines required for older age groups.
40
Outbreaks & emergencies
Goal Immunization programmes can (1) anticipate, prepare for, detect and rapidly respond to
of vaccine-preventable and emerging disease outbreaks, and (2) ensure immunization
service delivery during acute emergencies and among communities affected by conflict,
disaster and humanitarian crisis.
Objectives • Ensure preparation for, detection of and rapid, high-quality response to vaccine-
preventable disease outbreaks.
• Establish timely and appropriate immunization services during emergencies, and
in communities affected by conflict, disaster and humanitarian crisis.
Key areas
of focus
Coordination and integration: Strengthen coordination of implementation of
vaccination and outbreak preparedness, detection and activities in the overall
humanitarian response and in conformity with the International Health Regulations
(2005) and health systems development programming, with the participation of all
relevant stakeholders, including civil society, national and international organizations,
humanitarian and development partners and the private sector.
Local capacity: Invest in and sustain local capacity and health systems to ensure
timely detection of and response to vaccine-preventable disease outbreaks; identify
and address the underlying causes of outbreaks; ensure that communities affected
by outbreaks, other emergencies and humanitarian crises have continual access to a
package of health services that includes immunization; and ensure that immunization
recovery is embedded into outbreak and emergency response plans.
Comprehensive health response: Ensure that global, regional, national and
subnational coordination and governance mechanisms effectively support equitable,
transparent, timely decision-making on the allocation of essential supplies and
vaccines and mobilization of trained human resources.
Integrated surveillance: Rebuild national, regional and local capacity for rapid,
integrated surveillance of priority and emerging infectious diseases after an
emergency or humanitarian event, maximizing opportunities to monitor and
characterize multiple pathogens to ensure early detection of outbreaks. Strengthen
integrated disease surveillance for epidemic-prone vaccine-preventable diseases to
enhance prevention and response.
STRATEGIC PRIORITY 5.
41
Outbreaks & emergencies
Key areas
of focus
Tailored approaches and innovation: Develop, implement and evaluate innovative,
tailored approaches and relevant frameworks and tools for safe, ethical, equitable
vaccination of populations during outbreaks and in settings of humanitarian aid.
Re-establish vaccination services after acute emergencies as part of broader early
recovery and in line with disaster risk-reduction principles.
Community engagement: Prioritize two-way communication and engagement with
communities and health workers during outbreaks and in settings of humanitarian
aid to effectively limit health emergencies and outbreaks and promote participation
in decision-making; ensure access to and use of services, and identify and fill unmet
health needs.
Application
of the core
principles
People-centred. Anticipation of, preparedness for and response to outbreaks
and emergencies will include adaptation of interventions to meet all the needs
of affected individuals, including mobile and displaced populations, and tailored
interventions based on local knowledge. Mechanisms to ensure accountability
to affected people should be in place for continual improvement of emergency
vaccination interventions and transition to longer-term services.
Country-owned. National authorities will coordinate efforts to handle emergencies
and outbreaks with local authorities, and services will be delivered by trained local
staff and community mobilization networks. In crises in which national authorities
do not coordinate provision of services, access to impartial, independently provided
health care will be ensured.
Partnership-based. Partnerships will be built to prioritize and support capacity-
building, planning and leadership of local and national organizations for coordinated
provision of health care, including vaccination, in such a way as to support existing
health systems and surveillance strategies during outbreaks and other acute
emergencies and also in settings of humanitarian aid.
Data-guided. Routine, systematic collection of disaggregated data will be promoted
to target vaccination to the most vulnerable populations and those at risk of exclusion.
Research and evaluation will be conducted to generate evidence on novel approaches
to identifying outbreaks early and to deliver vaccination and health services during
outbreaks, other acute emergencies and in settings of humanitarian aid.
42
Supply & sustainability
Goal All countries have a reliable supply of appropriate and affordable vaccines of assured
quality, and sustainable financing for immunization programmes.
Objectives • Build and maintain healthy global markets across all vaccine antigens.
• Ensure sufficient financial resources for immunization programmes in all countries.
• Increase immunization expenditure from domestic resources in aid-dependent
countries, and when transitioning away from aid, secure government funding to
achieve and sustain high coverage for all vaccines.
Key areas
of focus
Innovation and affordability: Ensure that the supply of and access to new vaccines
meet country needs and that vaccines are introduced in a timely manner, regardless
of a country’s wealth, and at a price that is affordable, to ensure the supply.
Vaccine forecasting, procurement and supply: Improve national and global
forecasting, planning and procurement capability to safeguard affordable,
sustainable supplies, and strengthen relations with manufacturers to ensure that
vaccine production and supply meet national needs in all countries.
Sources of assured quality vaccines: Strengthen regulatory capacity in all
countries to improve timely access to vaccines of assured quality and to allow
diversification of manufacturing sources.
Supply for emergency situations: Strengthen mechanisms for rapid access in
emergencies, outbreaks or pandemics and for people who require humanitarian aid.
The mechanisms include sustainable manufacture and new means for rapid scaling-
up of production to meet surge requirements and rapid access.
Sufficient, predictable resources: Ensure that funding from all sources is sufficient
to procure and deliver recommended vaccines universally.
Immunization financing: Ensure good governance, stewardship and accountability
of financing for immunization programmes for optimal performance and best value
for money.
STRATEGIC PRIORITY 6.
43
Supply & sustainability
Key areas
of focus
Partner alignment: Streamline and align partnerships for immunization, primary
health care or integrated financing, and ensure effective global collaboration
in which the roles, responsibilities and accountability of all partners are clearly
defined, transparent and monitored.
Sustainable transitions: Ensure mechanisms for smooth transition of countries
from donor-supported programmes, while maintaining and enhancing their
immunization programmes.
Application
of the core
principles
People-centred. A strong focus on developing local capacity to govern and
manage immunization financing and to increase understanding of choices for better
forecasting of current and future vaccine markets.
Country-owned. Adequate country capacity to plan for and secure the financing
required for their immunization programme will reduce reliance on external support.
Countries will be able to plan, forecast, budget for and procure the required
vaccines and ensure their quality.
Partnership-based. Better partnerships will be built to plan for and ensure long-term,
sustainable financing, and all partners will have clear roles and responsibilities and
be accountable. Enhanced collaboration among stakeholders will support healthy
vaccine markets.
Data-guided. Data systems will be upgraded to better allocate resources within
national immunization programmes, monitor use of resources and forecast vaccine
demand, supply and pricing.
44
Research & innovation
Goal Innovations to increase the reach and impact of immunization programmes are rapidly
made available to all countries and communities.
Objectives • Establish and strengthen capacity at all levels to identify priorities for
innovation, and to create and manage innovation.
• Develop new vaccines and technologies, and improve existing products and
services for immunization programmes.
• Evaluate promising innovations and scale up innovations, as appropriate, on the
basis of the best available evidence.
Key areas
of focus
Needs-based innovation: Strengthen mechanisms to identify vaccine-related
research and priorities for innovation according to community needs, particularly
for underserved populations, and ensure that the priorities inform innovations in
immunization products, services and practices.
New and improved products, services and practices: Accelerate the development
of new vaccines, technologies and improved products, services and practices, while
ensuring continued progress in the development of vaccines for priority targets,
including HIV, TB, malaria and emerging infectious diseases.
Evidence for Implementation: Shorten the path to maximum vaccine impact by
implementation and operational research and through evidence-informed decisions on
policy and implementation based on sound evidence of needs, benefits and risks.
Local innovation: Build local capacity to address programme challenges and maximize
impact by cooperative creation, sourcing, adopting and scaling-up of innovations.
Application
of the core
principles
People-centred. Innovations in products, services and practices will be client-
focused and address community and provider needs and preferences.
Country-owned. Countries will be able to identify, source and manage
innovations in vaccines and immunization, including determining, documenting and
communicating their priorities and identifying, evaluating and using local and global
innovations. Country priorities will inform the global innovation agenda.
Partnership-based. Partners will devise ways to support the development,
evaluation, use and sustainability of suitable immunization solutions, drawing on the
complementary expertise of national and global stakeholders.
Data-guided. Evidence of unmet needs and the value of innovations in all aspects
of immunization will be rigorously collected and shared to promote evidence-based
research, development, execution and scale-up.
STRATEGIC PRIORITY 7.
IMPACT AND
STRATEGIC GOALS
4
48
Realizing the IA2030 vision will require achievement of the impact goals
(Fig. 4).
Figure 4. Impact goals for the IA2030 vision
In addition, each strategic priority will have specific goals and objectives
for evaluating progress in meeting the priorities (Table 2). The goals and
objectives will complement existing disease-specific goals and also the
broader health goals and the SDGs. They will mirror the ambition of existing
commitments and galvanize work to make important gains in immunization
over the coming decade.
A world where everyone,
everywhere, at every age...
Reduce mortality and morbidity from vaccine-preventable
diseases for everyone throughout the life course.
... fully benefits from
vaccines...
Leave non one behind, by increasing equitable access
and use of new and existing vaccines.
... for good health
and well-being
Ensure good health and well-being for everyone by
strengthening immunisation within primary health care
and contributing to universal health coverage and
sustainable development.
Vision Impact goals
49
Table 2. IA2030 strategic priority goals and objectives
Goals and objectives
Strategic priority goal 1
Effective, efficient and resilient immunization services are accessible to all people as an
essential part of primary health care, and thereby contribute to universal health coverage.
Objectives
1. Reinforce and sustain strong leadership, management and coordination of immunization
programmes at all levels.
2. Ensure the availability of an adequate, effective, sustainable health workforce.
3. Build and strengthen comprehensive vaccine-preventable disease surveillance as a
component of national public health surveillance system, supported by strong, reliable
laboratory networks
4. Ensure high-quality supply chains for vaccines and related commodities and effective
vaccine management, within the primary health care supply system.
5. Strengthen immunization information within a robust health information system, and
promote use of high quality, and “fit-for-purpose” data for action at all levels.
6. Establish and maintain a well-functioning vaccine safety system involving all
stakeholders.
Strategic priority goal 2
Immunization is valued and actively sought by all people, and health authorities commit to
ensuring that immunization is available as a key contributor to enjoyment of the highest
attainable standard of health as a fundamental right.
Objectives
1. Build and sustain strong political and financial commitment for immunization at all levels.
2. Ensure that all people and communities value, actively support, and seek out
immunization services.
Strategic priority goal 3
Everyone is protected by full immunization, regardless of location, age, socioeconomic
status or gender-related barriers.
Objectives
1. Extend immunization services to regularly reach “zero-dose” and under-immunized
children and communities.
2. Advance and sustain high and equitable immunization coverage nationally and in all districts.
50
Goals and objectives
Strategic priority goal 4
All people benefit from recommended immunizations throughout the life course, effectively
integrated with other essential health services.
Objectives
1. Strengthen immunization policies and service delivery throughout the life course,
including for appropriate catch-up vaccinations and booster doses.
2. Establish integrated delivery points of contact between immunization and other public
health interventions for different target age groups.
Strategic priority goal 5
Immunization programmes can 1) anticipate, prepare for, detect, and rapidly respond to vaccine-
preventable and emerging disease outbreaks, and 2) ensure immunization service delivery during
acute emergencies and among communities affected by conflict, disaster and humanitarian crisis.
Objectives
1. Ensure preparation for, detection of, and rapid, high-quality response to vaccine-
preventable disease outbreaks.
2. Establish timely and appropriate immunization services during emergencies, and in
communities affected by conflict, disaster and humanitarian crisis.
Strategic priority goal 6
All countries have a reliable supply of appropriate and affordable vaccines of assured
quality, and sustainable financing for immunization programmes.
Objectives
1. Build and maintain healthy global markets across all vaccine antigens.
2. Ensure sufficient financial resources for immunization programmes in all countries.
3. Increase immunization expenditure from domestic resources in aid-dependent countries,
and when transitioning away from aid, secure government funding to achieve and
sustain high coverage for all vaccines.
Strategic priority goal 7
Innovations to increase the reach and impact of immunization programmes are rapidly
made available to all countries and communities.
Objectives
1. Establish and strengthen capacity at all levels to identify priorities for innovation, and
to create and manage innovation.
2. Develop new vaccines and technologies, and improve existing products and services for
immunization programmes.
3. Evaluate promising innovations and scale up innovations, as appropriate, based on the
best available evidence.
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As the IA2030 framework is adaptable and flexible, goals may be revised in
response to major changes during the decade. The goals and objectives will
be further refined in the monitoring and evaluation framework and will include
indicators, targets and methods for evaluating progress.
The IA2030 goals will inspire action. In countries, action might include setting
evidence-based, ambitious national targets and milestones for the decade.
Regions might make plans to achieve the global goals by setting targets
and milestones in regional vaccination action plans. Partner organizations
might align their strategies and indicators towards attainment of the
IA2030 goals.
Global, regional and national goal- and target-setting should be:
• aligned with the vision of IA2030;
• responsive to changing trends and conditions;
• aligned with broader health agendas (SDG3, primary health care and
universal health coverage);
• ambitious but achievable and measurable to ensure accountability;
• linked to an action and a work plan; and
• designed to reinforce previous commitments (for example, the disease-
specific goals listed in Table 1).
OPERATIONALIZATION
5
OPERATIONALIZATION
56
IA2030 is an overarching strategy for establishing a shared vision of and
strategic priorities for vaccines and immunization in order to guide the
activities of countries and stakeholder organizations.
IA2030 must be contextualized within the global focus on improving access
to good-quality, affordable primary health care as a foundation for achieving
universal health coverage. The vision and strategy of IA2030 do not exist in
isolation. It is backed by technical analyses and documentation, complementary
strategies of stakeholder organizations, disease-specific initiatives and other
global health and development programmes for steering national strategies and
plans for vaccination.
Further, development of IA2030 will be a multistep process, starting with
agreement on the vision, strategic priorities and high-level goals. The second
step, translating the strategy into concrete actions, will require the development
of regional and national operational plans; a mechanism to ensure ownership and
accountability; and a monitoring and evaluation framework.
IA2030 will be adaptable to regional and national contexts. Thus, countries
will prioritize various focus areas in each IA2030 strategic priority according
to their situation. IA2030 will enable partners and stakeholders at all levels to
align their work to ensure that all actions reinforce each other, in the pursuit of
common goals.
5.1 Operational plans
The global strategy will become operational nationally, regionally and globally
through its seven strategic priorities and four core principles.
Nationally, the IA2030 vision and strategies can be incorporated into national
immunization strategies within national health planning. Countries will define
their own targets and timelines to achieve IA2030 goals. Support from partners
will be tailored to each context and integrated as much as possible into the
strengthening of primary health care, achievement of universal health care and
attainment of the SDGs.
Regional vaccine action plans will be updated to align them with the IA2030
vision and strategic priorities. Tailored support will be provided to countries
according to the needs of national immunization programmes. Regional
collaboration will involve stakeholders within and outside of immunization, to
take advantage of synergies and promote integration.
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Globally, operationalization of the IA2030 vision and strategy will focus on
those components that are best coordinated globally, with alignment among
stakeholders. It will require communication and advocacy to maintain momentum,
mobilize support for IA2030 and for immunization more generally and promote
acceptance of the IA2030 principles and strategic priorities.
5.2 Ownership and accountability
A mechanism will be necessary to ensure ownership accountability and definition
of the roles and responsibilities of all stakeholders in delivering IA2030 vision
and strategies. This will be a key objective in the second phase of IA2030
development.
5.3 Monitoring and evaluation framework
Drawing on the lessons learnt from GVAP, a robust monitoring and evaluation
framework will be developed to measure progress towards the IA2030 vision
and goals. It will be closely aligned with operational plans to ensure the greatest
possible transparency and accountability.
The approach to achieving the IA2030 vision will be dynamic and responsive.
While the vision and strategy will be constant throughout the decade,
operational plans at national, regional and global levels will evolve with changing
circumstances. Just as the battle against infectious diseases requires agile,
flexible immunization programmes, a global vaccine and immunization strategy
must also constantly adjust to changing needs and opportunities to respond to
rapid shifts in disease epidemiology, technological advances, community needs,
financial realities and political contexts.
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