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"Civil society organizations [CSOs]...were specifically invited to submit reports focusing on their efforts to improve ownership, leadership and accountability from national and subnational authorities."

The Global Vaccine Action Plan (GVAP), endorsed by the 194 Member States of the World Health Assembly in May 2012, is a framework to prevent deaths by 2020 through more equitable access to existing vaccines. A yearly report (see Related Summaries, below) is prepared by the Secretariat for the Decade of Vaccines (DoV), which is made up of: the Bill & Melinda Gates Foundation; Gavi, the Vaccine Alliance; the United Nations Children's Fund (UNICEF); the US [United States] National Institute of Allergy and Infectious Diseases; and the World Health Organization (WHO). This report serves as the basis for the independent review of the Strategic Advisory Group of Experts on immunization (SAGE). It reviews progress against each of the indicators in the Monitoring and Evaluation/Accountability Framework of the GVAP. In addition, it contains a narrative report on trends in vaccine prices, updates on tracking resources and commitments to immunisation, and independent voluntary submissions from various partners on the activities - including communication-centred activities - they conducted under the GVAP umbrella.

There are several goals/strategic objectives and corresponding indicators that guide the GVAP, such as: ensuring country ownership of immunisation, which is gauged by indicators including presence of an independent technical advisory group, and demand for immunisation, which is measured by indicators such as the percentage of countries that have assessed the level of hesitancy in vaccination at a national or subnational level. In the 2016 report, a new indicator on vaccine safety has been included following the request from the SAGE DoV working group (WG). Also, the indicator for integration of health care interventions and immunisation activities has been revised following the requests by the SAGE DoV WG. To facilitate the exploration of the data, for several indicators, some data visualisations that measure progress against the goals and strategic objectives of the GVAP have been made available in an interactive format on the TechNet-21 website. You can share your opinions or ask questions about these visualisations on the forum.

The GVAP Secretariat report covers various goals in detail (with bibliographies sharing materials that supported the description of each goal, such as: Achieve a world free of poliomyelitis (indicators G1.1 and G1.2). Highlights since the last annual report are included. For example, in April 2016, in a globally synchronised effort, 155 countries ceased using type 2 oral polio vaccine (OPV), switching from trivalent OPV (tOPV) to bivalent OPV (bOPV). Since August 2014, wild poliovirus (WPV) has been circulating in 2 countries: Afghanistan and Pakistan. In 2015, more countries were affected by circulating vaccine-derived poliovirus (cVDPV) outbreaks than by WPV, giving the former a greater precedence and illustrating how important the OPV switch will be in 2016. A sample of this section of the paper: "Planning for the post-polio eradication transition is the fourth objective of the current GPEI [Global Polio Eradication Initiative] Strategic Plan....GPEI has developed and issued transition guidelines to assist countries with their planning process. GPEI is now supporting countries in applying these guidelines, particularly emphasizing a high-quality process of mapping country needs and GPEI assets, as the basis for subsequent planning and engagement of a broad range of stakeholders in the planning process, including donors....It is critical to document the lessons learned from polio eradication, as one of the largest ever global health initiatives. GPEI will document and disseminate lessons learned from polio eradication in multiple media forums."

Communication strategies come into play in various portions of the report, such as in the section on "Indicator SO1.2: Presence of an independent technical advisory group that meets the defined criteria". Definitions of indicators for a functional National Immunization Technical Advisory Group (NITAG), as agreed upon in 2010 by the WHO and its partners in this effort are provided - as are data sources and the target (functional NITAGs in all Member States by 2020). Here is an excerpt from this portion of the report: "Various NITAG-related tools including the finalization of a NITAG training manual and an evaluation protocol have been finalized by the WHO Collaborating Centre on 'Evidence-informed immunization policy-making' at the Agence de Médecine Préventive, health policy and Institutional development unit (AMP-HPID). At the Veyrier-du-lac international NITAG meeting, the value of NITAG evaluations using the tool recently developed by AMP was stressed. This and other tools are accessible under the NITAG Resource Centre website, which aims to be a centralized resource compiling information and providing a collaborative platform for NITAGs and is maintained by AMP-HPID. Advocacy by involved stakeholders at national and global levels are necessary to ensure sufficient time, effort and money are invested."

Much concrete data is included in the report, such as findings from a study on main themes indicated as top 3 reasons for vaccine hesitancy for all WHO regions. The WHO-UNICEF Joint Reporting Form (JRF) 2015 revealed that the most frequently listed determinants for vaccine hesitancy continue to be: (i) risk–benefit issues of the vaccine, in particular concerns around vaccine safety; (ii) lack of knowledge and awareness of vaccination and its importance; (iii) religion, culture, gender, and socioeconomic issues - in particular, religious reasons.

Various case studies submitted by the Gavi CSOs Constituency are provided as part of Strategic Objective 2: Individuals and Communities Understand the Values of Vaccines and Demand Immunization both as a Right and a Responsibility. To cite only two of the many examples, in Afghanistan, CSOs are major players in the implementation of the Ministry of Public Health's Basic Package of Health Services (BPHS). The Ministry of Public Health initiated a "polio eradication is my responsibility" campaign, asking every Afghan to support this important issue. "For the polio eradication campaign, deepened civil society involvement was central to ensure access to children in times of conflict in the Southern region. District polio teams worked with CSOs to gain access to areas occupied by armed opposition groups. Equally important, CSOs have been critical partners in the actual delivery of vaccines and other health services. HealthNet TPO, a health-focused non-governmental organisation (NGO) and a key partner of the Ministry of Public Health, runs the health system in 3 provinces using an approach grounded in community participation, support, and ownership. Using its network of over 100 facilities and thousands of community volunteers, it participates in polio eradication campaigns, vaccinating children through fixed centres, outreach, and mobile services. HealthNet TPO also piloted a public-private partnership approach to deliver vaccines alongside reproductive health services in Uruzgan province in an effort to reach insecure and difficult-to-access villages. The initiative, supported by the government and Gavi, has expanded to other provinces, including Helmand in the south. "The success of these activities has bolstered acceptance of polio vaccination. The dedicated efforts of community health workers, especially female vaccinators who regularly visit households, have played a key role in pushing polio out of the Southern Region....Synchronized polio eradication campaigns between Afghanistan and Pakistan have been an encouraging sign that political commitment to eradicating polio remains high. The role of CSOs in educating parents, traditional and community leaders, and government officials on the benefits of the polio vaccine and other vaccines in preventing death and disease is more critical than ever."

Also included is the July 2016 Gavi CSO Constitutency Stakeholders' Report, which has been prepared since 2014 for inclusion in the annual GVAP Secretariat report. The purposes of the 2016 independent civil society report are to: (i) share examples of strategies used by CSOs in ensuring leadership and accountability from the local to the global level; (ii) highlight the results of these leadership and accountability strategies; and (iii) describe the extent to which civil society capacity has been strengthened in order to respond to and sustain participation in leadership and accountability processes for immunisation- and health-system strengthening and immunisation equity, etc. One section (see Table 7, beginning on page 226) includes examples provided by 22 country-level stakeholders from 9 focus countries, featuring indication of strengthened CSO capacity in the areas of: (i) communication and advocacy; (ii) networking, collaboration, and linkages (with government, donors, other organisations and stakeholders); (iii) gender (e.g., gender equity, gender-sensitive approaches); and (iv) community mobilisation, participation, and involvement at all levels. For 2016, civil society recommends that: (i) a meeting be organised with the Gavi CSO Steering Committee and the SAGE GVAP working group to discuss how recommendations from 2014 and 2015 can be supported, implemented, and monitored as appropriate and relevant at the country, regional, and global levels; (ii) guidance be made available to country-level immunisation and Health Systems Strengthening (HSS) staff regarding how to work with CSOs to strengthen immunisation and health programmes, with a focus on engaging local CSOs; and (iii) support be provided to, and work undertaken with, in-country CSOs to help them regularly collect data that they analyse and report on in order to clearly communicate their contributions to immunisation- and health-systems strengthening. Small grants should be provided for CSO trainings on data collection, analysis, monitoring, and reporting.

Editor's note: In addition to the GVAP Secretariat Report 2016 summarised above and linked below, click here to access: (i) 6 regional progress reports; (ii) 7 priority countries' progress reports; and (iii) the Score Cards for immunisation summarising the immunisation coverage for all antigens and for all countries from 2000 to 2015.