Immunization, Vaccines and Biologicals

Efforts to eradicate polio at serious risk of failure unless adequate resources are identified

SAGE participants seated around the meeting room
WHO/C. Scudamore

The emergency action plan to put polio eradication efforts back on track in Afghanistan, Nigeria and Pakistan was discussed at length during the meeting of WHO's Strategic Advisory Group of Experts on immunization (SAGE) held from 10-12 April in Geneva.

SAGE was seriously alarmed by the polio eradication funding gap for 2012-13, especially given the recent declaration at the WHO Executive Board that completing polio eradication was a public health emergency of the highest priority. Furthermore, the gap in financial resources comes at a crucial time when there is heightened political commitment from the Governments of Afghanistan, Nigeria and Pakistan and the number of polio cases and polio infected countries is at the lowest level ever. SAGE further noted that in many of the poorest countries, resources utilized for polio programmes were supporting the broader immunization effort and this too may be jeopardized if funds cannot be found.

“Loss of this opportunity to eradicate polio would be extremely tragic and unacceptable and a waste of the considerable investment already made in polio eradication with consequences for all of immunization activities, especially in the poorest countries. Any diminution of polio eradication activities due to a lack of funds is completely unacceptable. We urge all governments and partners to act immediately to meet the polio eradication funding needs if we are to wipe out this crippling disease,” warned SAGE.

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. However, SAGE emphasized that close monitoring of the rollout of the national plans in the coming months is essential 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.

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. Countries with existing influenza vaccination programs targeting any of these groups should continue to do so and incorporate immunization of pregnant women into such programs, SAGE reported. If they have not already done so, countries should decide which other risk groups to prioritize for vaccination based on burden of disease, cost-effectiveness, feasibility and other appropriate considerations.

On the topic of hepatitis A vaccine, SAGE concluded that while a two dose regimen of hepatitis A vaccines is currently in use in some countries, national immunization programmes may consider the use of single dose inactivated hepatitis A vaccines for inclusion in immunization schedules. In this context, SAGE applauded Argentina for its innovative approach that led to the generation of useful data and may result in cost savings for other countries. SAGE encouraged Argentina to continue monitoring the impact of its single dose hepatitis A vaccine program and to report back to WHO on an annual basis.

Other topics discussed during the meeting included the impact of introduction of new vaccines on the strengthening of immunization and health systems, vaccination in humanitarian emergencies, rotavirus vaccines schedules, the role of IPV in polio risk management, and information on vaccines in preparation for an Intergovernmental Negotiating Committee on a legally binding instrument on mercury.

The report of the meeting will be published in the WHO Weekly Epidemiological Record on 25 May 2012. The meeting documents — including presentations and background readings — can already be found on the web.

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