World Health Assembly Adopts Global Immunization Strategy

Geneva, May 25, 2005 (PAHO)—The World Health Assembly concluded its 2005 meeting today with governments committing to a new Global Immunization Vision and Strategy to fight vaccine-preventable diseases, which kill more than two million people every year, two-thirds of whom are young children.

The new immunization strategy, a framework for planning and implementing national programs during 2006-2015, has three main aims: to immunize more people against more diseases; to introduce a range of newly available vaccines and technologies; and to provide a number of critical health interventions with immunization.

Designed by the World Health Organization (WHO) and the United Nation's Children's Fund (UNICEF), the new strategy aims to achieve greater vaccination coverage and equity in access to immunization and to include other interventions, including insecticide-treated nets and vitamin A supplements when people are immunized.

"The new Vision and Strategy will enable us to rise to the serious challenges we foresee in the immunization field in the next decade. More people, from infants to seniors, must be protected from more diseases. We will take immunization to new heights, building on solid achievements of the past, and will bring good health to many more," said Dr Lee Jong-wook, Director-General of WHO.

Vaccination has been one of the most successful and cost-effective public health interventions in history. It has eradicated smallpox, eradicated polio from the Americas and lowered its global incidence by 99 percent since 1988, and achieved dramatic reductions in illness and death from diphtheria, tetanus, whooping cough and measles. In 2003 alone, immunization averted more than two million deaths.

However, immunization is far from universal in many countries, and some countries are slipping back from previously established vaccination coverage levels. In 2003, an estimated 27 million infants and 40 million pregnant women worldwide remained unprotected from vaccine-preventable diseases.

WHO estimates that 2.1 million people died in 2002 of diseases preventable by vaccines that are currently recommended by WHO, including 610,000 deaths from measles, 600,000 deaths from hepatitis B, 386,000 from Haemophilus influenzae type b, 294,000 deaths from pertussis or whooping cough, 213,000 deaths from tetanus, 36,000 from yellow fever, and other such as diphtheria and polio. Of the 2.1 million, 1.4 million were children under the age of five.

"One in four children is still deprived of lifesaving vaccines that should be within reach," said UNICEF Executive Director Ann M. Veneman. “This new Strategy recognizes that if we are to improve child survival, immunization must be sustained year in and year out."

Child health and survival will be improved through the delivery of a package of key health interventions, such as nutrition and insecticide-treated nets against malaria, at the point of immunization, especially for populations who are hard to reach. The strategy gives unprecedented attention to such people, who tend to be poor, socially marginalized and/or living in remote or underserved geographical areas such as urban slums and remote rural areas. The goal is for each country to reach 80 percent immunization coverage in each district by 2010.

New Vaccines
Another pillar of the strategy is to ensure access of those at risk in all countries to an unprecedented array of new vaccines and technologies that are already licensed or are at an advanced stage of development. These include vaccines against major killers such as rotavirus, which is responsible for as much as one-fourth of the 1.9 million annual child deaths due to acute diarrhea, and pneumococcal disease, which accounts for a large share of the two million annual deaths from acute respiratory infections.

Over the next ten years, the cost of immunization is expected to rise substantially as countries include the newer and more expensive vaccines in their immunization programs. Although these vaccines are still cost-effective, affordability will present a barrier to their use, particularly in low-income countries. Strategic partnerships with industry and new approaches to health financing to ensure equitable access to these vaccines are critical.

The global strategy urges all stakeholders to increase resources for immunization, ensuring that affordable vaccines and the necessary funds for immunization are available to all countries, including for use in health emergencies and global epidemics. GIVS also calls for every child, adolescent and adult to have equal access to immunization.

With adequate efforts and financial support, by 2015, immunization could be preventing 4-5 million child deaths per year and contribute significantly to the Millennium Development Goals, especially the reduction by two-thirds of the under-five child mortality rate. The strategy sets a number of specific immunization goals, such as reducing measles mortality by 90 percent within the next five years.

WHO and UNICEF will assist governments in designing, financing and implementing strengthened sustainable national immunization program that meet their specific, evidence-based needs. Above all, governments are strongly encouraged to put immunization high on all health agendas.

Other Actions
The World Health Assembly also adopted new International Health Regulations, approved a 2006-2007 budget with a 4 percent increase, reviewed progress in polio eradication and identified what needs to be done to interrupt the final chains of wild poliovirus transmission worldwide by the end of this year. The Assembly also noted the progress made in scaling-up treatment and care within a coordinated and comprehensive response to HIV/AIDS and discussed smallpox vaccine reserves and research on the smallpox virus.

Recognizing that too many people suffer and die in crises and disasters as a result of untreated and often preventable health problems, the World Health Assembly adopted a resolution on health action in crises and disasters, which calls on WHO to provide early warning of disease outbreaks, improve access to clean water and sanitation, and increase the availability of health care for people's physical and mental health. It also urges Member States to formulate disaster preparedness plans and pay more attention to gender-based violence as an increasing concern during crises.

The Assembly also called on all Member States to develop and implement national plans for pandemic influenza preparedness and response that focus on limiting the health impact and economic and social disruption. The resolution also calls on the WHO Director-General to seek a solution to the current global shortage of influenza vaccines. In a related resolution, the assembly noted that the containment of microbiological agents and toxins in laboratories is critical to preventing outbreaks of diseases such as SARS, and adopted a resolution to enhance laboratory safety.

Malaria and TB
To address the more than one million preventable deaths caused by malaria each year, the Assembly called for stepped up efforts to fight the disease. It calls on WHO to intensify its collaboration with Member States to reach internationally agreed malaria control goals, including the possibility of WHO undertaking bulk purchases of insecticide-treated nets and antimalarial medicines. The Assembly also addressed the increasing number of cases of multidrug-resistant tuberculosis, and worsening morbidity and mortality among HIV-positive tuberculosis patients, by adopting a resolution on sustaining financing for tuberculosis prevention and control. The resolution calls on countries to set up collaboration between TB and HIV programs and to integrate the prevention and control of TB in the mainstream of their health development plans.

Health-related Millennium Development Goals
It also adopted a resolution on "Accelerating the achievement of the internationally-agreed health-related goals including those contained in the Millennium Declaration", urging developed countries to make efforts to scale-up official development aid to 0.7 percent of gross national product and African countries to fulfill their commitment to allocate 15 percent of their national budgets to health. The resolution also identified specific issues for immediate action: the crisis in human resources for health and ensuring better health of the poorest people in countries, particularly those emerging from conflict and crisis. In a separate resolution, the Assembly stressed the importance of promoting the health of women, newborns and children, in meeting the development goals contained in the Millennium Declaration. The resolution urges Member States to commit resources and to accelerate national action towards universal access and coverage with maternal, newborn and child health interventions, through reproductive health care.

Migration of Health Personnel
The Assembly also addressed the issue of international migration of health personnel, particularly highly trained and skilled health personnel moving from developing to developed countries. A resolution was adopted requesting WHO to strengthen its program on human resources for health. The issue of development of human resources for health will be the theme of the 2006 World Health Report and World Health Day 2006. It will also be a key area of work in WHO’s General Program of Work 2006-2015.

Iodine Deficiency
The World Health Assembly has taken note that iodine deficiency disorder (IDD) is a leading cause of brain damage in childhood, and is calling for renewed efforts to eradicate the problem in the Member States with a high incidence of iodine deficiency. A lack of iodine intake during pregnancy and early childhood results in impaired cognitive and motor development in young children. WHO estimates 2 billion people are at risk of becoming iodine deficient. The solution to IDD is simple and cost-effective as iodine can easily be added to table salt. A resolution has been accepted which urges a renewed cooperative effort to eliminate IDD.

Antimicrobial Resistance
Recognizing the increasing threat posed by antimicrobial resistance, the Assembly adopted a resolution to improve its containment, particularly through the rational use of medicines. Resistance is increasing faster than the development of new drugs and current effective medicines for infections cannot keep pace. The resolution calls on Member States to develop a coherent, comprehensive and integrated approach to contain resistance, to encourage the appropriate use of antimicrobial agents, and monitor the use of these agents and the level of resistance occurring. It also urges WHO to strengthen its leadership role in containing resistance, to establish surveillance and patient education systems, and to collaborate with relevant programmes and partners to promote the rational use of medicines.

Harmful Use of Alcohol
The Assembly adopted a resolution calling on WHO to examine public health problems caused by the harmful use of alcohol. Changing global drinking patterns, rising rates of consumption and drinking to excess, particularly among young people are some of the factors which contribute to the harmful use of alcohol becoming one of the leading risks to health. It now results in 4 percent of the global burden of disease as a causal factor in more than 60 diseases, including cardiovascular disease, mental disorders, road traffic injuries and death, and high-risk behaviors. In consultation with a range of stakeholders, WHO will conduct assessments of these public health problems and develop effective policies, strategies and interventions to assist Member States to address and reduce them.

Sustainable health financing
Noting that health-financing systems in many countries need to be further developed in order to guarantee access to necessary services while providing protection against financial risk, the Assembly adopted a resolution on sustainable health financing and universal coverage and social health insurance and urged the Director-General to provide support to Member States to evaluate the impact of changes in health-financing systems on health services as they move towards universal coverage.

Health Research
Recognizing that high-quality research, and the generation and application of knowledge are critical for improving the performance of health systems and attaining equity in health, the Assembly adopted a resolution acknowledging the Mexico Statement on Health research resulting from the Ministerial Summit on Health Research.

The Assembly also discussed the United Nations reform process and WHO's role in harmonization of operational development activities at country level and agreed on a resolution calling on the WHO Director-General to ensure that WHO continues to implement country-level activities in accordance with Member States' priorities, and to coordinate the activities of WHO with those of other organizations of the UN system and with relevant actors working to improve health outcomes.

PAHO, which serves as the Regional Office for the Americas of the World Health Organization, works with all the countries of the Americas to improve the health and quality of life of their people. PAHO Member States today include all 35 countries in the Americas. France, the Kingdom of the Netherlands, and the United Kingdom of Great Britain and Northern Ireland are Participating States. Portugal and Spain are Observer States, and Puerto Rico is an Associate Member.