By Dr. Jean-Marie Okwo-Bele is the Former Director, Department of Immunization, Vaccines and Biologicals at the World Health Organization and Dr. Richard Mihigo is the Immunization and Vaccines Development Program Coordinator at the World Health Organization Regional Office for Africa.

In the current outbreak of Ebola in the Democratic Republic of Congo a promising new investigational vaccine is proven pivotal in controlling this much-feared and often fatal disease. The innovative solution was first tested in the West Africa Ebola outbreak in complementarity with other interventions.

Such findings highlight the stark improvement and expansion that has occurred to African immunization services in the last 40 years. There is however, still need for more robust policies for immunization, featuring sustainable programs funded on a country-by-country basis. Our global imperative is to bridge the vaccination gap prevalent around the world, our focus is, however, on Africa.

The Addis Declaration on Immunization of 2016 – was an important stepping-stone towards our end. It brought together all 54 African countries to recognize the need to accelerate progress on the goals of the Global Vaccine Action Plan for the 2011-2020 Decade. 

This Declaration represents a drive toward meeting a key UN Sustainable Development Goal, namely universal health coverage. Ongoing investment in vaccine research and development – and in large-scale immunization programs – is essential for preserving individual health and population security.

Only through high-level leadership, increased resources and a continent-wide commitment can we expect to achieve the ambitious immunization goals we have set out for ourselves.

How to turn this crusade into reality? How best to leverage our existing immunization infrastructure and establish long-term public-private partnerships. We hereby propose the following steps, all potentially transformative, to maintain our hard-earned momentum.

First, we should anchor immunization within primary healthcare. Vaccines should be regarded as key interventions, whether for pneumonia, diarrhea, cholera or typhoid. Immunization can also serve as a platform for treating neglected tropical diseases such as malaria and helminthiasis. Creating integrated management protocols would drive efficiency system-wide. It would represent a long-overdue shift from a disease-specific approach and help bring about universal healthcare.[1]

Next, we should guarantee the funding required for immunization. This is an absolute imperative. Preferably funds would come from national governments and respective partners, rather than from individual households making out-of-pocket payments. Already, for example, eight countries in the region[2], fully finance their own immunization activities. Every country should develop its own immunization financing plan, whether through taxes, special levies, loans, insurance premiums, or some combination thereof. Ultimately, the source of funding is vastly less important than sustaining it.[3]

Demand for vaccination needs to be created too. Key organizations involved should mount concerted national efforts to educate communities to appreciate and seek out immunization. So recommended the 2017 Assessment Report of the Global Vaccine Action Plan. It called for “ongoing community engagement and trust-building, active hesitancy prevention, regular national assessment of vaccine concerns, and crisis response planning.”[4]. It is vital to remember the warning from the World Health Organization about vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – namely, that it’s a threat to global public health[5]. 

Bridging the gap in access to vaccines between locations and populations is essential as well. Data can help target those most in need. Integrated strategies and sustained funding should minimize the inequalities in immunization service delivery — disparities in access, coverage and geographic diversity, as well as cultural and economic bias – so widespread over the last two decades. Programs should be tailored for given communities – for example, by collaborating with managers to plan health services around extreme weather events or humanitarian crises.

Likewise, it is vital to strengthen the micro-planning processes for local officials and communities in order to maximize access to immunization services and ensure future success. Precisely how our services are delivered – and how well – will matter more than ever. Case in point:  As in Rwanda and Tanzania, community health workers are deployed to connect target populations with the services needed and prevent individuals from being left behind.

Throughout all these steps, we must keep innovating, collaborating and learning from each other. In the process, we should focus support on those most responsible for delivering immunization services in Africa. Make no mistake: business-as-usual approaches will no longer drive the improvements so desperately needed.

Lastly, technology and digital communications will have to be harnessed to enhance services, accuracy and accountability. At the moment, mobile telecommunications in Africa hold promise but remain desperately underused. Bringing in new technology – such as Geographic Information Systems – can limit over-reporting, identify new settlements and improve vaccine storage facilities, among numerous other advantages.

These concrete, forward-looking actions should guide our agenda to reimagine – and in so doing, reform — immunization policy in Africa over the next 10 years. Only then can we do the job we are supposed to do and keep preventing, controlling and even eliminating diseases. Only then will we fulfill our humanitarian purpose to raise immunization rates, protect communities and save the lives of children and other vulnerable populations across the continent.

[1] World Health Organization. Working Together: an integration resource guide for immunization services throughout the life course. WHO 2018. https://apps.who.int/iris/bitstream/handle/10665/276546/9789241514736-eng.pdf?ua=1

[2] Algeria, Angola, Botswana, Equatorial Guinea, Gabon, Mauritius, Namibia, and South Africa

[3] Saxenian H, et al. Overcoming challenges to sustainable immunization financing: early experiences from GAVI graduating countries. Health Policy and Planning (2015); 30(2): 197–205, https://academic.oup.com/heapol/article/30/2/197/622945

[4] Strategic Advisory Group of Experts on Immunization. Geneva: World Health Organization; 2017. License: CC BYNC-SA 3.0 IGO.

[5] World Health Organization. Ten threats to global health in 2019. WHO 2019. https://www.who.int/emergencies/ten-threats-to-global-health-in-2019