WHO's new vaccines programme

4 WHO's new vaccines programme Jong-Wook Lee Centre for total care in Egypt. An integrated approach to immunization offers children a better chance to grow up in good health. WHO's new Global Programme on Vaccines and Immunization intends to use polio eradication as a leading wedge to implement effective, surveillance-based approaches to neonatal tetanus elimination and measles control. WHO has embarked on a new phase in its task of protect-ing the health of children around the world. An improved, integrated approach to immunization is needed if the world's ch ildren are to grow up healthy. In turn , there is a need to change the philosophy from a simplistic approach - all children have a right to be immunized- to a broader one: all ch ildren must be protected from death and disability by making the best vacc ines available and using them in the most effective manner. To meet these needs , WHO has created a new Global Programme on Vaccines and Immunization (GPV). Twenty years ago, when the Expanded Programme on Immunization (EPI) was founded, fewer than 5% of children born each year were immunized. In the last two decades, immunizat:on programmes have been established in every coun- try of the world. WHO estimates that more than 75% of infants born in 1993 were fu ll y immunized and 45 % of pregnant women were immunized to protect their infants aga inst neo- natal tetanus. Wi th current levels of immunization, EPI prevents an estimated 2 900 000 deaths from measles, neonatal teranus and whooping cough and 560 000 cases of poliomyelitis each year. World Health • 48th Year, No. 1, Janua ry-February 1995 Pitfalls ahead This is a remarkable achievement. What then are the problems that demand a new approach to immunization? Firstly, instead of ris ing to 90% as planned, immuniza- tion coverage is now falling. In addition, there are at least 18 coun- tries where immunization coverage remains less than 50%. If we are to protect every child , we must redou- ble our efforts to increase coverage in countries which have extremely low coverage and stop the trend towards lower coverage in some successful countries. Secondly, EPI has essentially been limited to the six antigens initially recommended by the pro- gramme. With some exceptions, we have fai led to incorporate other, ex- isting vacc ines into the programme. Children in the developing world re- main at ri sk for hepatitis B, rubella ("German measles") and in some countries ye llow fever and infection with Haemophilus injluenzae. Now that so many countries are doing so well , we must accelerate the intro- duction of additional vaccines into EPI programmes around the world . Thirdly, poor quality vacc ines have been used in some countries. All the effort involved in immuniz- ing a chi ld is wasted when there is no immunological response to the vac- cine. If unsafe or impotent vacc ines are used, parents lose faith and will no longer bring their children for im- munization. We must, therefore, work with countries to ensure that only safe and effective vaccines are used in EPI programmes. Fourth ly, EPI's three disease control object ives have yet to be reached. WHO estimates that each World Health • 48th Yeor, No. 1, Jonumy-februory 1995 year 110 000 children are still being crippled by polio, 500 000 babies die from neonatal tetanus, and I 200 000 children die from measles. Controlling these three diseases re- quires an epidemiological approach to disease, defining high-risk groups and targeting immunization to those most in need. As is clear from this issue of World Health , the global po- liomyelitis eradication target for the year 2000 is the most advanced of the three objectives. All the evidence indicates that this disease has been eradicated from the Western Hemi- sphere, and rapid progress is being made towards the goal in the five WHO Regions where polio remains endemic. GPV is fully committed to the polio eradication goal and intends to use polio as a leading wedge to implement effective, surveillance- based approaches to neonatal tetanus elimination and measles control. Fifthly, global research and devel- opment of vaccines has primarily been driven by the market forces and sc ientific interests of the industrial- ized countries. If we are to achieve our goal of protecting the most vul- nerable children, special efforts will be required to channel the develop- ment, testing and licensing process so that appropriate new and/or improved vaccines are available to immunization programmes in devel- oping nations. WHO's leadership in developing a more thermostable oral polio vaccine, for example, will result in simplified logistics and lower costs for conducting mass campaigns. At the same time, the likelihood that a child will rece ive an impotent vaccine will be greatly reduced. Three operational units GPV will implement this new approach to immunization through its three operational units, the Expanded Programme on Immunization (EPI), Vaccine Supply and Quality (VSQ), and Vaccine Research and Development (VRD). EPI will define global immunization policies and provide technical support to countries, through the s A young child in Costa Rico receives protection against measles. A pregnant woman in Bangladesh is immunized against tetanus. WHO Regional Offices. VSQ will work with countries, donors, and vaccine manufacturers to ensure that adequate quantities of vaccines are available to all national EPI programmes, and that only safe and fully potent vaccines are provided to those programmes. VRD will stimulate and support the research and development activities, which will lead both to new vaccines and to improved, exist ing vaccines and will provide the sc ientific basis for their optimum use. I believe that the three sections of the new Global Programme for Vaccines and Immunization are in keeping with the ideal of the Children's Vaccine Initiative- to link all stages of the vaccine life-cycle from the bench to the bush. EPI, VSQ and VRD will work synergisti- cally to link vaccine research, devel- opment, supply and delivery so as to accelerate our efforts to protect chil- dren from illness, disability and death. I anticipate that the most im- mediate effects wi ll be the eradica- tion of polio and dramatic improve- ments in the control of measles , neonatal tetanus and other EPI diseases. In addition , our capacity will be increased to prevent and con- trol other diseases and bring us closer to WHO 's ultimate goal of Health for All. • Dr jong·Wook Lee is Director of the Global Programme for Vaccines and Immunization , World Health Organization, I 2 I I Geneva 27, Switzerland.