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Global vaccine action plan: monitoring, evaluation and accountability: secretariat annual report 2020

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GLOBAL VACCINE ACTION PLAN MONITORING, EVALUATION & ACCOUNTABILITY SECRETARIAT ANNUAL REPORT 2020 Global vaccine action plan: monitoring, evaluation and accountability. Secretariat annual report 2020 ISBN 978-92-4-001432-9 (electronic version) © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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GLOBAL VACCINE ACTION PLAN MONITORING, EVALUATION & ACCOUNTABILITY SECRETARIAT ANNUAL REPORT 2020 Note: In line with the reporting in 2019, this year’s annual GVAP secretariat report presents a collection of figures and graphs with the latest available data, for a selection of GVAP indicators, mainly covering disease elimination, coverage and equity and the surveillance dimensions. For some indicators, succinct notes complement the figures. For indicators which have not been updated this year, as well as for all background references and sources, please refer to the 2018 GVAP secretariat report. For indicators related to supply and financing, a Global vaccine market report will be published in September 2020 on the WHO webpage (www.who.int/immunization/MI4A). Vaccine coverage data displayed in this report are based on the July 2020 revised time series of the WHO-UNICEF estimates of national immunization coverage 2010–2019. The majority of data provided in this report were updated through the end of December 2019. This means that there is no direct impact of the COVID-19 pandemic depicted in this report, which only started to impact countries in the first quarter of 2020. Nevertheless there is an indirect impact that is measurable: reporting of immunization figures was less exhaustive than in previous years due to the workload on COVID-19 response in 2020. CONTENTS ABBREVIATIONS �� IV BOX 1: PROGRESS TOWARDS MEETING CORE GVAP INDICATORS – 2020 REPORT��V 1. DISEASE ELIMINATION �� 1 2. IMMUNIZATION COVERAGE AND EQUITY �� 6 3. EXCEED THE MILLENNIUM DEVELOPMENT GOAL 4 TARGET FOR REDUCING CHILD MORTALITY AND INTEGRATION INDICATORS ��15 4. ENSURING COUNTRY OWNERSHIP OF IMMUNIZATION �� 18 5. STRONG IMMUNIZATION SYSTEMS ARE AN INTEGRAL PART OF A WELL-FUNCTIONING HEALTH SYSTEM ��21 6. VACCINE SAFETY �� 24 © W H O / A sa d Z ai d i ABBREVIATIONS AEFI adverse events following immunization cVDPV circulating vaccine-derived poliovirus cases DTP diphtheria–tetanus–pertussis-containing vaccines DTP1 diphtheria–tetanus–pertussis-containing vaccines, first dose DTP3 diphtheria–tetanus–pertussis-containing vaccines, third dose HepB BD Hepatitis B vaccine, birth dose IB-VPD invasive bacterial vaccine-preventable diseases IPV inactivated poliovirus vaccines MCV measles-containing vaccines MCV2 measles-containing vaccine, second dose MDG Millennium Development Goal MNT maternal and neonatal tetanus PCV pneumococcal conjugate vaccine PCV3 pneumococcal conjugate vaccine, third dose RCV rubella-containing vaccines RCV1 rubella-containing vaccines, first dose UNICEF United Nations Children’s Fund WEUNIC WHO/UNICEF Estimates of National Immunization Coverage WHO World Health Organization WPV1 wild poliovirus serotype 1 P. iv - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS Box 1: Progress towards meeting core GVAP indicators – 2020 report Goal /Strategic objective Indicators GOALS Achieve a world free of poliomyelitis G1.1 Interrupt wild poliovirus transmission globally Fig. 1, Fig. 2, Fig. 3 G1.2 Certification of poliomyelitis eradication Meet global and regional elimination targets G2.1 Maternal and neonatal tetanus elimination Fig. 4, Fig. 5 G2.2 Measles elimination Fig. 6, Table 1 G2.3 Rubella/congenital rubella syndrome (CRS) elimination Fig. 7, Table 2 Meet vaccination coverage targets in every region, country and community G3.1 By 2015, reach 90% national coverage and 80% in every district or equivalent administrative unit with three doses of diphtheria–tetanus–pertussis-containing vaccines Fig. 8, Fig. 9, Fig. 10, Fig. 11, Fig. 12, Fig. 13, Fig. 14 G3.2 By 2020, reach 90% national coverage and 80% in every district or equivalent administrative unit for all vaccines in national programmes, unless otherwise recommended Fig. 15, Fig. 16, Fig. 17 Develop and introduce new and improved vaccines and technologies G4.3 Number of low-income and middle-income countries that have introduced one or more new or under-utilized vaccines Fig. 18 Exceed the MDG Goal 4 target for reducing child mortality and Integration indicators G5.1 Reduce under-five mortality rate Fig. 19, Fig. 20 STRATEGIC OBJECTIVES (SOs) Ensuring country ownership of immunization SO1.2 Presence of an independent technical advisory group that meets the defined criteria Fig. 21, Fig. 22 The benefits of immunization are equitably extended to all people SO3.1 Percentage of districts with 80% or greater coverage with three doses of diphtheria–tetanus–pertussis- containing vaccine Fig. 13 SO3.2 Reduction in coverage gaps between wealth quintiles and other appropriate equity indicator(s) Fig. 14 Strong immunization systems are an integral part of a well-functioning health system SO4.1 Drop-out rates between first dose (DTP1) and third dose (DPT3) of diphtheria–tetanus–pertussis-containing vaccines Fig. 9 SO4.2 Sustained coverage of diphtheria–tetanus–pertussis- containing vaccines 90% or greater for three or more years Fig. 12 SO4.4 Number of countries meeting established surveillance standards with case-based surveillance for vaccine-preventable diseases and with viral and bacterial laboratory confirmation of suspect or probable cases Fig. 23, Fig. 24, Table 3 Vaccine safety Fig. 25 P. v - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS © W H O / F an ja n C om b rin k 1. DISEASE ELIMINATION A) POLIOMYELITIS ERADICATION In 2019 and through 20 May 2020 two countries, Afghanistan and Pakistan, have accounted for all new wild poliovirus serotype 1 (WPV1) cases (Figs. 1 and 3). In 2019 circulating vaccine-derived poliovirus cases (cVDPV) have been detected in 18 countries: Angola, Benin, Burkina Faso, Central African Republic, Chad, China, Democratic Republic of the Congo, Ethiopia, Ghana, Malaysia, Myanmar, the Niger, Nigeria, Pakistan, the Philippines, Somalia, Togo and Zambia (Figs. 2 and 3). Of note, the independent Africa Regional Certif ication Commission (ARCC) for Polio Eradication officially declared on 25 August 2020 that the World Health Organization (WHO) African Region is free of wild poliovirus. Fig. 1: Number of wild poliovirus cases globally, 2010–2020a 2011 2012 2013 2014 2016 2015 2017 2018 202020192010 0 200 400 600 800 1000 1200 1400 1600 1352 650 223 416 359 74 37 22 33 175 59 N o. o f c as es a Data for 2020 as of 20 May. Fig. 2: Number of circulating cVDPV globally, 2010–2020a 2011 2012 2013 2014 2016 2015 2017 2018 20202010 60 66 70 65 56 32 5 96 104 110 2019 364 0 50 100 150 200 250 300 350 400 N o. o f c as es a Data for 2020 as of 20 May. P. 1 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS Fig. 3: Global distribution of wild poliovirus and cVDPV in 2019a Endemic country (WPV1) WPV1 (Afghanistan: 29; Pakistan: 147) cVDPV2 cases (Angola: 130; Benin: 8; Burkina Faso: 1; Central African Republic: 21; Chad: 10; China: 1; Democratic Republic of the Congo: 88; Ethiopia: 13; Ghana: 18; Niger: 1; Nigeria: 18; Pakistan: 22; Philippines: 13; Somalia: 3; Togo: 8; Zambia: 2) cVDPV1 cases (Malaysia: 3; Myanmar: 6; Philippines: 2) a Data for 2020 as of 28 May. For further information see: http://polioeradication.org/polio-today/polio-now/; https://extranet.who.int/polis/public/CaseCount.aspx � P. 2 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS B) MATERNAL AND NEONATAL TETANUS ELIMINATION In 2019, Chad and the Democratic Republic of the Congo were validated as having eliminated maternal and neonatal tetanus (MNT). This leaves 12 countries yet to be validated as of 25 May 2020. This is in addition to other areas being validated as having eliminated MNT: the Punjab province of Pakistan (in 2016), the south-east zone of Nigeria (in 2017), six southern regions in Mali (in 2018) and the south-west zone in Nigeria (in 2019). Figs. 4 and 5 show the trends of MNT elimination over the past decade and globally. Fig. 4: Number of countries with validated MNT elimination status by yeara 2011 2012 2013 2014 2016 2015 2017 2018 202020192010 40 0 5 10 15 20 25 30 35 40 45 26 2828 Number of priority countries verified for MNTEGVAP target N o. o f c ou n tr ie s Note: In 2010, 40 countries still had not yet eliminated MNT. a Data for 2020 as of 25 May. Fig. 5: Countries with validated elimination of maternal and neonatal tetanus (as of June 2020) Not eliminated Eliminated between Jan. 2000 and June 2020 Eliminated prior to 2000 Not applicable Source: WHO-UNICEF database, June 2020. Geneva: World Health Organization/United Nations Children’s Fund; 2020. For further information see: https://www.who.int/immunization/diseases/MNTE_initiative/en/index4.html; http://extranet.who.int/iris/restricted/bitstream/handle/10665/331939/WER9518-eng-fre.pdf P. 3 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS C) MEASLES AND RUBELLA/CONGENITAL RUBELLA SYNDROME ELIMINATION As of 31 December 2019, 83 countries were verified as having eliminated measles. Since 2018, when the Region of the Americas lost its elimination status, no World Health Organization (WHO) region has been verified as having eliminated measles, and only one region is verified as having eliminated rubella (Region of the Americas) (Figs. 6 and 7). Table 1 shows a significant increase of measles cases globally, beginning in 2018 and continuing in 2019 with all regions experiencing outbreaks. Fig. 6: Number of regions and countries achieving measles elimination 1 1 1 77 4 80 4 82 83 4 5 0 0 5 60 65 70 75 80 85 90 0 1 2 3 4 5 6 2010 2016 2017 2018 2019 2020 N o. o f c ou n tr ie s N o. o f W H O r eg io n s Since the Region of the Americas lost its status in 2018, no region is verified as having eliminated measles. GVAP target 83 countries achieved measles elimination in 2019 Fig. 7: Number of regions achieving rubella elimination Only the Region of the Americas is verified as having eliminated rubella 0 1 2 3 4 6 5 2010 2016 2017 2018 20202019 N o. o f W H O r eg io n s 1 1 1 5 1 2 2 2 1 2 GVAP target Coverage estimates for, and incidence of, measles- containing vaccines (MCV) and rubella-containing vaccines (RCV) by WHO region are shown in Tables 1 and 2. Table 1: MCV coverage (first and second dose) and measles incidence by WHO region, in 2010, 2018 and 2019 WHO region WHO-UNICEF estimates for MCV1 national coverage (%) WHO-UNICEF estimates for MCV2 national coverage (%) Measles incidence per million population Countries with measles incidence < 5 per million pop. (%) 2010 2018 2019 2010 2018 2019 2010 2018 2019 2010 2018 2019 African 73 69 69 4 25 33 232 118 587 30 47 35 Americas 93 91 88 67 84 75 0 17 28 100 91 91 Eastern Mediterranean 77 81 82 52 74 75 17 93 28 40 33 35 European 93 95 96 80 91 91 34 96 166 69 30 40 South-East Asia 83 93 94 15 81 83 30 18 15 36 36 12 Western Pacific 96 95 94 87 91 91 27 15 41 68 77 48 All 84 85 85 42 69 71 50 47 125 60 52 48 P. 4 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS Table 2: Rubella incidence and RCV coverage by WHO region, in 2010, 2018 and 2019 WHO region Rubella incidence per million population RCV1 coverage* (%) 2010 2018 2019 % change 2010–2019 2010 2018 2019 % change 2010–2019 African 4 11 6 63 0 32 33 Americas 0 0 0 103 93 91 88 -5 Eastern Mediterranean 4 2 4 10 37 45 45 22 European 14 1 0 -97 93 95 96 3 South-East Asia 26 2 2 -91 3 85 93 3000 Western Pacific 27 4 18 -31 61 94 94 54 All 15 3 7 -51 35 69 71 103 For further information see: http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/ measles_monthlydata/en/ P. 5 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS 2. IMMUNIZATION COVERAGE AND EQUITY A) NATIONAL-LEVEL DTP3 COVERAGE 1 Progress and challenges with achieving universal immunization coverage. 2019 WHO/UNICEF Estimates of National Immunization Coverage. Geneva: World Health Organization/United Nations Children’s Fund; 2020 (https://www.who.int/ immunization/monitoring_surveillance/who-immuniz.pdf?ua=1, accessed 26 August 2020). Global vaccination coverage – the proportion of the world’s children who receive recommended vaccines – has remained stable over the past few years at around 85%. During 2019, approximately 85% of infants worldwide (116 million infants) received 3 doses of diphtheria–tetanus–pertussis-containing vaccines (DTP), protecting them against infectious diseases that can cause serious illness and disability or be fatal (Fig. 8). One hundred and twenty-five (64%) countries achieved a national DTP3 (third dose) coverage rate of 90% or above in 2019. District data were available and valid for 122 (63%) countries. Overall only 51 (26%) of the countries had national DTP3 coverage above ≥ 90% and valid district data above 80% in all districts. Important increases in coverage (≥ 10%) between 2018 and 2019 were seen in Samoa, Senegal, Solomon Islands, Syrian Arab Republic, Ukraine, Viet Nam and Yemen. In a five-year time frame, 10 countries improved coverage by 10% or more. Those include countries that are recovering from crises, such as Ukraine, Syrian Arab Republic and Iraq, as well as countries that have gradually improved their programmes.1 Fourteen million infants did not receive an initial dose of DTP vaccine, pointing to a lack of access to immunization and other health services and an additional 5.7 million are only partially vaccinated. Fig. 8: Average coverage rates (%) with DTP3 globally and by WHO region, 1980–2019 D TP 3 co ve ra g e (% ) Global African Region Region of the Americas Eastern Mediterranean Region European Region South-East Asia Region Western Pacific Region 19 80 19 81 19 82 19 83 19 84 19 85 19 86 19 87 19 88 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 0 0 20 0 1 20 0 2 20 0 3 20 0 4 20 0 5 20 0 6 20 0 7 20 0 8 20 0 9 20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 0 20 40 60 80 100 20 2 3 25 3 8 4 5 4 9 5 2 5 6 64 68 75 71 70 70 73 73 72 71 7 2 72 72 7 3 73 7 4 76 7 7 78 7 9 81 8 3 84 8 5 84 84 84 8 5 86 86 85 85 20 18 85 20 19 P. 6 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS Regional coverage for the third dose of DTP in South Asia has increased by 12% over the past 10 years, notably across India, Nepal and Pakistan. However, that hard-won progress could be undone in 2020 by COVID-19-related disruptions. Countries that had recorded significant progress, such as Pakistan and Ethiopia, are now also at risk of backsliding if immunization services are not restored as soon as feasible. The situation is especially concerning for Latin America and the Caribbean, where historically high coverage has slipped over the past decade. In Brazil, the Plurinational State of Bolivia, Haiti and the Bolivarian Republic of Venezuela, immunization coverage plummeted by at least 14% since 2010. In addition, these countries are now also confronting moderate to severe COVID-19-related disruptions. Drop-out rates between first and third dose of DTP have been analysed in all 64 countries where DTP3 coverage was below 90%. In 2019, 21 countries with DTP3 coverage between 50% and 89% experienced a drop-out rate of 10% or more. Among those, 7 countries had a drop-out rate of 20% or more. Fig. 9 shows drop-out rates globally in 2019. Fig. 9: Drop-out rates between first dose (DTP1) and third dose (DTP3) of DTP-containing vaccines, 2019 ≥ 20 points or more (10 Member States or 5%) 10 to <20 points (15 Member States or 8%) >0 to <10 points (128 Member States or 66%) no dropout (41 Member States or 21%) Not applicable The coverage trend has plateaued over the past decade, leaving almost 20 million children unprotected. Almost half of these children live in the African Region (Fig. 10). Fig. 10: Number of un- or under-vaccinated with DTP by year and WHO region, 2000–2019 African Region Region of the Americas European Region Eastern Mediterranean Region South-East Asia Region Western Pacific Region 0 5 10 15 20 25 30 35 40 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 20 18 20 19 M ill io n s P. 7 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS Ten countries account for 12.2 of the 19.7 million un- and under-vaccinated children in the world (62%). This list includes countries across five WHO regions, some with moderate coverage but very large birth cohorts, and others with substantially lower coverage: Angola, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Mexico, Nigeria, Pakistan and the Philippines (Fig. 11). DTP3 coverage rates from 2000 to 2019 are shown in Fig. 12. Fig. 11: Countries with the highest number of un- or under-vaccinated (in millions) with DTP, and their DTP3 coverage rate in 2019 Others Nigeria DTP3= 57% India DTP3= 91% Democratic Republic of the Congo DTP3= 57% Pakistan DTP3= 75% Ethiopia DTP3= 69% Brazil DTP3= 73% Philippines DTP3= 65% Indonesia DTP3= 85% Angola DTP3=57% Mexico DTP3= 82% 7.53 3.05 2.11 1,42 1,42 1.07 0.77 0.75 0.710.52 0.39 Source: WHO-UNICEF Joint reporting form July 2020 [database]. Geneva: World Health Organization/United Nations Children’s Fund; 2020 WUENIC July 2020 update [database]. Geneva: World Health Organization/United Nations Children’s Fund; 2020 (https:// www.who.int/immunization/monitoring_surveillance/data/en/, accessed 9 September 2020). Fig. 12: Number of countries that reached and sustained ≥ 90% coverage for DTP3 and global DTP3 coverage, 2000–2019 ≥90% coverage <90% coverage Global DTP3 coverage 59 6 3 65 66 6 9 76 8 0 83 83 8 6 90 9 2 95 98 10 0 10 3 10 5 10 9 12 0 13 2 12 8 12 7 12 6 12 3 11 6 11 3 11 0 11 0 10 7 10 3 10 2 99 96 9 4 91 89 8 5 74 0 10 20 30 40 50 60 70 80 90 100 0 40 80 120 160 200 180 140 100 60 20 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 20 18 12 5 69 20 19 D TP 3 co ve ra g e (% ) N o. o f c ou n tr ie s P. 8 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS B) DISTRICT-LEVEL DTP3 COVERAGE Only 57 countries declare having an 80% or more DTP3 coverage in all their districts. Fig. 13 shows district- level DTP3 coverage. Fig. 13: Countries by the percentage of districts with DTP3 coverage ≥ 80% and valid data, 2019 < 50% (25 Member States (13%), 11 of which have administrative coverage DTP3 data considered not valid) 50–79% (38 Member States (20%), 19 of which have administrative coverage DTP3 data considered not valid) 80–99% (46 Member States (24%), 11 of which have administrative coverage DTP3 data considered not valid) All districts (57 Member States (29%), 3 of which have administrative coverage DTP3 data considered not valid) WHO-UNICEF (WUENIC) estimate is < 90% or differs from country administrative coverage reported on the JFR and therefore district data are not considered valid (47 Member States or 24%) Not available (28 Member States (14%), 3 of which have administrative coverage DTP3 data considered not valid) Not applicable P. 9 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS C) BENEFITS OF IMMUNIZATION ARE EQUITABLY EXTENDED TO ALL PEOPLE Data from Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS) conducted between 2010 and 2018 on national diphtheria–tetanus–pertussis (DTP3) coverage rates by wealth quintiles were available for 85 of the 194 WHO Member States (44%). The latest survey data available for each country was considered for the purpose of this analysis. Coverage in 67 of these 85 Member States (79%) was generally higher in the wealthiest quintile than in the poorest quintile (Fig. 14). Of the 85 countries with available data, 58 (68%) have met the target of < 20% difference in immunization coverage between the highest and lowest wealth quintiles; this includes 18 countries (21%) for which DTP3 national coverage for the richest is lower than for the poorest population. Twenty- seven countries (32%) had a quintile differential ≥ 20% and have thus failed to meet the target. This confirms trends described in previous reports. Fig. 14: Countries with DTP coverage data by wealth quintiles available between 2010 and 2018 18 countries having a quintile differential of <0% 30 countries having a quintile differential of ≥0% and <10% 10 countries having a quintile differential of ≥10% and <20% 27 countries having a quintile differential of ≥20% Not available Not applicable P. 10 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS D) NATIONAL AND DISTRICT-LEVEL COVERAGE FOR ALL VACCINES IN THE NATIONAL PROGRAMME In 2019, 77 countries (40%) had achieved the national coverage of ≥ 90% for all vaccines included in the national infant immunization schedule (Fig. 15), compared with 85 (43%) countries in 2010. However, between 2010 and 2019 most national schedules have expanded significantly the list of vaccines included, which renders time series diff icult to interpret. Figs. 16 and 17 present the coverage rates for selected vaccines since 1980. Fig. 15: Number of countries that have reached and sustained ≥ 90% coverage for all vaccines included in the national infant schedule in 2019 Yes (77 Member States or 40%) No (117 Member States or 60%) Not available Not applicable Fig. 16: Global coverage estimates (%) of four vaccinesa, 1980–2019 % c ov er ag e 0 10 20 30 40 50 60 70 80 90 100 BCG DTP1 DTP3 Pol3 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04 20 06 20 08 20 10 20 12 20 14 20 16 20 18 20 19 a Bacille Calmette–Guérin (BCG) vaccine, DTP1, DTP3, Third dose of Polio vaccine (Pol3) P. 11 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS Fig. 17: Global coverage estimates (%) of six vaccinesa, 1980–2019 PCV3 RotaHepB BD MCV2 YFV % c ov er ag e 0 10 20 30 40 50 60 70 80 90 100 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04 20 06 20 08 20 10 20 12 20 14 20 16 20 19 20 18 RCV1 a Hepatitis B vaccine birth dose (HepB BD), measles-containing vaccines second dose (MCV2), pneumococcus-containing vaccine third dose (PCV3), rubella-containing vaccine first dose (RCV1), rotavirus vaccine last dose (Rota) and yellow fever vaccine (YFV). For further information see: https://www.who.int/immunization/monitoring_surveillance/data/en/; http://www.who.int/entity/immunization/monitoring_surveillance/SlidesGlobalImmunization. pptx?ua=1; http://www.who.int/immunization/monitoring_surveillance/who-immuniz.pdf?ua=1 P. 12 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS E) DEVELOP AND INTRODUCE NEW AND IMPROVED VACCINES AND TECHNOLOGIES 2 http://databank.worldbank.org/data/download/site-content/CLASS.xls (as of 14 September 2020) 3 That is, one of the following: Haemophilus influenzae type b conjugate (Hib)-containing vaccine, pneumococcal conjugate vaccine (PCV), rotavirus vaccine, human papillomavirus vaccine, rubella and Japanese encephalitis vaccines. Fig. 18 shows the number of low- and middle- income countries that have introduced new or under-utilized vaccines, including inactivated poliovirus vaccines (IPV). According to the new World Bank Classif ication from June 20202, 132 countries are currently categorized as either low or middle income. There were 21 countries that did not introduce or did not sustain the introduction of any new vaccine since 20103, excluding IPV: Bosnia and Herzegovina, Chad, China, Comoros, Costa Rica, Cuba, Dominica, Grenada, Guinea, Marshall Islands, Mongolia, Montenegro, Republic of Moldova, Saint Lucia, Samoa, Syrian Arab Republic, The former Yugoslav Republic of Macedonia, Tonga, Turkey, Tuvalu and Ukraine. Fig. 18: Number of low- and middle-income countries that have introduced one of more new or under- utilized vaccines (NUV)a between 2010 and 2018 (and have sustained it for at least one year) NUV introduction excl. IPV NUV introduction incl. IPVGVAP target 104 118 98 101 78 81 58 61 39 42 17 19 105 109 120 124 111 127 0 20 40 60 80 100 120 140 160 2010 2011 2012 2013 2014 2015 90 2016 2017 2018 2019 2020 132 N o. o f c ou n tr ie s a Among the following: Haemophilus influenzae type b conjugate (Hib)-containing vaccine, pneumococcal conjugate vaccine (PCV), rotavirus vaccine, human papillomavirus vaccine, rubella and Japanese encephalitis vaccines. IPV is in addition to this list included in the red curve. For further information see: http://www.who.int/entity/immunization/monitoring_surveillance/VaccineIntroStatus.pptx P. 13 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS © W H O / P at ri ck B ro w n 3. EXCEED THE MILLENNIUM DEVELOPMENT GOAL 4 TARGET FOR REDUCING CHILD MORTALITY AND INTEGRATION INDICATORS The Millennium Development Goal (MDG) 4 target was attaining in 2015 a two thirds reduction in under five global mortality compared with the 1990 baseline, i.e. less than 31.1 deaths per 1000 live births. Global under-five mortality was 38.6 in 2018 (Fig. 19). Each year since 2010 there has been an annual additional reduction of approximately 1.5 to 2 points (per 1000 live births) globally. Under-five mortality figures by country are shown in Fig. 20. Fig. 19: Under-five mortality rate in 1990, 2000 and from 2010 to 2018, globally and by WHO region MDG 4 target African Region Region of the Americas Eastern Mediterranean Region European RegionGlobal South-East Asia Region Western Pacific Region 31,1 93,2 76,4 51,3 49,0 47,1 45,4 43,8 42,4 41,1 39,8 38,6 75,9 13,5 46,9 8,6 33,6 11,8 0 20 40 60 80 100 120 140 160 180 1990 2000 2010 2011 2012 2013 2014 2015 2016 2017 2018 U n d er -fi ve m o rt al it y ra te (d ea th s p er 1 0 0 0 li ve -b ir th s) Source: United Nations Inter-Agency Group for Child Mortality Estimates. Levels and trends in child mortality: Report 2018. New York (NY): United Nations; 2018. P. 15 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS Fig. 20: Under-five mortality rates globally in 2018 100 and more (6 countries or 3%) 75 to <100 (13 countries or 7%) 50 to <75 (19 countries or 10%) 25 to <50 (37 countries or 19%) 10 to <25 (49 countries or 25%) Not applicable < 10 (70 countries or 36%) Deaths per 1000 live-births Not available Source: United Nations Inter-Agency Group for Child Mortality Estimates. Levels and trends in child mortality: Report 2018. New York (NY): United Nations; 2018. For further information see: https://childmortality.org/ and http://apps.who.int/gho/data/node.gswcah?lang=en P. 16 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS © W H O / C h ris ti n e M cN ab 4. ENSURING COUNTRY OWNERSHIP OF IMMUNIZATION PRESENCE OF FUNCTIONAL NATIONAL IMMUNIZATION TECHNICAL ADVISORY GROUP One hundred and fifty-eight countries reported the existence of a National Immunization Technical Advisory Group (NITAG) in 2019. The 120 NITAGs meeting the six process criteria in 2019 (5.3% increase over 2018), cover 87% of the world population, compared to 52% in 2010 (Figs. 21 and 22). Fig. 21: Number of countries served by a NITAG, meeting all process criteria between 2010 and 2019 53 52 62 75 81 82 87 99 114 120 0 20 40 60 80 100 120 140 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 N o. o f c ou n tr ie s P. 18 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS Fig. 22: Existence and functionality of NITAGs in 2019 120 countries meeting the six NITAG process criteria 153 countries having a NITAG with administrative or legislative basis 154 countries reporting the existence of a NITAG with terms of reference 158 countries reporting the existence of a NITAG No NITAG / not available Not applicable Source: WHO IVB database as of 1 July 2020. Geneva: World Health Organization; 2020. For further information see: http://www.who.int/immunization/sage/national_advisory_committees/en/; http://www.nitag-resource.org/ P. 19 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS © W H O / N O O R / S eb as ti an L is te 5. STRONG IMMUNIZATION SYSTEMS ARE AN INTEGRAL PART OF A WELL-FUNCTIONING HEALTH SYSTEM VACCINE-PREVENTABLE DISEASE SURVEILLANCE Globally, the number of countries that conduct surveillance for rotavirus or invasive bacterial vaccine-preventable disease (IB-VPD) remains high, although there is a continued trend of fewer countries reporting data to the WHO-coordinated surveillance networks (Table 3). Surveillance is conducted in most of the populous countries with high burden of disease, including those that are Gavi-eligible in Africa and Asia, with current gaps in reported surveillance data in northern Africa and the Middle East (Figs. 23 and 24). Table 3: Number of countries conducting surveillance for rotavirus and IB-VPD, 2017–2019 2017 2018 2019 Rotavirus IB-VPD Rotavirus IB-VPD Rotavirus IB-VPD Part of WHO-coordinated global surveillance network 61 54 54 50 47 46 Conducts surveillance but not part of WHO-coordinated global surveillance network 72 100 78 101 80 103 No reported surveillance 61 40 62 43 67 45 P. 21 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS Fig. 23: Countries conducting rotavirus surveillance, 2019a Countries in the WHO Global Rotavirus Surveillance Network (GRSN) (47 countries) Gavi eligible countries Not available Not applicable Countries conducting Rotavirus Surveillance but not reporting to GRSN (80 countries) a Most countries in the WHO African Region report diarrhoea with blood (dysentery) and diarrhoea with dehydration in children aged under 5 years as part of Integrated Disease Surveillance and Response (IDSR), which triggers investigation and laboratory confirmation of these syndromes. Fig. 24: Countries conducting IB-VPD surveillance, 2019a Countries in the WHO Global IB-VPD Surveillance Network (GISN) (46 countries) Gavi eligible countries Not available Not applicable Countries conducting IB-VPD Surveillance but not reporting to GISN (103 countries) a Most countries in the WHO African Region report meningitis (bacterial) and severe pneumonia in children aged under 5 years as part of Integrated Disease Surveillance and Response (IDSR), which triggers investigation and laboratory confirmation of these syndromes. For further information see: https://www.who.int/immunization/monitoring_surveillance/resources/NUVI/en/; https://www.who.int/immunization/monitoring_surveillance/burden/VPDs/en/; WHO Global Invasive Bacterial Vaccine-Preventable Disease and Rotavirus and Pediatric Diarrhea; Surveillance Networks Bulletin February 2020: https://mailchi.mp/d61958d8bbd1/who-ib-vpd-and-rotavirus-surveillance-bulletin-june-4779233 P. 22 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS © W H O / S eb as ti an M ey er 6. VACCINE SAFETY Adverse events following immunization (AEFI) case reporting rates were stable or marginally decreased in most of the regions over the past year (Fig. 25). The only significant decline was observed in the European Region. Note that this indicator does not allow for the differentiation between minor and serious AEFI, nor does it account for special immunization campaigns (e.g. supplementary immunization activities) that influence reporting rates. Fig. 25: Percentage and number of countries reporting at least 10 per 100 000 AEFI cases by WHO region, in 2010, 2016–2019 Not reporting at least 10 cases per 100 000 surviving infants Reporting ≥ 10 cases/ 100 000 surviving infants 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 20 10 20 16 20 17 20 19 20 18 20 10 20 16 20 17 20 19 20 18 20 10 20 16 20 17 20 19 20 18 20 10 20 16 20 17 20 19 20 18 20 10 20 16 20 17 20 19 20 18 20 10 20 16 20 17 20 19 20 18 African Americas Eastern Mediterranean European South-East Asia Western Pacific 7 22 20 27 27 21 24 21 25 25 8 10 12 12 11 34 37 45 35 28 4 7 9 9 7 6 11 13 12 11 40 25 27 20 20 14 11 14 10 10 13 11 9 9 10 19 16 8 18 25 7 4 2 2 4 21 16 14 15 16 For more information, see: http://www.who.int/vaccine_safety/en/ P. 24 - GLOBAL VACCINE ACTION PLAN SECRETARIAT REPORT 2020  CONTENTS © W H O / S eb as ti an M ey er For more information, contact: World Health Organization Department of Immunization, Vaccines and Biologicals 1211 Geneva 27 Switzerland E-mail: vaccines@who.int Web: www.who.int/immunization/global_vaccine_action_plan/en/ ISBN 978-92-4-001432-9

Основные сведения

Организация Всемирная организация здравоохранения (ВОЗ / WHO)

Тип документа Publications

Дата принятия 8 декабря 2020 г.

Источник Всемирная организация здравоохранения