PHM-Exch> : WHO looking to develop new Vaccine Action Plan

[Claudio Schuftan]

--From: Editor <editor at phmovement.org>

But one size does not fit all

View this email in your browser
<https://mailchi.mp/275723ae0082/who-looking-to-develop-new-vaccine-action-plan?e=916df65fd1>
WHO looking to develop a new vaccine action plan Experts advise on lessons
learned after disappointing outcomes from Global Vaccine Action Plan
2011-2020

The shortfalls. against targets, of the 2011-20 Global Vaccine Action Plan
2011-2020 (GVAP)
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=067f3f4399&e=916df65fd1>
are
clearly set out in the Expert Group report 'Review and lessons learned'
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=67b45bea91&e=916df65fd1>
to be considered by WHO's Executive Board at its 146th meeting 3-8 February
2020.

   - Polio has not been eradicated;
   - Measles has not been eliminated;
   - Rubella and congenital rubella syndrome (CRS) have not been eliminated;
   - Maternal and neonatal tetanus has not been eliminated from the 40
   priority countries (while there has been a big reduction in incidence,
   still 30,000 neonates died of tetanus infection in 2017);
   - global DTP3 coverage has plateaued at 86% since 2010;
   - child mortality has declined but largely because of non vaccine
   related causes.

There have been some achievements. The number of countries with established
immunisation technical advisory groups (NITAGs) has increased from 41 to
114 countries; and donor support for immunisation has doubled since 2011 to
over $US1 billion in 2018.

The Expert Group identifies a range of areas where a new vaccine action
plan might do things differently.

One of these 'lessons learned' is that *one size does not fit all.* The new
vaccine action plan must place countries at the centre of policy and
implementation. The cost effectiveness of a new vaccine (for example the
new meningitis vaccine), no matter how effective in clinical trials, is a
function of disease burden and health system capacity in country and must
be assessed by national (or regional) expert advisory groups. This is
particularly so for expensive vaccines and middle income countries who are
not Gavi eligible. The old top down and expert led approach to the
immunisation schedule has contributed to a loss of engagement at many
levels.

The PHM comment
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e5ac51090c&e=916df65fd1>
on this agenda item provides further advice for the Executive Board, as
follows.
Address the 'causes of the causes'

EB146/8
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d84d99f206&e=916df65fd1>
notes that:

*“Urbanization and its accelerating pace, migration and displacement,
conflict and political instability, vaccine unaffordability in
middle-income countries, unexpected vaccine supply shortages, and rising
vaccine hesitancy have all presented major challenges throughout the
decade. Even though these challenges have been recognized, the global
vaccine action plan has limited levers to influence responses to them.”*

Accordingly the Secretariat suggests that the post-2020 immunization
strategy should “encourage greater collaboration and integration within and
outside the health sector.” In fact, while “building linkages outside the
health sector” was already one of the GVAP’s objectives, progress has been
limited.

It is evident that these ‘challenges’ are not merely issues of
‘relationships’, but need to be traced to the ‘causes of the causes’: the
causes of rural to urban migration, the role of conflict and climate change
in migration and displacement, and weak health systems, further weakened by
austerity and privatisation.

The donor support for immunisation is appreciated although with two
caveats.

Most of the funding for polio and GVAP has come from bilateral donors and
philanthropies. If these donors were looking for a magic bullet which would
control communicable disease without disrupting the economic status quo
they have clearly made a big mistake. An integrated approach to
communicable disease control must include economic justice and health
system strengthening as well as immunisation.

It is clear that Gavi has encouraged low income countries to add new
expensive vaccines to their immunisation schedules while the are Gavi
eligible. However, these commitments can become quite burdensome and not
necessarily cost-effective when those countries graduate out of
eligibility.
Vaccine unaffordability: Market transparency should be the first step

The immunisation experts' report (2019)
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=99ff563a44&e=916df65fd1>
says that:

“Middle-income countries that are not eligible for Gavi support have
introduced fewer vaccines due in part to slow adoption of newer, more
costly vaccines.”

“Middle-income countries still report that the cost of vaccines is a major
obstacle to their introduction. Such countries pay higher prices for
vaccines, … To help address their needs, the Market Information for Access
to Vaccines initiative aims to enhance vaccine-pricing transparency, …”

“GVAP’s monitoring and evaluation framework delivered many benefits…
Countries used these discussions to raise issues such as affordability of
new vaccines for middle-income.

However, EB146/8
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a5fa6d84b0&e=916df65fd1>
has no comment at all about price and market transparency, but only about
“vaccine unaffordability in middle-income countries.” Recognising the
previous adoption of WHA68.6
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=2f6cdc3b2b&e=916df65fd1>
(2015) and WHA72.8
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=bd8a656bb9&e=916df65fd1>
(2019) on market transparency, a post-2020 immunization strategy should
promote price transparency for all MSs including non-Gavi middle-income
countries, to assist them in negotiating affordable prices. (See Global
Health Watch (GHW) 5 chapter on Gavi
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7a71dc2f21&e=916df65fd1>
.)
Local research and production

In 2018 the report by the Director-General on Access to Essential Medicines
and Vaccines (in Annex, see A71/12
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c223097fe1&e=916df65fd1>),
it was noted that:

*“Access to safe, effective and quality medicines and vaccines requires
above all sufficient political will at the national level. It also requires
a comprehensive health-systems approach that addresses all stages of the
pharmaceutical value chain, including: needs-based research, development
and innovation; public health-oriented intellectual property and trade
policies; manufacturing processes and systems, including strategic and
sustainable local production that ensures quality products; pricing
policies and coverage schemes that contribute to the attainment of
universal health coverage; integrity and efficiency in procurement and
supply chain management; and appropriate selection, prescribing and use.”*

The report of the immunisation experts (2019)
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=da9236ae91&e=916df65fd1>
says that:

*“For the first time, GVAP included a focus on R&D, including vaccine
technologies and new vaccine development – where significant progress has
been made. Although local research capacity and vaccine production
capabilities in some middle-income countries have significantly increased,
there is still much progress to be made to encourage local involvement in
vaccine R&D and production, especially in low-income countries of
disease-endemic regions.”*
Immunisation must be part of an integrated primary health care approach.

PHM welcomes the recognition, in both the Experts' Report and in EB146/8,
of the central importance of closer integration of immunization within
comprehensive PHC.

The delivery of immunisation services depends on and lies within the remit
of the primary care sector while technical guidance lies with NITAGs and
public health authorities. However, community confidence in immunization
depends on confidence in efficacy and safety and in the integrity of
technical leadership.

PHM calls for assiduous adverse event surveillance and assessment as well
as country focused priority setting. If PHC practitioners and agencies are
familiar with, and confident in, the technical leadership, they will
enthusiastically share their confidence with their communities.
More

For further links and more detailed comment on the GVAP item on the WHO
Executive Board agenda see the PHM comment
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f0a190a131&e=916df65fd1>
on Item 8.

The full agenda for the EB can be accessed through the WHO Tracker at
who-track.phmovement.org/eb146
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d6e6865718&e=916df65fd1>,
including PHM comments on most items.

To provide feedback on this commentary please write to editor at phmovement.org
.
Spread the word

The WHO Tracker and PHM item commentaries are produced through WHO Watch
which is a project of the People's Health Movement
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=123345cbad&e=916df65fd1>
in association with Medicus Mundi International
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=9ee2a195f8&e=916df65fd1>,
Third World Network
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7f036bd322&e=916df65fd1>
and a number of other civil society networks.

The purpose of WHO Watch is to contribute to democratising global health
governance, through new alliances and new information flows.

You can help by forwarding our updates, including on social media, and by
inviting others to subscribe to the WHO Watch Newsletter
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=43aeb55dae&e=916df65fd1>
.

Update Reports from previous WHO governing body meetings and earlier Item
Alerts regarding EB146 here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7a1d97844a&e=916df65fd1>
.
[image: WHO Tracker]
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=979302b5e3&e=916df65fd1>
[image: PHM Global]
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=fe6c76a5c7&e=916df65fd1>
[image: PHM Global]
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=641a1d6cce&e=916df65fd1>
[image: PHM]
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7f5edc358c&e=916df65fd1>
*Copyright © 2020 People's Health Movement, All rights reserved.*
You are receiving this email because you subscribed to the WHO Watch
Updater.
Not subscribed? Sign up here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=496abc89cb&e=916df65fd1>
.

*Our mailing address is:*
WHO Tracker / People's Health Movement
P.O. 13698, St. Peter's Square, Mowbray
Cape Town, Western Cape 7705
South Africa

Add us to your address book
<https://phmovement.us20.list-manage.com/vcard?u=559d715f58f654accf3de987e&id=8f92c15adf>


Want to change how you receive these emails?
Update your preferences
<https://phmovement.us20.list-manage.com/profile?u=559d715f58f654accf3de987e&id=8f92c15adf&e=916df65fd1>
or unsubscribe from this list
<https://phmovement.us20.list-manage.com/unsubscribe?u=559d715f58f654accf3de987e&id=8f92c15adf&e=916df65fd1&c=56faab7fae>.






This email was sent to cschuftan at phmovement.org
*why did I get this?*
<https://phmovement.us20.list-manage.com/about?u=559d715f58f654accf3de987e&id=8f92c15adf&e=916df65fd1&c=56faab7fae>
    unsubscribe from this list
<https://phmovement.us20.list-manage.com/unsubscribe?u=559d715f58f654accf3de987e&id=8f92c15adf&e=916df65fd1&c=56faab7fae>
    update subscription preferences
<https://phmovement.us20.list-manage.com/profile?u=559d715f58f654accf3de987e&id=8f92c15adf&e=916df65fd1>
WHO Tracker / People's Health Movement · P.O. 13698, St. Peter's Square,
Mowbray · Cape Town, Western Cape 7705 · South Africa

[image: Email Marketing Powered by Mailchimp]
<http://www.mailchimp.com/monkey-rewards/?utm_source=freemium_newsletter&utm_medium=email&utm_campaign=monkey_rewards&aid=559d715f58f654accf3de987e&afl=1>
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20200128/2a93b341/attachment.html>