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Basa JE, Clemens R, Clemens SAC, Nicholson M. Landscaping analysis of immunization progress and program structures in selected middle income Southeast Asian countries. Vaccine 2024; 42:2326-2336. [PMID: 38448324 DOI: 10.1016/j.vaccine.2024.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/28/2024] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
This study examined the performance and structures of national immunization program in five middle-income Southeast Asian countries - Malaysia, Thailand, Philippines, Viet Nam, and Myanmar, and analyzed how the different structures relate to the difference in program performance to identify effective strategies in the study countries that facilitated good immunization performance. Data were derived from published literature, and WHO/UNICEF/Gavi databases, with 2010 as the baseline year. UMICs Malaysia and Thailand maintained ≥90 % coverage from 2010 to 2020 and even during the COVID-19 pandemic in 2021. LMICs Viet Nam and donor-supported Myanmar also achieved 80-90 % coverage for most routine vaccines in 2020. The Philippines have not reached ≥90 % coverage since 2010, with the maximum only 72 % (MCV1 and Polio3) in 2020. All study countries prioritize immunization and increased government financing since 2010 by minimum 91 % in Malaysia and 1897 % in Myanmar. However, Myanmar still largely depended on donor support with government financing only 32 % of immunization costs in 2021. The Philippines funds 100 % of immunization costs and ensures sustainable financing for the NIP through earmarked "sin tax" revenues from alcohol and tobacco. Donor support influenced new vaccine introductions among the study countries, with Gavi countries Myanmar and Viet Nam introducing more new vaccines, compared to Gavi-ineligible Malaysia and Thailand. The Philippines reported vaccine stock-outs every year amounting to 28 stock-outs events from 2010 to 2019, compared to only 1-4 stockouts in the other study countries. Donor support, innovative financing, and domestic vaccine manufacturing all play an important role in the efficient delivery of immunization services as demonstrated by the several new vaccine introductions and high immunization rates in Myanmar though Gavi and UNICEF support, additional annual $1.2 billion budget for health and immunization from "sin taxes" in the Philippines, and lack of stockouts for vaccines sourced at affordable prices from domestic manufacturers in Viet Nam.
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Affiliation(s)
- Jessabelle E Basa
- Research Institute for Tropical Medicine, Department of Health, Philippines; Institute for Global Health, University of Siena, Siena, Italy.
| | - Ralf Clemens
- Institute for Global Health, University of Siena, Siena, Italy; International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Sue Ann Costa Clemens
- Institute for Global Health, University of Siena, Siena, Italy; Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
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MacDonald N, Mohsni E, Al-Mazrou Y, Kim Andrus J, Arora N, Elden S, Madrid MY, Martin R, Mahmoud Mustafa A, Rees H, Salisbury D, Zhao Q, Jones I, Steffen CA, Hombach J, O'Brien KL, Cravioto A. Global vaccine action plan lessons learned I: Recommendations for the next decade. Vaccine 2020; 38:5364-5371. [PMID: 32563607 PMCID: PMC7342005 DOI: 10.1016/j.vaccine.2020.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
Abstract
The Global Vaccine Action Plan 2011-2020 (GVAP) was developed to realize the ambitions of the Decade of Vaccines - that all individuals and communities enjoy lives free from vaccine-preventable diseases. It included a comprehensive monitoring and evaluation/accountability framework to assess progress towards global targets with recommendations for corrective actions. While many of the GVAP targets are very unlikely to be met by the end of 2020, substantial progress has nevertheless been made, establishing a strong foundation for a successor global immunization strategy, the Immunization Agenda 2030 (IA2030). The Strategic Advisory Group of Experts on immunization has made a series of recommendations to ensure that the lessons learned from GVAP inform the development and implementation of IA2030.
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Affiliation(s)
- Noni MacDonald
- SAGE Decade of Vaccines Working Group; Professor of Paediatrics, Dalhousie University, IWK Health Centre, Canada. Chair of the SAGE Decade of Vaccines Working Group.
| | - Ezzeddine Mohsni
- SAGE Decade of Vaccines Working Group; Senior Technical Adviser in Global Health Development/Eastern Mediterranean Public Health Network
| | - Yagob Al-Mazrou
- SAGE Decade of Vaccines Working Group; Secretary General - Health Services Council of the Kingdom of Saudi Arabia, Saudi Arabia
| | - Jon Kim Andrus
- SAGE Decade of Vaccines Working Group; Adjunct Professor and Director, Division of Vaccines and Immunization, Center for Global Health, University of Colorado, USA
| | - Narendra Arora
- SAGE Decade of Vaccines Working Group; Executive director, International Clinical Epidemiology Network, India
| | - Susan Elden
- SAGE Decade of Vaccines Working Group; Health Adviser, Department for International Development, London, UK
| | - Marie-Yvette Madrid
- SAGE Decade of Vaccines Working Group; Independent Consultant, Geneva, Switzerland
| | - Rebecca Martin
- SAGE Decade of Vaccines Working Group; Director of the Center for Global Health, US CDC, USA
| | - Amani Mahmoud Mustafa
- SAGE Decade of Vaccines Working Group; Project Manager, Sudan Public Health Training Initiative, Carter Center, Sudan
| | - Helen Rees
- SAGE Decade of Vaccines Working Group; Executive Director, Wits Reproductive Health and HIV Institute, Personal Professor, Ob/Gyn Codirector, African Leadership in Vaccinology Excellence, University of Witwatersrand, South Africa
| | - David Salisbury
- SAGE Decade of Vaccines Working Group; Associate Fellow, Centre on Global Health Security, Chatham House, London, UK
| | - Qinjian Zhao
- SAGE Decade of Vaccines Working Group; State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ian Jones
- Jinja Publishing Ltd, Bishop's Stortford, UK
| | - Christoph A Steffen
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Joachim Hombach
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Katherine L O'Brien
- Immunization, Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Alejandro Cravioto
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico; Chair, Strategic Advisory Group of Experts on Immunization (SAGE)
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Hwang A, Veira C, Malvolti S, Cherian T, MacDonald N, Steffen C, Jones I, Hinman A, Mantel C. Global Vaccine Action Plan Lessons Learned II: Stakeholder Perspectives. Vaccine 2020; 38:5372-8. [PMID: 32505440 DOI: 10.1016/j.vaccine.2020.05.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 01/17/2023]
Abstract
GVAP built visibility for immunization and was an improvement over prior plans. GVAP implementation was incomplete due to limited awareness and stakeholder buy-in. The GVAP Monitoring & Evaluation/Accountability framework gave valuable guidance. Future strategies should build greater buy-in and communicate more effectively.
Introduction The Global Vaccine Action Plan (GVAP), unanimously endorsed by the World Health Assembly in 2012, defined an ambitious strategy to improve immunization. At the end of the decade, significant progress has been made but four of the five GVAP goals are likely to be missed. This report describes a set of surveys and interviews relating to GVAP, conducted to inform the immunization strategy for the next decade. Methods Three surveys and two sets of semi-structured interviews were conducted from 2017 to 2019. Respondents consisted of immunization stakeholders at global, regional, and country levels, and included individuals who had been involved in the development and implementation of GVAP or its monitoring, evaluation and accountability (M&E/A) process; national immunization managers; academics; and personnel from non-governmental organizations and civil society organizations. Results The surveys and interviews gave consistent results. They highlighted the value of GVAP in increasing visibility for immunization and the benefits of the GVAP M&E/A framework. The main limitations of GVAP were identified as the limited ownership by countries and other stakeholders leading to incomplete implementation of the strategy and poor accountability for achieving GVAP targets. Discussion These results informed the review of GVAP and the development of its successor strategy, the Immunization Agenda 2030. In addition, these surveys and interviews identified two challenges in assessing the value of GVAP: the need to rely exclusively on stakeholder perspectives and difficulties in attributing benefits. These challenges are inherent in evaluating an over-arching strategy such as GVAP and should be factored into interpretation of the results.
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Cherian T, Hwang A, Mantel C, Veira C, Malvolti S, MacDonald N, Steffen C, Jones I, Hinman A. Global Vaccine Action Plan lessons learned III: Monitoring and evaluation/accountability framework. Vaccine 2020; 38:5379-5383. [PMID: 32430149 PMCID: PMC7342004 DOI: 10.1016/j.vaccine.2020.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The Monitoring & Evaluation/Accountability (M&E/A) framework of the Global Vaccine Action Plan (GVAP) was used to report progress annually to the World Health Assembly (WHA). METHODS Stakeholder feedback was obtained through five reviews consisting of surveys and semi-structured interviews conducted from 2017 to 2019. Participants consisted of individuals involved in the development and implementation of GVAP or its M&E/A process, national immunization managers, academics, representatives of non-governmental organizations, and civil society organizations. RESULTS The feedback was mixed and contradictory for some components, though most participants reported that the M&E/A process was a highlight of GVAP and a step in the right direction. Several of the goals and targets were considered aspirational and unrealistic for many countries. There were mixed responses on whether it promoted accountability, especially at the country level. DISCUSSION The mixed and contradictory views on the M&E/A processes and its impact suggested a failure of communication about its scope and intent. Though the process, especially the annual reporting to the WHA, kept immunization high on the global agenda, it failed to fully meet the expectations in promoting accountability. Engaging with countries to capture the local context in setting global goals and targets and promoting local M&E/A processes will be important to achieve accountability in the next decade.
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Affiliation(s)
- Thomas Cherian
- MMGH Consulting GmbH, Kuerbergstrasse 1, 8049 Zurich, Switzerland.
| | - Angela Hwang
- MMGH Consulting GmbH, Kuerbergstrasse 1, 8049 Zurich, Switzerland; Angela Hwang Consulting, P.O. Box 6601, Albany, CA 94706, USA.
| | - Carsten Mantel
- MMGH Consulting GmbH, Kuerbergstrasse 1, 8049 Zurich, Switzerland.
| | - Chantal Veira
- Task Force for Global Health, 330 West Ponce de Leon Ave., Decatur, GA 30030, USA.
| | - Stefano Malvolti
- MMGH Consulting GmbH, Kuerbergstrasse 1, 8049 Zurich, Switzerland.
| | - Noni MacDonald
- Dalhousie University, IWK Health Centre, Halifax, Canada
| | - Christoph Steffen
- World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
| | - Ian Jones
- Jinja Publishing Ltd, Bishop's Stortford, United Kingdom
| | - Alan Hinman
- Task Force for Global Health, 330 West Ponce de Leon Ave., Decatur, GA 30030, USA.
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Al Gunaid M, Lami F, Jarour N. A Collaborative Initiative to Strengthen Sustainable Public Health Capacity for Polio Eradication and Routine Immunization Activities in the Eastern Mediterranean Region. JMIR Public Health Surveill 2019; 5:e14664. [PMID: 31663863 PMCID: PMC6913771 DOI: 10.2196/14664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 09/01/2019] [Accepted: 09/25/2019] [Indexed: 11/13/2022] Open
Abstract
The many challenges in the Eastern Mediterranean region put the involved countries at risk of polio transmission and affect their ability to meet progress targets in eliminating vaccine-preventable diseases. The Global Health Development (GHD) and Eastern Mediterranean Public Health Network (EMPHNET) are working together on the project "Strengthening sustainable public health capacity in the Eastern Mediterranean region for polio eradication and routine immunization activities" with an overall goal of improving routine immunization, eradicating poliovirus, and controlling/eliminating or eradicating other vaccine-preventable diseases in the Eastern Mediterranean region. The aim of this manuscript is to describe the project and the achievements of GHD/EMPHNET over the last 3 years (2016-2018) to build effective surveillance and immunization systems in the Eastern Mediterranean region through the development of a sustainable and competent public health system to eradicate polio and control/eliminate vaccine-preventable diseases. This project assists the targeted Eastern Mediterranean region countries to build effective surveillance and immunization systems in an effort to expand their capacities to eradicate polio and control/eliminate other vaccine-preventable diseases. The project is streamlined with the Global Polio Eradication Initiative, the Centers for Disease Control and Prevention's Strategic Framework for Global Immunization 2016-2020, and the Polio Eradication and Endgame Strategic Plan 2013-2018. The project also supports the Global Health Security Agenda by focusing on efforts to accelerate progress toward a world safe and secure from infectious disease threats. Project activities were designed to respond to countries' needs and assist them in building their institutional and workforce capacity to effectively plan, implement, and evaluate activities to eradicate polio and strengthen routine immunization activities. The project activities covered a set of areas including surveillance of acute flaccid paralysis and other vaccine-preventable diseases, family and community engagement, workforce capacity building, improvement of data quality, management and use of information systems, use of polio assets to control/eliminate other vaccine-preventable diseases, support of countries to develop national strategies, piloting of innovative initiatives, program evaluation and accountability, and immunization strengthening. The project adopts the Global Polio Eradication Initiative strategies for assisting countries to strengthen routine immunization services, maintain highly sensitive acute flaccid paralysis surveillance, and sustain polio eradication functions.
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Affiliation(s)
- Magid Al Gunaid
- Polio and Immunization Team, Global Health Development/Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Faris Lami
- Department of Community and Family Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Najwa Jarour
- Polio and Immunization Team, Global Health Development/Eastern Mediterranean Public Health Network, Amman, Jordan
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Wiyeh AB, Sambala EZ, Ngcobo N, Wiysonge CS. Existence and functionality of national immunisation technical advisory groups in Africa from 2010 to 2016. Hum Vaccin Immunother 2018; 14:2447-2451. [PMID: 29771634 PMCID: PMC6284504 DOI: 10.1080/21645515.2018.1475815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the existence and functionality of National Immunisation Technical Advisory Groups (NITAGs) in Africa between 2010 and 2016, using data from the WHO-UNICEF Joint Reporting Form. The number of African countries with NITAGs increased from 15 (28%) in 2010 to 26 (48%) in 2016. Countries with a functioning NITAG increased from 5(9%) in 2010 to 16 (30%) in 2016. In 2016, 13 of the 27 (48%) low-income African countries reported having a NITAG; seven (54%) of them functional. Thirteen of the 26 (50%) middle-income countries reported having a NITAG; nine (69%) of them functional. In 2016, six of the seven African countries (86%) in the WHO Eastern Mediterranean Region had a NITAG, with three (50%) functional. In the WHO African Region, 20 of the 47 countries (43%) had NITAGs; 13 (65%) of them functional. Substantial investments should be made to ensure that every African country has a functional NITAG.
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Affiliation(s)
- Alison B Wiyeh
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Evanson Z Sambala
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Ntombenhle Ngcobo
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Charles S Wiysonge
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa.,b Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics , Department of Global Health, Stellenbosch University , Cape Town , South Africa.,c Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town , Cape Town , South Africa
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Wiysonge CS, Waggie Z, Hawkridge A, Schoub BD, Madhi SA, Rees H, Hussey GD; delegates of the first International African Vaccinology Conference. The Cape Town Declaration on Vaccines 2012: Unlocking the full potential of vaccines in Africa. Vaccine 2016; 34:3713-4. [PMID: 27317265 DOI: 10.1016/j.vaccine.2016.05.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 11/20/2022]
Abstract
Delegates at the first International African Vaccinology Conference noted, with dismay, that many African children have limited access to existing and new vaccines as a consequence of weak immunisation programmes, lack of political will, and high vaccine prices. This inequality is a denial of the African child her basic right to a healthy life, and jeopardises long term economic growth on the continent. In addition, there is insufficient emphasis in Africa on adolescent and adult immunisation. The delegates documented various concerns and made various commitments; contained in this Cape Town Declaration on Vaccines, adopted on 11 November 2012. Finally, delegates confirmed their agreement with the goals and strategic objectives of the Global Vaccine Action Plan, and committed to hold African leaders accountable for its implementation during the Decade of Vaccines. The full list of registered conference delegates is provided as supplementary data to this manuscript.
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