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Integrating Immunization with Other Health Interventions for Greater Impact: The Right Strategic Choice

Monday, 9th of January 2017

• The Journal of Infectious Diseases, Volume 205 Issue suppl 1, pp. S4-S5.

Integrating Immunization with Other Health Interventions for Greater Impact: The Right Strategic Choice

1. 1.        J. M. Okwo-Bele
2. Correspondence: J. M. Okwo-Bele, MD, Immunization Program, Department of Vaccines and Biologicals, World Health Organization, Geneva, Switzerland (okwobelej{at}who.int).

1.        Immunization Program, Department of Vaccines and Biologicals, World Health Organization, Geneva, Switzerland

 

This The Journal of Infectious Diseases supplement rightly focuses on the notion of integrated healthcare, which has a long history in public health. Integrated healthcare has been proposed to tackle the need for complementarity of different interdependent services and structures to better achieve common goals [1]. Integration offers the opportunity to focus on the resolution of broader health system barriers, such as absence of qualified human resources or poor infrastructure that hamper immunization as well as other health interventions. By alleviating these barriers and providing multiple preventive and curative interventions, there is a high expectation of a corresponding increase in the demand and use of health services by the target population.

In 2005, the World Health Organization (WHO) and UNICEF launched the Global Immunization Vision and Strategy (GIVS) in response to estimates that more than 10 million children were dying each year [2, 3]. GIVS calls for deliberate planning efforts to extend immunization coverage, especially for underserved, hard-to-reach people. GIVS has served to guide countries in expanding the scope of national immunization programs to reduce vaccine-preventable disease mortality and morbidity by two thirds by 2015 compared with 2000, as a contribution towards achieving the Millennium Development Goals, especially Goal 4: reducing under-5 mortality. Although the estimated number of deaths had fallen to 8.1 million by 2009, the levels of mortality in children less than 5 years old in the WHO African Region (127 per 1000 live births) and in low-income countries (117 per 1000 live births) were still higher than the 1990 global level of 89 per 1000 live births [4].

The next decade will undoubtedly provide an unprecedented opportunity to protect more people against more diseases worldwide, with increasing availability and affordability of existing vaccines and the introduction of new vaccines and technologies in the national immunization programs [5]. Through extensive consultative processes, WHO has recently released a series of evidence-based recommendations, position papers, and guidelines for broadening the scope of immunization efforts to all age groups [6]. The introduction of Haemophilus influenzae type b in developing countries has gained traction, with 158 of 193 member states having introduced this vaccine at the end of 2010. Further progress is still expected because China, India, Nigeria, and Indonesia, comprising 45% of the developing world birth cohort, have yet to introduce this vaccine. The pneumococcal conjugate and rotavirus vaccines licensed recently have been introduced in 42 and 23 countries, respectively, worldwide. These numbers will rapidly increase with the growing demand for these vaccines. Support from the GAVI Alliance to the neediest countries will be critical. The launch of the Advance Market Commitment in 2010 is predicted to contribute to accelerated uptake of pneumococcal vaccine in the developing countries that are eligible for GAVI support. Recent announcements of vaccine price reductions, such as for rotavirus vaccine, will also facilitate country adoption and introduction. GAVI Alliances support should encompass the need for sustainable introduction of new vaccines while contributing to the strengthening of integrated delivery mechanisms and systems more broadly.

Most of the remaining child deaths are due to a few preventable causes: pneumonia, diarrhoeal diseases, malaria, and human immunodeficiency virus/AIDS; all of which are often compounded by malnutrition. Much more needs to be done to further expand coverage of existing interventions, and to develop and introduce new ones in a sustainable and universal manner. Recognizing that some new vaccines do not address the entirety of major public health problems, more comprehensive disease prevention and control strategies are promoted where immunization is just one element. The Global Action Plan for the Prevention and Control of Pneumonia (GAPP) is one example that sets out specific goals, targets, and strategies to scale up disparate key interventions of proven benefits such as exclusive breastfeeding, vaccination, and treatment of pneumonia. The plan outlines the priority actions that are required at various levels to ensure progress. Additional integrated action plans have been designed by WHO and other partners for the prevention and control of diarrhoeal diseases and cervical cancer. Another important global initiative is the Decade of Vaccines Collaboration, which plans to create a Global Vaccine Action Plan and enhance coordination of national policymakers, donor agencies, civil society, and other key players to maximize protection against diseases through adoption of integrated interventions that address health promotion, health prevention, care, and treatment.

Recently, WHO member states have renewed their commitment to improving the performance of health systems to reach the Millennium Development Goals. Achieving equity and high coverage with a package of lifesaving interventions must remain central for health planners, especially in resources-constrained settings.

There is a general consensus that a primary healthcare approach can bring people value by responding to their demands and their needs [7]. Furthermore, there are abundant experiences and clear evidence that where health centers offer a range of services, vaccine coverage rates tend to be higher. It is thus imperative that immunization be delivered as part of a package of lifesaving interventions. Lessons can be learned from the experience that has been accumulating on the roll-out to scale of primary healthcare interventions in a variety of settings, including among population groups living in areas where health services are inadequate or fragmented.

However, WHOs vision of planning and providing integrated health services, especially to the hard-to-reach, can only be successful if adequate human and financial resources are allocated. Indeed, accomplishing an expanded agenda is much more challenging than a narrower one. Governments and their development partners must therefore vigorously establish mechanisms that facilitate synergies within the health sector, as well as collaborate in intersectoral approaches, to increase their responsiveness to community needs and priorities.

 

Potential conflicts of interest.

Author certifies no potential conflicts of interest.

The author has submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

• © The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

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