Global Vaccine Action Plan 2019 Regional reports on progress towards GVAP-RVAP goals Draft 13 September 2019 Annex to the GVAP review and lessons-learned report 1 Introduction In its Global Vaccine Action Plan (GVAP) Assessment Report 2015, the Strategic Group of Experts on Immunization (SAGE) made the recommendation that “WHO Regional Directors should make sure the progress towards the Global and Regional Vaccine Actions Plans is reviewed annually at Regional Committee meetings as requested in the World Health Assembly (WHA) resolution WHA65.17. Reports prepared at the country level to review and discuss the progress made should be the basis of the discussion.” As part of this process, WHO Regional Offices provide annually a report on the progress made towards the achievement of the GVAP and the Regional Vaccine Actions Plans (RVAP) goals1. The reports summarize the main issues, challenges, successes and opportunities for countries in each respective region in 2018. These reports are collated in an annex of the GVAP review and lessons-learned report. 1 http://www.who.int/immunization/global_vaccine_action_plan/en/ 2 Contents WHO Regional Office for Africa: Progress Report for the African Region WHO Regional Office for the Americas: Progress Report for the Region of the Americas WHO Regional Office for Eastern Mediterranean: Progress Report for the Eastern Mediterranean Region WHO Regional Office for Europe: Progress Report for the European Region WHO Regional Office for South-East Asia: Progress Report for the South-East Asia Region WHO Regional Office for the West Pacific: Progress Report for the West Pacific Region 3 WHO Regional Office for Africa: Progress Report for the African Region Contents 1- Background/Introduction ..................................................................................................................... 4 2- Achievements ....................................................................................................................................... 5 Objective 1: Increase immunization coverage beyond the current levels .............................................................. 5 Objective 2: Complete the interruption of wild poliovirus transmission and ensure virus containment ............... 8 Objective 3: Eliminate measles and advocate for the elimination of rubella and congenital rubella syndrome .... 9 Objective 4: Attain and sustain elimination/control of other vaccine preventable diseases ................................ 10 2- Challenges ........................................................................................................................................... 11 3- Perspectives ........................................................................................................................................ 12 4- Country highlights ............................................................................................................................... 13 Conclusion ............................................................................................................................................... 14 Annex 1: Progress in the attainment by Member States of key targets of the Regional Strategic Plan for Immunization ....................................................................................................................................... 14 Annex 2: Regional Immunization coverage 2013-2018 ....................................................................................... 15 Annex 3 : Immunization financing 2018 ............................................................................................................. 16 Annex 4: DTP3 and MCV1 coverage 2013-2018 ................................................................................................ 16 1- Background/Introduction The 47 countries of the World Health Organization’s (WHO’s) African Region are home to over 1 billion people, with a combined annual birth cohort of over 37 million. The Global Vaccine Action Plan (GVAP) 2011-2020 was developed with a vision of having a world in which all individuals and communities enjoy lives free from vaccine-preventable diseases. Significant progress has been made towards the GVAP goals in the African region. The Africa Regional Strategic Plan for Immunization 2014-2020 (RSPI) which is aligned with the GVAP goals is the main guiding strategic plan for immunization in the African region. The RSPI aims at achieving universal immunisation coverage and reducing mortality and morbidity from vaccine preventable diseases (VPD) by the end of 2020. In January 2017, Heads of State from across Africa signed the Addis Declaration on Immunization (ADI) and committed to ensuring that everyone in Africa, no matter who they are or where they live, can access equitably all the required vaccines. The ADI is recognised as a political and advocacy instrument which is being used to support the implementation of the RSPI at the highest level of government. The Business case for WHO immunization activities on the African continent 2018-2030 was developed in 2017 with the overall objective of mobilizing sufficient resources for WHO to continue supporting all Member States on the African continent to accelerate efforts toward the achievement of the GVAP targets 4 and ADI commitments as well as to mitigate the risks of Global Polio Eradication Initiative (GPEI) and Gavi transitions. In May 2019, the Pan African Parliamentary meeting in Midrand South Africa adopted a resolution on the establishment of an African Parliamentarian Caucus on Immunization, to drive forward the body’s commitment to ensuring that all children across the continent have access to the vaccines they need. This progress report highlights the achievements made so far in expanding access to vaccines in the WHO African region, as well as challenges and perspectives in moving forward the immunization agenda on the African continent. 2- Achievements Objective 1: Increase immunization coverage beyond the current levels Between 2013 and 2018, the Regional coverage for the third dose of the DTP containing-vaccine (DTP3) and the first dose of the measles containing vaccine (MCV1) increased from 70 to 76% and from 70 to 74% respectively as illustrated in Figure 1 Immunization coverage, performance and progress. The coverage increased from 71 to 74% for the third dose of the oral poliovirus vaccine (OPV3) during the same period. Twenty-one countries2 in 2018 achieved the RSPI coverage target of >=90% for DTP3, an increase from the 17 countries in 2013. Fourteen countries3 in 2018 achieved the MCV1 coverage of at least 90% compared to the 15 countries in 2013. The low coverage in the three largest countries4 responsible for around 38% of the total birth cohort in the Region is the major cause of this relatively low progress. Contextual factors which negatively influenced coverage include multiple competing developmental priorities, gaps in country ownership, lack of community engagement, low data reliability and use, limited logistics capacity, inadequate and uneven distribution of the workforce, and weak health systems aggravated by insecurity and disease outbreaks in various countries (e.g. Ebola Virus Disease, yellow fever, meningococcal meningitis, cholera, etc). 2 Algeria, Botswana, Burkina Faso, Burundi, Cabo Verde, Comoros, Eritrea, Eswatini, The Gambia, Ghana, Kenya, Lesotho, Malawi, Mauritius, Rwanda, Sao Tome and Principe, Seychelles, Sierra Leone, Uganda, United Republic of Tanzania and Zambia. 3 Botswana, Cabo Verde, Comoros (the), Eritrea, Gambia, Ghana, Lesotho, Liberia, Mauritius, Rwanda, Sao Tome and Principe, Seychelles, United Republic of Tanzania, Zambia 4 DRC, Ethiopia and Nigeria 5 Figure 1 Immunization coverage, performance and progress Coverage for selected vaccines, 2013-2018 Countries performances, DTP3 & MCV1 coverage, 2018 100 90 80 80 80 80 77 78 80 76 76 76 Cov <50% Cov >50<80% 72 73 75 75 70 71 74 70 70 Cov >=80<90% Cov >=90% 70 71 72 73 60 62 50 49 Coverage(%) 40 MCV1 15 26 4 14 14 30 23 25 34 18 20 10 7 10 Vaccines 0 DTP3 10 2013 2014 2015 2016 2017 2018 5 11 21 Years 0 10 20 30 40 50 BCG DTP3 MCV1 MCV2 PCV3 Number of countries Source: WUENIC 2018 Source: WUENIC 2018 DTP3 coverage, 2013, 2017, 2018 Sub-national coverage: % of districts with at least 80% coverage Source: reported data, JRF 2018 Source: WUENIC 2018 6 New vaccines introduction By the end of 2018, 40 countries in the African region have introduced pneumococcal conjugate vaccine, and the rotavirus vaccine was introduced in 35 countries while the MenAfriVac was introduced in 21 countries in campaign mode and in seven countries through routine immunisation (Figure 2 New Vaccine introduction). On-going studies in several countries in the African Region have demonstrated 38% reduction in rotavirus hospitalizations and substantial reduction in vaccine type invasive pneumococcal disease following introduction of rotavirus vaccines and pneumococcal conjugate vaccine (PCV) respectively. Surveillance for diseases targeted by new vaccines remains a priority because of the need to document the burden of diarrhoea and pneumococcal disease and concerns about serotype replacement. Figure 2 New Vaccine introduction New vaccine introduction status and coverage, 2018 Comparison between OPV3 and Rotavirus coverage, 2018 110 110 90 90 70 70 50 50 30 30 10 10 Mali -10 STP -10 Togo Kenya Eritrea Liberia Ghana Malawi Angola Zambia Burundi Gambia Uganda Lesotho Ethiopia Namibia Rwanda Senegal Eswatini Mauritius