Kate O’Brien, Director of the Department of Immunization, Vaccines and Biologicals at WHO
The WHO/UNICEF estimates of national immunization coverage (WUENIC) for 2022 were released on 18 July. I would like to express my heartfelt appreciation to everyone who worked tirelessly to collate, analyse, interpret, and present the data so it was ready for release to the world. The data that make their way into the WUENIC estimates are collected day in and day out, year-round, in immunization programmes of every country around the world. Those data are assessed and checked by immunization staff, before being verified and collated again at the national level. They are triangulated with additional data from surveys, vaccine stock data, and other information to further zero-in on the most likely coverage in countries and these are checked again with country programmes. The immunization community eagerly awaits the WUENIC estimates year after year. The exceptional work, passion and relentless pursuit of the best estimates possible by the entire team has made this year the best yet in terms of output. I hereby welcome you to this month’s GIN, showcasing on the WUENIC estimates.
The WUENIC findings are encouraging: some immunization services have begun to recover after the disruptions caused by COVID-19 – meaning that immunization services reached 4 million more children than in 2021. Despite this overall improvement, the recovery has been uneven across countries, across vaccines, and across age groups. Even with evidence of a recovery underway in 2022, more than 20 million children still missed out on one or more vaccines last year, and over 14 million missed out entirely. These numbers are higher than in 2019, the year before the pandemic hit.
The world has not yet achieved targets to reach children with measles, HPV, yellow fever, and many other vaccines, resulting in outbreaks and daily occurrence of diseases that can be prevented. Of the 75 countries with substantial declines in immunization during the pandemic, only 15 have recovered their immunization programme performance to pre-pandemic levels, with the rest stagnant or even declining further.
Most concerningly is that as a group, low-income countries are not yet showing signs of immunization recovery. For these countries, measles vaccine coverage has continued to backslide in 2022, raising the alarm even further for immediate action. We must catch-up, restore, and strengthen all national immunization programs to ensure that all children, no matter where they are, have access to and receive the life-saving vaccines which are their right.
The WUENIC-2022 release of country estimates coincided with the halfway mark for the Big Catch-Up, underscoring the need for sustained action to strive for catch-up, equitable recovery and strengthening for the remainder of the year and beyond. The work of the Big Catch-Up is about addressing the backsliding of the pandemic, but it specifies doing so in a way that builds sustainable immunization programmes. Every year, programmes need to catch-up those who have missed out. Every year programmes need to step forward to restore services which have been affected by the unexpected. And every year programmes need to innovate to achieve an even stronger capacity to reach all who are in need. It has been a pleasure to see WHO’s regional offices embrace the three tenets of Big Catch Up (Catch-up. Restore. Strengthen), with dedicated activities to support countries develop and strengthen recovery plans to reach zero dose children and those who are not fully vaccinated wherever they are living.
2023 is a critical year in the fight against malaria, as twelve countries across multiple regions in Africa are poised to receive 18 million doses of the first-ever malaria vaccine over the next two years.
The malaria vaccine is a breakthrough to improve child health and child survival. It has already been administered to 1.6 million children in Ghana, Kenya and Malawi since 2019 through the Malaria Vaccine Implementation Programme (MVIP), coordinated by WHO and funded by Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Unitaid. The initial 18 million dose allocation will enable nine more countries, including Benin, Burkina Faso, Burundi, Cameroon, the Democratic Republic of the Congo, Liberia, Niger, Sierra Leone and Uganda, to introduce the vaccine into their routine immunization programmes for the first time.
The high demand for the vaccine and the strong reach of childhood immunization will increase equity in access to malaria prevention and save many young lives. On the horizon are the policy and prequalification assessments of a second malaria vaccine, R21/Matrix-M. WHO’s Strategic Advisory Group of Experts on Immunization and the Malaria Policy Advisory Group (SAGE and MPAG) will be jointly reviewing the evidence on that vaccine in late September. WHO’s work to enable an increase in malaria vaccine supply will continue with urgency until all children at risk have access.
Exciting news from a new global study funded by the Wellcome Trust and the Bill & Melinda Gates Foundation: a candidate tuberculosis vaccine – M72/AS01E (M72) – is moving on to late-stage evaluation, raising the potential for the world to have it’s first new tuberculosis (TB) vaccine in over a century.
A 26,000-person, Phase 3 study, set to begin in 2024, will evaluate the safety and efficacy of the M72 vaccine in countries with high rates of TB in Africa and South-East Asia. This trial could be a game changer for controlling tuberculosis. If proven safe and effective, M72 could become the world’s first vaccine to protect adolescents and adults from pulmonary TB, potentially saving millions of lives by preventing up to 76 million cases over the next 25 years. The impact would be life-changing for communities burdened by the disease.
While new funding for clinical trials of the M72 candidate is a major step, the road ahead is long. To achieve a TB-free world will require significant global investment, including in research of candidates and pathways and programmes to implement new TB vaccines. We look forward to the upcoming UN High-Level Meeting on TB, which will no doubt galvanize states and stakeholders to continue to invest in promising tuberculosis vaccines already in the pipeline and innovative solutions to address infection and disease from this ancient bacterium.
There will be several important events coming in the next several months, starting with the 78th session of the UN General Assembly (UNGA 78) opening on 12 September, where heads of state and government, as well as other senior government officials, are welcomed to the UN Headquarters in New York. The UNGA will include High-Level Meetings on health, presenting a historic opportunity for world leaders to place health back on the high-level political agenda as they recommit to ending tuberculosis (TB), delivering universal health coverage (UHC) and strengthening pandemic prevention, preparedness, and response (PPR). Immunization programmes and strengthening feature in each of these high-level topics and side-events. Keep your eyes peeled for the declarations on each and the focus within those on vaccines and immunization.
At this mid-point towards the Sustainable Development Goals (SDGs), the world is off track to achieve the health targets by 2030. Millions of people cannot access lifesaving and health-enhancing interventions. Out-of-pocket spending on health catastrophically affects over 1 billion people, pushing hundreds of millions of people into extreme poverty. The situation has worsened due to the COVID-19 pandemic.
The High-Level Meetings come at a critical moment as the world recovers from the COVID-19 pandemic, confronted with multiple humanitarian and climate crises. Upholding the human right to health and building equitable health systems are essential to achieve UHC, to build sustainable prevention, preparedness and response to pandemics as well as other health emergencies, and to ending epidemics such as TB.
WHO will be hosting a High-Level Meeting on primary health care (PHC). Immunization services are a vital part of PHC, a fact underlined by the WUENIC data which shows that countries that were making progress in immunization coverage prior to the pandemic, have rebounded faster than others.
The meetings can be viewed live on UN WebTV.
