"...reaching more...introducing new...linking with others...” (WHO)
Immunization is one of the most powerful tools available to improve public and global health. Immunization is both cost-effective and life-saving and it “benefits all people, not only through improvements in health and life expectancy but also through its social and economic impact at the global, national and community level” (GIVS 17). It is estimated to have averted over 2 million deaths in 2003 alone (GIVS 3). Providing immunizations to those in need has a promising future; however millions of people are still at risk for preventable diseases and every year, approximately 2.5 million children die as a result of diseases that could be prevented by immunization. The Global Immunization Vision and Strategy, GIVS, was developed by the World Health Organization and United Nations Children’s Fund because “globally and in some regions immunization coverage has increased only marginally since the early 1990s” (GIVS 3.) GIVIS works to recognize past immunization achievements and use experience to develop ways to immunize more people globally, introduce new vaccines and technologies, and provide other health interventions at immunization sites. GIVS “aims to immunize more people, from infants to seniors, with a greater range of vaccines. Its chief goal is to, by 2015 or earlier, reduce illness and death due to vaccine-preventable diseases by at least two thirds compared to 2000 levels” (WHO). The GIVS strategy will enable stakeholders to address the challenge through financing new technology and underused vaccines and ensuring adequate supply and access (GIVS 3).
The first stage in developing a strategic and action plan is to convene a planning group made of individual and organizational stakeholders. GIVIS was jointly developed by the expertise of many partners including WHO, UNICEF, Australian Aid, Canadian International Development Agency, Centers for Disease Control and Prevention, United States Health and Human Services Department, United Nations Foundation, Bill and Melinda Gates Foundation, Global Alliance for Vaccines and Immunization (GIVS), The Vaccine Fund (VF), and Program for the Appropriate Technology in Health. Input from stakeholders helped to create the multiple vision statements and the strategic framework of GIVS. The vision of GIVS is a world by 2015 in which:
- “immunization is highly valued;
- every child, adolescent and adult has equal access to immunization as provided for in their national schedule;
- more people are protected against more diseases;
- immunization and related interventions are sustained in conditions of diverse social values, changing demographics and economies, and evolving diseases;
- immunization is seen as crucial for the wider strengthening of health systems and a major element of efforts to attain the Millennium Development Goals (MDGs);
- vaccines are put to use in improving health and security globally; and
- solidarity among the global community guarantees equitable access for all people to the vaccines they need” (GIVS 16).
Also in describing the GIVS vision for the community, a set of guiding principles was developed. These principles were the inspiration for the global strategy. Guiding principles included: equity and gender equality; ownership, partnership, and responsibility; stakeholder and actor accountability; assured quality and safe products and services; strong district-based immunization systems; sustainability through technical and financial capacity building; and policies and strategies based on evidence and best practice. Objectives and goals of the initiative serve as a marker of accomplishments. Objectives for GIVIS fall into two categories: supporting the MDGs and selective immunization goals. Goals that support the MDGs include:
- Reducing child mortality by two thirds between 1990 and 2015 (MDG 4)
- Improving maternal health by reducing the maternal mortality ration by three quarters between 1990 and 2015 (MDG 5)
- Combating HIV/AIDS, malaria and other diseases (MDG 6)
Selective immunization goals, developed in conjunction with GAVI and VF which follow the SMART+C acronym include:
- By 2010 or sooner, all countries will have routine immunization coverage at 90% nationally with at least 80% coverage in every district;
- By 2007, all countries with adequate delivery systems will have introduced hepatitis B vaccines, and
- By 2005, 50% of the poorest countries with the highest disease burden and adequate delivery systems will have introduced Hib vaccine” (GIVS 17).
One additional goal is to “increase immunization against influenza among all people at high risk, reaching 75% coverage by 2010” in the event of an influenza pandemic (GIVS 17).
Out of the goals and global assessment, a global strategy was created to respond to the needs of immunization services around the world. Information generated from immunization monitoring and history helped to identify personal and environmental risk and protective factors. These included issues such as existing community demand for vaccines, the strength of vaccine-management systems, management of human resources, and affordability of vaccines. The prioritized population for change who can most benefit from the effort are the “28 million children (27% of all births)” “born in 32 countries, where immunization coverage is less than 70%, including the 10 million in countries with coverage under 50%” (GIVS 19). Agents of change include global partners with shared goals, research institutions developing new technologies such as vaccine aerosols and patches, health workers, and national, regional, and district health systems.
GIVS identifies four key strategic areas in their framework which affect the targets of change on many levels. Within each of the four strategic areas, there are a total of 24 component strategies with accompanying actions that will result in the accomplishment of the goals and objectives. The four strategic areas are: I. Protecting more people in a changing world; II. Introducing new vaccines and technologies; III. Integrating immunization, other linked health interventions and surveillance in the health systems context; and IV. Immunizing in a context of global interdependence. An example of a component strategy and activity for strategic area I is: strategy 3, “ensure that unreached people are reached in every district at least four times a year” “through micoplanning at the district or local level, map (geographically, socially, culturally) the entire population in order to identify and reach the unreached target population” (GIVS 71).
By evaluating the action plan, GIVIS acknowledges numerous potential challenges for each of the strategic areas and attempts to create solutions to the challenges. Examples of potential challenges include the divergence of vaccine markets, the loss of contact with immunization services during humanitarian emergencies, inadequately planned financial resources, and poor budgetary management in many countries. Global interdependence has increased the vulnerability of people around the world to disease (GIVIS 3). The GIVS strategic and action plan both guide and enhance the work to reduce this vulnerability.
Please see the following link for the complete GIVS strategic plan:
"Global Immunization Vision and Strategy." World Health Organization. 1 Dec. 2007 <http://www.who.int/immunization/givs/en/index.html>.
Adapted from: Global Immunization Vision and Strategy, 2006-2015. World Health Organization and UNICEF. Geneva: WHO Department of Immunization, Vaccines and Biological and UNICEF Programme Division, Health Section, 2005.