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07.20.16

Strengthening Immunization in Conflict-Affected Countries

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Nicholas J. Diamond, J.D., LL.M., M.B.E.

Woman with Immunization Kit

Source: UNICEF

Earlier this month, the World Health Organization (WHO) and the United Nation Children’s Emergency Fund (UNICEF) released the latest data on global immunization coverage. While the data showed evidence of improvement in global immunization coverage, progress remains short of global immunization targets set by the Global Vaccine Action Plan (GVAP), a framework adopted by 194 Member States of the World Health Assembly in 2012 to address vaccine-preventable diseases and advance equitable access to existing vaccines. For instance, the recent data showed that 67 States have not yet been able to reach and sustain GVAP coverage targets and that coverage for newer vaccines (e.g., rotavirus) lagged in middle-income countries.

Most troubling, however, is the fact that immunization in conflict-affected countries remains a significant global concern. Immunization rates in conflict-affected countries, such as Somalia, have hovered at very low levels (less than 50 percent) across basic vaccines for a number of years. Immunization rates in conflict-affected countries, such as Ukraine, which has experienced sustained conflict in recent years, has resulted in significant declines in immunization rates across basic vaccines from higher rates (over 90 percent) in the early 2000s. Still other conflict-affected countries, such as Guatemala and Iraq, have experienced recent declines in immunization rates due to an under-investment in national immunization programs and vaccine stock-outs, among other factors, in addition to conflict.

What is more, children in conflict-affected countries have especially low immunization rates. As UNICEF reported earlier this year, nearly two-thirds of children who have not been immunized with basic vaccines live in at least partially conflict-affected countries. As a result, vaccine-preventable disease, such as measles and poliovirus, leave children in conflict-affected countries especially vulnerable.

While the GVAP provides a crucial blueprint for improving global immunization, the WHO and UNICEF must expand GVAP’s reach, particularly to address concerns in conflict-affected countries. As a threshold concern, vaccine prices remain prohibitively high for many countries. Public-private partnership like the Gavi Alliance have had wide success with market shaping to reduce vaccine prices, while maintaining key quality standards, the lessons from which the WHO and UNICEF should more fully utilize. For instance, the WHO and UNICEF should leverage prior success driven by Gavi around pooled procurement systems to develop similar targeted systems for conflict-affected countries and for crucial childhood vaccine-preventable diseases like measles.

To support targeted pooled procurement systems, recommendations in the GVAP around developing new versions or reformulations of basic vaccines—for instance, that require fewer doses, do not require refrigeration, or do not use needles—must be more aggressively implemented. As Médecins Sans Frontières has emphasized, conflict-affected countries especially benefit from newly developed versions or reformulations because of the logistical ramifications of easier vaccine delivery.

UNICEF’s supply chain division, which makes vaccine procurement purchases, could offer incentives, such as preferential purchasing status, to manufacturers that develop new versions or reformulations of basic vaccines that meet quality standards. More specifically, such incentives could target high-cost areas, such as the cold chain, and offer even greater incentives for new versions or reformulations that reduce resource burdens in interrelated delivery processes. Additionally, partnership agreements and targeted pooled procurement systems could include requirements to prioritize the development and use of new versions or reformulations of basic vaccines. What is more, innovative financing options under the technical guidance of the World Bank could be included to support the implementation of such requirements.

If the GVAP is to reach its immunization objectives by 2020, the WHO and UNICEF must augment their current strategy to address the specific needs of conflict-affected countries.

Nicholas J. Diamond, J.D., LL.M., M.B.E. leads market strategy in the healthcare and life sciences sectors at a global technology headquartered in Silicon Valley, serves on the adjunct faculty of the Department of Health Policy and Management at George Washington University, and serves as the managing director of Logos Advisors LLC.

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