Global Health Security Agenda: GHSA Immunization Action Package (GHSA Action Package Prevent-4)

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Five-Year Target: A functioning national vaccine delivery system—with nationwide reach, effective distributions, access for marginalized populations, adequate cold chain, and ongoing quality control—that is able to respond to new disease threats.

As Measured by: At least 90% coverage of the country’s fifteen-month-old population with at least one dose of measles-containing vaccine as demonstrated by coverage surveys or administrative data.

Desired National Impact: Effective protection through achievement and maintenance of immunization against measles and other epidemic-prone vaccine-preventable diseases (VPDs). Measles immunization is emphasized here because it is widely recognized as a proxy indicator for overall immunization against VPDs. Countries will also identify and target immunization to populations at risk of other epidemic-prone VPDs of national importance (e.g., cholera, Japanese encephalitis, meningococcal disease, typhoid, and yellow fever). In the case of some diseases that are transferable from cattle to humans, such as anthrax and rabies, animal immunization should also be taken into account.

Country Commitments to Action Package:

  • Leading countries: Italy, Portugal
  • Contributing countries: India, Pakistan, Republic of Korea, Saudi Arabia, United Arab Emirates, Yemen
  • Contributing international organizations: FAO, OIE, WHO

Five-Year Action Items:
Actions will be coordinated, as appropriate, with relevant international organizations including FAO, OIE and WHO.

  1. Conduct routine immunization activities, focusing on measles coverage of fifteen-month-olds.
  2. Establish activities that address immunity gaps for measles and other epidemic-prone VPDs by strengthening routine immunization services and implementing supplementary immunization activities (SIAs).
  3. Implement case-based surveillance according to minimum standards.
  4. Implement a communication plan to accompany immunization campaigns and practices.
  5. Detect and investigate measles and other VPD outbreaks that occur.
  6. Provide access to a laboratory in a VPD laboratory network for diagnostic confirmation in order to strengthen capacity for early detection of measles and other epidemic-prone VPDs.
  7. Strengthen effective outbreak response immunization for measles and other epidemic-prone VPDs by a) improving capacity to conduct high-quality SIAs, including development and maintenance of detailed and validated microplans, rigorous selection and training of vaccination teams, identification and dissolution of barriers to vaccination within older age groups and vulnerable populations; and b) providing access to vaccine stockpiles.
  8. Achieve and document sufficient vaccine production.
  9. Achieve and document conduct of safe injection practices.
  10. Achieve and document vaccination of health care workers.
Baseline Assessment and Planning Activities
  1. Assess and document past and current achievement of national and subnational vaccination coverage targets for measles and other epidemic-prone VPDs by conducting vaccine coverage surveys and serosurveys when appropriate, with an initial focus on measles coverage.
  2. Identify barriers to improving efficiencies in the prevention of VPDs (e.g., poor bacteriology capacity, prior antibiotic use, improper specimen collection/handling/transport, lack of standardization of laboratory procedures, barriers to vaccination among older age groups, poor quality control, limited human resources, poor network coordination, poor communications).
  3. Identify laboratory capacities necessary to address VPDs, and identify the applicability of using Global Laboratory Network laboratories to respond to emerging infectious diseases with new diagnostics.
  4. Work with the Expanded Program on Immunization to identify the applicability of routine immunization in endemic situations and identify gaps.
  5. Identify areas of improvement for VPD surveillance components including epidemiology, laboratory, and data management.
  6. Identify ways to leverage countries’ immunization priorities with regard to the Millennium Development Goals and various GAVI Alliance initiatives.
  7. Identify instruments to use (e.g., the new user-friendly tool for district-level measles risk assessment developed by the United States Centers for Disease Control with a grant from the Bill and Melinda Gates Foundation).
Monitoring and Evaluation Activities
  1. Conduct appropriate monitoring and evaluation of the implementation and impact of VPD immunization, with an initial focus on 90% measles-containing vaccine (MCV1) coverage and later considering post-introduction evaluations for second dose (MCV2) coverage.