<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div><br><div class="gmail_quote"><div dir="ltr" class="gmail_attr">--From: <b class="gmail_sendername" dir="auto">Editor</b> <span dir="auto"><<a href="mailto:editor@phmovement.org">editor@phmovement.org</a>></span><br></div><br><u></u>
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<h1 style="text-align:center;display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:26px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal">WHO looking to develop a new vaccine action plan</h1>
<h2 style="text-align:center;display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal">Experts advise on lessons learned after disappointing outcomes from Global Vaccine Action Plan 2011-2020</h2>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The shortfalls. against targets, of the 2011-20 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=067f3f4399&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Global Vaccine Action Plan 2011-2020 (GVAP)</a> are clearly set out in the Expert Group report <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=67b45bea91&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">'Review and lessons learned'</a> to be considered by WHO's Executive Board at its 146th meeting 3-8 February 2020.</p>
<ul>
<li>Polio has not been eradicated;</li>
<li>Measles has not been eliminated;</li>
<li>Rubella and congenital rubella syndrome (CRS) have not been eliminated;</li>
<li>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);</li>
<li>global DTP3 coverage has plateaued at 86% since 2010;</li>
<li>child mortality has declined but largely because of non vaccine related causes.</li>
</ul>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">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.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The Expert Group identifies a range of areas where a new vaccine action plan might do things differently.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">One of these 'lessons learned' is that <b>one size does not fit all.</b> 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.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e5ac51090c&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM comment</a> on this agenda item provides further advice for the Executive Board, as follows.</p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Address the 'causes of the causes'</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left"><a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d84d99f206&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB146/8</a> notes that:</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left"><i>“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.”</i></p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">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.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">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. </p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The donor support for immunisation is appreciated although with two caveats. </p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">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. </p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">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. </p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Vaccine unaffordability: Market transparency should be the first step</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=99ff563a44&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">immunisation experts' report (2019)</a> says that:</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">“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.” </p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">“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, …” </p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">“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. </p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">However, <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=a5fa6d84b0&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB146/8</a> has no comment at all about price and market transparency, but only about “vaccine unaffordability in middle-income countries.” Recognising the previous adoption of<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=2f6cdc3b2b&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank"> WHA68.6</a> (2015) and<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=bd8a656bb9&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank"> WHA72.8</a> (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<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7a71dc2f21&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank"> Global Health Watch (GHW) 5 chapter on Gavi</a>.)</p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Local research and production</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">In 2018 the report by the Director-General on Access to Essential Medicines and Vaccines (in Annex, see <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c223097fe1&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">A71/12</a>), it was noted that:</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left"><i>“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.”</i></p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=da9236ae91&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">report of the immunisation experts (2019)</a> says that:</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left"><i>“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.”</i></p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Immunisation must be part of an integrated primary health care approach.</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">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.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">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.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">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.</p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">More</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">For further links and more detailed comment on the GVAP item on the WHO Executive Board agenda see the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f0a190a131&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM comment</a> on Item 8.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The full agenda for the EB can be accessed through the WHO Tracker at <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d6e6865718&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">who-track.phmovement.org/eb146</a>, including PHM comments on most items.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">To provide feedback on this commentary please write to <a href="mailto:editor@phmovement.org" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">editor@phmovement.org</a>.</p>
<h3 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:20px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Spread the word</h3>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The WHO Tracker and PHM item commentaries are produced through WHO Watch which is a project of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=123345cbad&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">People's Health Movement</a> in association with <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=9ee2a195f8&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Medicus Mundi International</a>, <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7f036bd322&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Third World Network</a> and a number of other civil society networks.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">The purpose of WHO Watch is to contribute to democratising global health governance, through new alliances and new information flows.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">You can help by forwarding our updates, including on social media, and by inviting others to <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=43aeb55dae&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">subscribe to the WHO Watch Newsletter</a>.</p>
<p style="margin:10px 0;padding:0;color:#202020;font-family:Helvetica;font-size:16px;line-height:150%;text-align:left">Update Reports from previous WHO governing body meetings and earlier Item Alerts regarding EB146 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=7a1d97844a&e=916df65fd1" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">here</a>.</p>
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