Vaccine report highlights barriers to global vaccine action plan

By Julie Griffiths on 27 November 2018 Measles vaccination

Vaccine hesitancy and measles outbreaks have been two of the barriers to the so-called ‘decade of vaccines’ launched in 2010. 

The global vaccine action plan (GVAP), a multi-sectoral effort led by WHO, set ambitious targets for 2020 and its penultimate assessment report has been published. 

In the past eight years, coverage of first dose measles-containing vaccine has stagnated at around 85% globally, with major local discrepancies in coverage. However, coverage with the second dose of this vaccine has risen from 39% in 2010 to 67% in 2017.

But measles outbreaks in 2017-18 illustrate the fragility of success. 

In six years, the incidence of measles had decreased from 50 cases per million in 2010 to 19 in 2016. But, in just one year, it rose to 25 cases per million globally. 

Over the course of the year, four of the six WHO regions had substantial measles outbreaks – measles was once again endemic in every region of the world after the Americas lost their measles-free status. 

Humanitarian crises and violence catalysed many of these setbacks. With the complex political situation in Venezuela came the re-emergence of measles. After 24 years without the disease, 1600 suspected cases of diphtheria were recorded between 2016 and 2018. 

Two other major diphtheria outbreaks affecting Rohingya refugees in Cox's Bazaar in Bangladesh and conflict-ravaged Yemen occurred in 2017-18. 

Maternal and neonatal tetanus elimination remains particularly elusive in countries affected by conflict such as Afghanistan, Central African Republic, Nigeria, and Yemen.

Vaccine hesitancy has been another major barrier. 

In 2017, of the 159 countries that provided information about vaccine hesitancy, only seven countries reported its complete absence. 

Evidence indicates that hesitancy due to lack of awareness or knowledge is decreasing and is now substantially surpassed by concerns about the risk versus benefit of vaccination. 

There has been a rise in the politicisation of immunisation – for example, Italy's radical turn on mandatory vaccination for measles, tetanus, and polio in August and the discovery that Russian bots and trolls were creating fake online debate about vaccines on Twitter.