Immunization, Vaccines and Biologicals

Report of the SAGE April 2012 meeting published

During its meeting of 10-12 April 2012, the Strategic Advisory Group of Experts (SAGE) on immunization discussed issues including polio eradication, seasonal influenza vaccine, rotavirus immunization schedules and information on vaccine for an Intergovernmental Negotiating Committee on mercury.

Polio eradication

SAGE was seriously alarmed by the polio eradication funding gap for 2012-13 and urged all governments and partners to act immediately to fill the funding needs to wipe out polio. SAGE welcomed the Global Polio Emergency Action Plan and notes the progress made in developing and implementing the national plans for Afghanistan, Nigeria and Pakistan, aimed at reaching missed children with polio vaccines and in articulating the accountability processes at all levels. SAGE emphasized the need for close monitoring of the rollout of the national plans in the coming months to ensure that maximum impact is achieved. SAGE also welcomed the much needed emphasis on the synergy between polio eradication activities and the strengthening of routine immunization.

Seasonal influenza vaccine

SAGE discussed seasonal influenza vaccination and recommended pregnant women as the most important risk group for seasonal influenza vaccination. SAGE also supported the recommendation, in no particular order of priority, of vaccination of the following targeted populations: healthcare workers; children 6 to 59 months of age; the elderly; and those with high-risk conditions. SAGE recommended that countries with existing influenza vaccination programmes targeting any of these groups should continue to do so but incorporate immunization of pregnant women into such programs. Countries should decide which other risk groups to prioritize for vaccination based on burden of disease, cost-effectiveness, feasibility and other appropriate considerations.

Rotavirus immunization schedules

Following a review of new evidence on rotavirus disease burden, timeliness of vaccination and the safety and effectiveness of different immunization schedules, SAGE continues to recommend that the first dose of rotavirus vaccine be administered as soon as possible after 6 weeks of age as this maximizes disease protection and along with diphtheria-tetanus-pertussis (DTP) doses. Early immunization is favored but the current age restrictions for the first and last dose of rotavirus vaccines would prevent vaccination of many vulnerable children in settings where the DTP doses are given late (i.e. after 15 weeks for DTP1 or after 32 weeks for DTP 2 or DTP3). By allowing children to be immunized at any time with DTP, programmes will be able to immunize children who are currently excluded from the benefits of rotavirus vaccines. However, timelines of vaccination remains a key attribute of effective immunization programmes. SAGE recognized that countries have different burdens of disease and may or may not have introduced rotavirus vaccines. As such, countries that have already introduced rotavirus vaccines, should develop specific plans on vaccine administration in a manner that supports existing programmes and encourages early protection of infants against rotavirus infection.

Information on vaccine for an Intergovernmental Negotiating Committee on mercury

Whilst SAGE supports global moves to minimize mercury releases to the environment, it is essential that access to thiomersal-containing vaccines is not restricted under this global initiative. SAGE reaffirmed that thiomersal-containing vaccines are safe, essential and irreplaceable components of immunization programmes, especially in developing countries. Removal of these products would disproportionately jeopardize the health and lives of the most disadvantaged children worldwide. Global advocacy and communication efforts at the highest level of government and by stakeholders are urgently needed to ensure continued availability of thiomersal-containing vaccines. SAGE requested WHO to produce a report on the security of the supply of affordable vaccines and encouraged donors to invest in the development of new vaccine technologies that facilitate the delivery of effective, affordable vaccines to populations most at risk.

Other topics discussed at the meeting included the impact of introduction of new vaccines on immunization and health systems; vaccination in humanitarian emergencies and hepatitis A vaccine.