Message by the Director of the Department of Immunization, Vaccines and Biologicals at WHO – January 2024 – World Health Organization

Kate O'Brien, Director of the Department of Immunization, Vaccines and Biologicals at WHO

As the world welcomes a new year, the global health landscape is brimming with both opportunities and challenges. Let's take a closer look at the ongoing efforts and significant developments shaping the narrative of the first months of 2024.

Last week, the WHO Executive Board (EB) concluded its review of the Immunization Agenda 2030 (IA2030) 2nd progress report summarizing where things stand on the IA2030 goals, high-level priorities, and the implementation status of the IA2030 at country, regional, and global levels. The EB expressed strong appreciation for the DGs report to the Member States and re-emphasized many points raised in the report while recognizing the role played by WHO, UNICEF, Gavi Alliance and other partners. The EB emphasized the need for continued cooperation, essential to achieve the goals of the IA2030, across all key partners and stakeholders, and through national effortsandinvestment. Member States are calling for enhanced political will to increase investment in immunization.

We also achieved a significant milestone for child health as the scale up of malaria vaccines start across Africa, first in Cameroon on 22 January, and soon in many more countries. The first malaria vaccine, RTS,S, has been evaluated in large pilot implementations in Ghana, Kenya and Malawi that reached more than 2 million children and the impact of vaccination was remarkable: a 13% drop in mortality among children age-eligible to receive the vaccine, and a substantial reduction in child hospitalizations for severe malaria. There is high demand for malaria vaccine, and with the recent WHO policy recommendation and prequalification of a second malaria vaccine, R21, we now have two safe and effective malaria vaccines to drive down child illness and death from malaria. Tens of thousands of lives could be saved every year through the implementation of malaria vaccines, adding to the existing prevention tools.

The past year has seen the continued re-emergence of vaccine-preventable diseases such as cholera and measles in areas where they had previously been well controlled, while the total number of outbreaks of vaccine-preventable diseases also continued on an upward trend. The underlying, and often interrelated, drivers of this trend include insufficient vaccination coverage, health system fragility, conflict and insecurity, as well as climate factors, population growth, urbanization and displacement.

Nearly a year after the World Health Organization (WHO) classified the global resurgence of cholera as a grade 3 emergency, operations to control the disease continue. Since January 2023, 30 countries have officially reported cases of cholera. The overall global risk is very high, and up to 1 billion people are at risk of being affected by cholera. Given vaccine supply constraints and the increase in outbreaks and cases, the risk is getting more significant. WHO is conducting a comprehensive review of its response globally. The aim is to identify key lessons and make evidence-based adjustments for more effective coordination in the months ahead.

Dengue has been now classified as a Grade 3 emergency by WHO, as it demands the highest level of response from WHO and touches almost all the regions. About 4 billion people are at risk of becoming infected with the dengue virus worldwide, with over five million cases and 5000 deaths of dengue reported across 80 countries in 2023. The distribution of mosquitoes has changed in the last few years due to several factors and in 2023, El Nino phenomena and climate change have resulted in a rise in dengue, along with other arboviruses such as Zika, chikungunya and yellow fever.

Of particular concern is the elevated risk of vaccine-preventable disease outbreaks in areas marred by conflict or fragility, especially in the African and Eastern Mediterranean regions. Such settings often experience compromised healthcare and water and sanitation infrastructure, limited access to immunization services, and population displacements, amplifying the vulnerability to these diseases. To mitigate these risks, WHO is intensifying efforts to strengthen surveillance, laboratory capacity, clinical management and vector control in conflict and fragile settings, ensuring equitable access to vaccines when possible, and fostering community engagement. WHO is leading the Global Arbovirus Initiative - an integrated strategic plan to tackle emerging and re-emerging arboviruses with epidemic and pandemic potential focusing on monitoring risk, pandemic prevention, preparedness, detection, and response, and building a coalition of partners.

In a significant stride toward eradicating poliomyelitis, WHO has officially prequalified the novel oral polio vaccine type 2 (nOPV2) in December 2023, the first vaccine ever to be prequalified after previously being used under a WHO Emergency Use Listing (EUL) recommendation. This innovative vaccine is a critical tool to combat outbreaks of variant poliovirus type 2 (circulating vaccine-derived poliovirus type 2), affecting numerous countries primarily in the African and Eastern Mediterranean Regions.

The WHO's prequalification follows thorough reviews of safety, effectiveness, genetic stability, and quality assurance checks of manufacturing sites, marking the end of the vaccines EUL use phase. The transition to prequalification aims to streamline access to nOPV2, making it more readily available for countries grappling with outbreaks of variant poliovirus type 2.

While the availability of this vaccine is a crucial step, the success of polio eradication efforts also hinges on strengthening routine immunization services and surveillance. Efforts to ensure communities have access to routine immunizations and the establishment and maintenance of robust surveillance systems are essential components of a comprehensive strategy to detect and respond promptly to outbreaks.

This year marks an important public health anniversary. It is exactly 50 years ago, in 1974, that WHO established the Expanded Programme on Immunization(EPI). This milestone offers an opportunity to celebrate the program's success in preventing diseases, improving child and maternal health, and advancing healthcare equity. It is also an important moment to look ahead at the next decade with promises new and improved vaccines, technologies, and opportunities. The commitment of various stakeholders, including national governments, global and regional agencies, civil society, vaccine manufacturers, and many more, will be crucial for sustainability and delivering vaccines throughout the lifespan.

As the world progresses towards universal health coverage, the call for stronger, more equitable health systems resonates. Accessible and high-quality healthcare for all remains a shared goal, underscoring the collective efforts needed to create a healthier and more prosperous world.

Thank you for all you do, each day, to help get us there.

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Message by the Director of the Department of Immunization, Vaccines and Biologicals at WHO - January 2024 - World Health Organization