"Communities and civil society are increasingly recognized for their critical role in shaping immunization systems and improving vaccine coverage by increasing demand and holding governments accountable. This roadmap is intended to build on this momentum..."
Launched at the first World Health Organization (WHO) Africa Health Forum in Kigali, Rwanda, this document provides a roadmap to guide Member States' implementation of the Addis Declaration on Immunization (ADI), a pledge adopted in January 2017 to ensure that everyone in Africa receives the full benefits of immunisation. The roadmap was developed in close collaboration between Member States, the African Union (AU) Commission, and the WHO Offices in the African Region (AFRO) and Eastern Mediterranean Region (EMRO), as well as immunisation partners. It builds on and complements existing efforts aimed at improving immunisation in Africa and around the world, particularly the Global Vaccine Action Plan (GVAP).
Routine immunisation coverage has increased across Africa during the last two decades. The percentage of children in Africa receiving the third dose of the diphtheria-tetanus-pertussis vaccine (DTP3) rose from approximately 57% in 2000 to 77% in 2015. Yet one in five children across the continent still lack access to all available vaccines, leaving them vulnerable to vaccine-preventable diseases. Barriers to vaccine access include weak supply chains and insufficient data to identify coverage gaps at the local level. The ADI roadmap identifies strategies for confronting these and other challenges early to ensure that immunisation efforts are uninterrupted.
The document provides Member States with three specific strategies to accelerate progress toward universal access to immunisation in Africa:
- Generate and sustain political commitment and funding for immunisation through advocacy and communication. The approaches outlined in this section include:
- Develop effective messages: Immunisation messaging must be accurate and strategic. All stakeholders at the national and sub-national levels have an important role to play in ensuring that evidence-based and culturally sensitive messages reach different audiences - from decision-makers to communities - to maintain political will and drive demand for vaccines at the local level. Messages must be tailored for each audience, based on their specific knowledge and beliefs, to ensure resonance. One proposed activity delineated here: Conduct message testing surveys.
- Identify, develop, and engage immunisation champions, particularly national and sub-national leaders: Champions - highly influential stakeholders, such as Heads of State, ministers, parliamentarians, and state-level leaders, who actively push for policy and programmatic changes - can have an impact on immunisation in Africa. National-level leaders can leverage their positions to champion immunisation through various forums at the sub-national, national, regional, and global levels. Efforts should be made to identify other trusted champions, such as scientists, service providers, community and religious leaders, and artists, who can elevate the issue of immunisation through the media, public-facing forums, and their communities. One proposed activity delineated here: Encourage national and sub-national leaders to participate in various public immunisation activities, particularly around awareness days (e.g., African Vaccination Week). Such events should be broadly publicised to help build leaders' reputations as immunisation champions and bolster public awareness of and support for immunisation.
- Engage in advocacy and communication activities at the community level: Researching and understanding barriers to immunisation at the local level, engaging influential members of the community to speak out in support of immunisation, and developing targeted communication strategies are all ways to build support for immunisation within communities, increase uptake of existing immunisation services, and raise awareness about new vaccines. One proposed activity delineated here: Engage and inform local media outlets (e.g., newspapers, radio stations), which can help provide immunisation education and information at the community level. Tactics to engage and inform local media outlets could include media trainings, journalist and editor roundtables, and invitations or scholarships to attend events, such as conferences or meetings.
- Address gaps in immunisation and work with key partners to overcome barriers to access and utilisation of immunisation services. The approaches outlined in this section include:
- Focus on improving access and equity: To ensure that vaccine access is equitable, Member States must address challenges on both the supply side (e.g., weak health infrastructure) and the demand side (e.g., low community awareness about immunisation). Suggested tactics range from improving programme planning at the community level and investing in strengthening health systems to ensuring communities are informed of their right to access quality immunisation services.
- Improve immunisation programme monitoring and vaccine-preventable disease surveillance: Member States with poor quality or insufficient data on immunisation should allocate resources toward improving data collection systems at the national and sub-national levels, consider new approaches and technologies for monitoring, and build stronger capacity to analyse data and apply data to programme management, among other actions. In addition, strong surveillance systems are needed to measure the impact of diseases and ensure that immunisation targets are being reached.
- Efficiently manage resources and prepare for upcoming transitions and their impact on immunisation programmes and programmatic sustainability: Funding for polio eradication will gradually ramp down by 2020, and some countries in Africa are transitioning away from eligibility for immunisation support through Gavi, the Vaccine Alliance. Member States must begin preparing early for these shifts in financing to ensure that vaccine access is uninterrupted.
- Expand and invest in Africa-based research, development, and production of vaccines: Additional efforts - by Member States and regional coordinating bodies - are needed in this area to: improve research capacity; enhance regulatory oversight for the development and approval of new vaccines that meet quality, safety, and efficacy standards; and build manufacturing capacity.
- Monitor progress to drive impact and ensure accountability: WHO AFRO, WHO EMRO, and the African Union Commission (AUC) will report annually at the African Union (AU) level on Member States' progress on a core set of ADI indicators that are outlined in the roadmap (see pages 29-30). Specifically, these organisations will: (i) collate and synthesise Member States' data through existing reporting mechanisms, (ii) document progress toward roadmap indicators, (iii) coordinate an independent review body comprised of representatives from immunisation partner organisations, (iv) disseminate annual regional progress reports to all Member States, and (v) provide and/or coordinate technical assistance for Member States, if necessary.
It is noted that this roadmap is the first step in providing Member States with a framework for achieving the ADI commitments, which they should continue to work toward in partnership with civil society organisations, donors, local governments, and one another. To further support Member States and immunisation partners, WHO AFRO, WHO EMRO, and the AUC propose to establish an ADI Secretariat that will provide assistance and help monitor progress. The specific roles and responsibilities of the secretariat are in the process of being discussed.
WHO Regional Office for Africa website, March 13 2018.