History as African Heads of State adopt Addis Declaration on Immunisation

Highlights:

• Increasing vaccine-related funding
• Strengthening supply chains and delivery systems
• Making universal access to vaccines a cornerstone of health and development efforts

Heads of State from across Africa today in Addis Ababa , Ethiopia,  adopted a Declaration on Universal Access to Immunization in Africa, in which they endorsed the Addis Declaration on Immunization, a historic and timely pledge to ensure that everyone in Africa – regardless of who they are or where they live – receives the full benefits of immunization. The endorsement was issued during the 28^th African Union (AU) Summit in Addis Ababa, Ethiopia.

While Africa has made impressive gains over the last 15 years toward increasing access to immunization, progress has stagnated, and the continent is falling behind on meeting global immunization targets. One in five children in Africa still does not receive basic life-saving vaccines and, as a result, vaccine-preventable diseases continue to claim too many lives. Measles alone accounts for approximately 61,000 preventable deaths in the African region every year.

“We know that universal access to immunization is achievable,” noted outgoing African Union Commission Chairperson Nkosazana Dlamini-Zuma. “The Addis Declaration on Immunization is a historic pledge. With political support at the highest levels, we are closer than ever to ensuring that all children in Africa have an equal shot at a healthy and productive life.”

The Addis Declaration on Immunization calls for countries to increase political and financial investments in their immunization programmes. It includes 10 commitments, including increasing vaccine-related funding, strengthening supply chains and delivery systems, and making universal access to vaccines a cornerstone of health and development efforts.

“Vaccines are among the most effective public health tools available,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “When children are given a healthy start, communities thrive and economies grow stronger. This show of support from Heads of State is a significant step forward in our efforts to achieve universal access to immunization and, ultimately, improve child health and drive sustainable development across Africa.”

Fewer than 15 African countries fund more than 50% of their national immunization programmes. As Africa nears polio eradication, critical funding for immunization through the polio eradication programme is expected to ramp down. Additionally, countries approaching middle-income status will transition away from Gavi support for immunization in the coming years. Consequently, governments must redouble their efforts to make universal immunization coverage a national priority.

“As long as even one child in Africa lacks access to immunization, our work remains unfinished,” said Dr Ala Alwan, WHO Regional Director for the Eastern Mediterranean. “With the right mix of political will, financial resources and technical acumen, Africa can – and will – stem the tide of vaccine-preventable diseases across the continent.”

With strong leadership and investment, increased access to immunization is within reach. For example, in 2010, Ethiopia built 16,000 new health centres, purchased 2,000 battery-free solar refrigerators for vaccine storage, and built a network of millions of health extension workers and volunteers at community level to increase access to immunization throughout the country. Since these investments were made, Ethiopia has made remarkable gains, with immunization rates soaring from 61% in 2010 to 86% in 2015.

“Immunization is one of the smartest investments a country can make in its future,” said H.E. Professor Yifru Berhan Mitke, Ethiopia’s Minister of Health. “We must do more to protect all our children from preventable diseases – not only because it is the right thing to do, but also because it makes economic sense. When our children are healthy, our families, communities and countries thrive.”

The Addis Declaration on Immunization was signed by Ministers of Health and other line ministers at the Ministerial Conference on Immunization in Africa (MCIA) in February 2016 in Addis Ababa. MCIA was the first-ever ministerial-level gathering with a singular focus on ensuring that children across the continent can access life-saving vaccines. To guide the implementation of the ADI, a roadmap is being developed in close collaboration with the WHO offices in the African Region and Eastern Mediterranean Region, the African Union Commission and immunization partners.

“African leaders are showing outstanding leadership by endorsing this landmark commitment which will allow more African children to be reached with life-saving vaccines no matter where they live,” said Dr Ngozi Okonjo-Iweala, Chair of Gavi, the Vaccine Alliance board. “We must now ensure that the commitments translate into sustainable financing for immunization. Gavi stands ready to support African countries in their efforts to implement equitable health approaches and maintain strong immunization coverage so we can create together a more prosperous future for communities across our continent.”

– APO Release

The Addis Declaration on Immunization

We, African Ministers of Health, Finance, Education, Social Affairs, Local Governments attending the Ministerial Conference on Immunization in Africa, which took place from 24 to 25 February 2016 in Addis Ababa, Ethiopia, and convened by the World Health Organization in collaboration with the African Union Commission, are committed to continued investment in immunization programs and a healthy future for all people of the African continent.

Recognizing the tremendous advances that are improving the health of Africa’s citizens, including:

• A 50% decline in child death rates, and ever-growing numbers of children attending school;
• Widespread access to vaccines that were not available to African children and adults just a decade ago;
• Higher vaccine coverage rates across the continent in each five-year periods between 1999-2014;
• The remarkable achievement of the Africa continent for interrupting wild poliovirus transmission for more than one year; achieving near elimination of Meningococcal meningitis A epidemics, and the significant reduction in disease burden and mortality due to measles.

Bearing in mind the recently ratified Sustainable Development Goal target of Universal Health Coverage which calls for access to immunisation for all (New York, September 2015); and that health is fundamental to social and  economic development;

Acknowledging that broad-based, inclusive growth in Africa is dependent on a healthy population; and that strong immunization programs are a cornerstone of robust systems that help achieving universal health coverage, which is critical to helping national leaders achieve their economic and development goals;

Reaffirming the economic imperative and benefits of reducing vaccine-preventable diseases and consequential deaths, which will improve overall health, empower our future generation and allow every person to achieve his or her full potential;

Recalling the Heads of State Declaration on Polio Eradication in Africa: “Our Historic Legacy to Future Generations” (Johannesburg, June 2015); the World Health Assembly resolution (WHA68.6) on the Global Vaccine Action Plan (Geneva, May 2015), the commitment made by African Ministers of Health on Universal Health Coverage in Africa (Luanda, April 2014); the Immunize Africa 2020 Declaration (Abuja, May 2014) endorsed by African Heads of State; the World Health Assembly resolution that commits all 194 Member States to apply the vision and strategies of the Global Vaccine Action Plan (GVAP) (Geneva, May 2012), and the African Heads of State endorsement of the Pharmaceutical Manufacturing Plan in 2012 as the framework for African people to have access to essential, quality, safe and effective medical products and technologies.

Recognizing that despite progress, universal access to immunisation by 2020, as endorsed under the GVAP, is largely off track in Africa as indicated by the 2014 GVAP report; but that with resolve we can still achieve the GVAP target of at least 90% coverage in our countries and at least 80% coverage in every district for all nationally available vaccines;

Admitting that to sustain the progress made in vaccine introduction and coverage – and achieve the full potential to save children’s and adult’s lives – current national budgetary allocations to vaccination programmes within the context of national health systems financing will need to be further increased;

We hereby collectively and individually commit ourselves to:

• Keeping universal access to immunisation at the forefront of our efforts to reduce child mortality, morbidity and disability, and in doing so help our countries achieve their long-term health, economic and development goals;
• Increasing and sustaining our domestic investments and funding allocations, including innovative financing mechanisms, to meet the cost of traditional vaccines, fulfil our new vaccine financing requirements, and providing financial support for the operational implementation of immunization activities by EPI programs;
• Addressing the persistent barriers in our vaccine and healthcare delivery systems, especially in the poorest, vulnerable and most marginalized communities, including the strengthening of data collection, reporting and use at all levels as well as building effective and efficient supply chains and integrated procurement systems;
• Increasing the effectiveness and efficiency, as well as changing the approaches as needed, of our immunization delivery systems as an integrated part of strong and sustainable primary health care systems;
• Attaining and maintaining high quality surveillance for targeted vaccine preventable diseases.
• Monitoring progress towards achieving the goals of the global and regional immunization plans
• Ensuring polio legacy transition plans are in place by end-2016 that will allow future health programs to benefit from the knowledge and expertise the polio program has generated through the eradication initiative;
• Developing a capacitated African research sector to enhance immunization implementation and uptake;
• Building broad political will, working with communities, civil society organizations,  traditional and religious leaders, health professional associations and parliamentarians, for the right of every child and every community to have universal access to life-saving vaccines, and by extension the best possible chance for a healthy future;
• Promoting and investing in regional capacity for the development and production of vaccines in line with the African Union Pharmaceutical Manufacturing Plan including the strengthening of national regulatory authorities.

We call upon:

• Member states and partners, including African development banks and African regional economic communities, to support the implementation of this Declaration, and to increase their efforts to mobilize resources and secure new investments to strengthen national immunization programmes to achieve the GVAP goals and overall health care delivery systems in the Member States;
• Member states and partners, to negotiate with vaccine manufacturers to facilitate access to available vaccines at affordable prices, and in increasing price transparency as well as developing price databases in line with resolution WHA68.6;
• Gavi, the vaccine alliance to consider refugees and internally displaced populations as eligible recipients of Gavi support for vaccines and operational costs;
• The World Health Organization and the African Union Commission to support member states to share experiences, strengthen capacity, and establish mechanisms for monitoring progress towards the fulfilment of these commitments.

We thank his Excellency Hailemariam Desalegn, Prime Minister of the Federal Democratic Republic of Ethiopia, and host country for this Ministerial Conference on Immunization in Africa, for agreeing to champion this declaration and further request him to present it to the African Heads of States at the 26th Summit of the African Union, to be held in June 2016.