Opinion: Advancing universal health care through a new global immunization agenda

An ambitious global immunization strategy, set to launch at the upcoming World Health Assembly, is critical at a time when we are seeing a rise in the spread of certain vaccine-preventable diseases and simultaneously facing pandemic threats for other diseases — something that should focus the minds of governments, given the rapid spread of COVID-19 and the recent outbreaks of Ebola and Zika.

It is hoped that governments will unite around the Immunization Agenda 2030, an important and necessary step toward aligning and strengthening both immunization and national health systems. Working more effectively together can improve disease control and the health and well-being of everyone.

As Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, has said: “There is no health for all without vaccines for all. … They’re the foundation for individuals, families, communities, and nations to flourish.”

Behind WHO’s new strategy stands great momentum in the global health community to continue to advance the availability of lifesaving vaccines, while ensuring routine immunization can provide an effective platform to expand universal health care coverage. But to ensure vaccines do, in fact, work for all who are recommended to receive them, we must also ensure immunization is accessible at all stages of life.

Despite the availability and continued research and development of vaccines for adolescents and adults, they are still viewed by policymakers primarily as a tool to prevent infectious diseases for children. However, with people over 60 on track to outnumber children under 5 this year, proper attention to safeguarding adult health by adopting a life-course approach to immunization can have a big impact on public health and have a positive impact on the resources and capabilities of health care systems to support other groups and health challenges.

A report from IFPMA and The Health Policy Partnership has drawn lessons from six countries that are, to differing degrees, implementing a life-course approach to immunization. As the first country to introduce a comprehensive government-funded program for HPV in 2007, vaccine coverage for the virus in Australia increased to 80% of girls and 76% of boys. In the U.K., a group of general practitioners initiated a program to increase pertussis vaccination in pregnant women by identifying those who required the vaccine, then contacting and inviting them to be vaccinated.

The coverage rate rose from 63% to 73%, demonstrating how health care professionals can promote immunization across the life course. And in Japan, public health officials are creating targeted vaccination programs, having devised a campaign using comic book characters — in the Japanese genre known as manga — to offer free rubella vaccinations and antibody tests for unvaccinated men between the ages of 39 and 56.

Besides improving health throughout the population, a life-course approach to immunization has the potential to strengthen health systems. The report shows that by using a life-course approach, countries can provide individuals and communities with ongoing and sustained interaction with trained health care providers. This not only spreads the benefits of immunization, but it also helps countries move toward universal health coverage — an important goal of the Immunization Agenda 2030 and the Sustainable Development Goals.

And as our research shows, governments are central to strengthening and integrating immunization services — something recognized by government leaders themselves in the political declaration from the United Nations General Assembly’s first high-level meeting on UHC in September 2019. The declaration commits countries to accelerate progress toward full coverage for citizens in four major primary care areas and emphasizes the importance of increased access to affordable, safe, and effective medicines and vaccines. In addition, the declaration reaffirms the primary responsibility of governments to identify and pursue their own path toward UHC — noting “whole-of-society” and life-course approaches as particularly important.

This does, of course, require a shift in the mindset of health care investment, as systems are still largely built on treating illness, not preventing disease. About 3% of health care budget expenditure, on average, is currently spent on prevention — and even less on vaccines. If we can redress this balance, we will be able to put immunization at the heart of strategies to prevent disease and maximize health over one’s entire life. Consider the current COVID-19 situation: Increasing uptake of recommended vaccines for other diseases can help the availability of health care resources to focus on the potential impact of COVID-19 on their local populations, families, and individuals.

This is the test for the new immunization agenda. If it can help countries and health partners transition to a preventive life-course approach, it will be the game changer in health that the world needs. Doing so can help reduce the burden on health systems and lead to greater economic benefits for communities and countries by promoting workforce productivity. It can also lessen the spread of antimicrobial resistance, with one analysis of 75 countries estimating that universal coverage with a pneumococcal conjugate vaccine could lead to a 47% reduction in the amount of antibiotics used for pneumonia caused by Streptococcus pneumoniae in children younger than 5 years.

Countries aren’t on this journey alone. The global health community has never been more connected, determined, and focused to deliver impact. For our part, industry is engaging at all levels of responsibility to support the strengthening of immunization services, from building surveillance capacity and supporting effective procurement to the vaccine research and development programs currently underway for diseases such as RSV, HIV, chlamydia, and Clostridium difficile. Breakthroughs in these areas would offer the potential for further protection over a person’s life span, but the immunization programs are what will ensure their benefit is felt by people and communities around the world.

It is timely for policymakers and global health stakeholders to extend the benefits of immunization to everyone, everywhere, at every age that is recommended — leaving no one behind. The Immunization Agenda 2030 is an important opportunity to expand thinking and services. It sets the global health community on a clear path to helping control the spread of disease through new routine and comprehensive immunization programs, while building resilience in the services and systems needed to prevent and manage pandemic threats.

Even in these testing times, it is important that we remain hopeful about what we can achieve together today and for tomorrow.