Measles & Meningitis Elimination – WHO EB Sets Direction For Next Decade Of Vaccines Action

The World Health Organization Executive Board unanimously adopted two decisions that began to set the stage for global vaccine policy in the next decade – a draft resolution on “strengthening global immunization efforts to leave no one behind” and another on “eliminating meningitis by 2030,” after reviewing a report prepared by the Director-General on lessons learned from the Global Vaccine Action Plan (GVAP) 2011-2020.

The two decisions outlined key concerns for the architects of the global strategies to consider as they finalize the drafts for the “Immunization Agenda 2030” and “Meningitis Elimination by 2030” strategy for approval at this year’s World Health Assembly.

Health worker vaccinates young child against measles

According to the DG’s review, although more than 116 million children are now vaccinated annually, global vaccination coverage has plateaued at 85% in the past few years. Several members of the EB pointed out that the world is unlikely to eliminate measles and rubella – two recurring threats that have caused outbreaks worldwide.

The EB recognized the “unfinished agenda,” so dubbed by WHO Head of Vaccines and Biologicals Kate O’Brien, of stalling and backsliding vaccine coverage for measles, failure to achieve polio eradication, and the lack of improvement in reaching so-called “zero-dose” children – kids who have never received the first dose of the most common infant vaccine, DTaP.

Along with these standing items, new challenges such as vaccine hesitancy, urbanization and migration, climate change, and the difficulties of vaccinating in fragile, conflict-affected settings emerged as new challenges for the next decade, added O’Brien.

All of these issues, O’Brien said, are “being addressed” as the next iteration of the Global Vaccination Action Plan is being drafted.

Vaccine hesitancy, first recognized by WHO as a major threat to global health in 2019, was of particular interest to many members and observers. Indeed, the somber prophecy was fulfilled as refusal to vaccinate or delays in vaccinating played parts in causing four European countries to lose measles elimination status in 2019, and were factors in a deadly measles outbreak in Samoa that infected over 5,000 people.

“As infectious diseases decrease, public attention shifts from the dangers of diseases to the dangers of vaccines,” said the delegate of Singapore. “Misinformation is amplified by social media.” Australia, Iran, Germany on behalf of the European Union, the United States, Mexico, and Brazil also echoed these concerns.

But other delegates brought up that misinformation and vaccine hesitancy were only one part of the puzzle. Indonesia added that outside of “sociocultural” factors related to vaccine refusal, “lack of support from stakeholders, communications strategies, and geographical concerns,” along with “affordable access” are still preventing the final 15% of unvaccinated and under vaccinated children from being reached.

China, home to a strong emerging vaccine manufacturing industry, urged WHO to support “local vaccine production” and “proprietary research” in countries struggling to eliminate measles. Brazil, another large host of vaccines producers, added that the next GVAP should consider “diversification of vaccine manufacturers.”

Observers were in less agreement on the timeline of measles elimination. Norway asked WHO to “postpone a time-bound measles goal until elimination is in sight,” while Russia followed up by asserting that “global eradication of measles and rubella… are topical and achievable aims of the next decade.”

Meningitis Elimination by 2030

Along with concerns around the long-standing goal of measles elimination, the focus was pointed towards a deadlier vaccine-preventable disease – meningitis.

However, many countries expressed they would have preferred a separate discussion completely on the disease, rather than have the discussion on meningitis under the larger agenda item of immunization.

A young girl receives a meningitis vaccine.

Burkina Faso, backed up by a previous comment from Germany on behalf of the EU, expressed that “many countries” felt that “more than vaccination” was needed to address the disease.

“In Africa… we say you can only count the total number of your children when the meningitis outbreak has passed,” the delegate from Burkina Faso expressed. “That is how serious it is. I think to a certain extent you have to have suffered from this problem to know how grave it is.”

Germany, on behalf of the EU, stated that they were concerned about the governance structure of the current meningitis strategy.

As the clock ticked towards dinner, the Chair of the EB proposed a compromise on the decision – the resolution itself would be supported with an added request to the secretariat to “make an extensive effort to strengthen governance.”

Meningitis is an infection of the brain and spinal cord lining causes epidemics across the world, but most often in the so-called “meningitis belt” – a region of sub-Saharan Africa that stretches from Senegal to Ethiopia.

Gavi-Transitioning Countries Concerned

Tanzania, along with other countries receiving support from Gavi, the public-private partnership that has helped multiple low- and middle-income countries rapidly increase the number of vaccines in their national immunization programmes, urged the international community to continue supporting such efforts.

“We are worried about the ‘post-Gavi’ era,” said the delegate for Tanzania.

“Under the GVAP 2011-2020, Tanzania has introduced a record number of new vaccines… however we are worried… to sustain gains and introduce new vaccines. We plead for continued support, especially for measles, mumps, and rubella vaccines, across the regions.”

The United Kingdom, a founding member of Gavi, followed up with an appeal to support the partnership’s fifth replenishment this year, which will be hosted in London in June 2020.

Image Credits: WHO, WHO/John Kisimir.