Immunization Highlights 2015: Report of the WHO Regional Office for Europe

This report describes the activities of the Vaccine-Preventable Diseases and Immunization (VPI) programme of the World Health Organization (WHO) Regional Office for Europe in pursuing the goals and objectives of the European Vaccine Action Plan 2015-2020 (EVAP) - namely, sustain polio-free status, eliminate measles and rubella, control hepatitis B infection, meet regional vaccination coverage targets, pave the way to evidence-based immunisation policies, and build capacity to ensure long-term financial sustainability. EVAP proposes strategies (including communication strategies) to meet these goals through five operational objectives, priority action areas, and a framework to evaluate and monitor progress towards them. The report covers both the accomplishments of 2015 and the challenges that lie ahead to meet the Region's immunisation targets.

In short, in 2015, protection from more vaccine-preventable diseases (VPDs) was provided through the introduction of new vaccines in several countries. 32 countries demonstrated interruption of measles and/or rubella transmission - described as a significant achievement for such a large and diverse Region, but far short of its potential. Through concerted efforts, the Region maintained its polio-free status as of the end of 2014, but was also dramatically tested by a vaccine-derived poliovirus outbreak in Ukraine that put millions of un- or undervaccinated children at acute risk of contracting the disease. National immunisation programmes, evidence-based decision making, and disease surveillance were strengthened, and tools were introduced to address vaccine hesitancy through better communication.

Three case studies included in the report illuminate these overall reflections by highlighting the EVAP goals, listed above, in action. The stories focus on: circulating vaccine-derived poliovirus in Ukraine (page 10), polio outbreak simulation exercises in Romania and Kazakhstan (page 12), and extensive engagement with Armenia in development of new advocacy resources (page 28).

The report also examines activities in support of each EVAP objective. These objectives include:

• Ensuring high-level commitment to immunisation as a public health priority - 39 of the 53 Member States have established a national immunisation Technical Advisory Group (NITAG). The Regional Office provides ongoing support to strengthen the role of NITAGs and to pursue other work toward this objective through high-level advocacy, capacity building, and development of tools and mechanisms for information dissemination and exchange. A case study of the immunisation programme managers' meeting in Belgium (page 34) provides a concrete example. Another story, that of efforts to cope with the migration crisis in Europe (page 36), explains how WHO together with United Nations High Commissioner for Refugees (UNHCR) and the United Nations Children's Fund (UNICEF) developed joint technical guidance on the principles of vaccination of refugees, asylum seekers, and migrants. The guidance stresses that an effective response requires strengthening national and regional health systems and ensuring that the services are fully inclusive and user-friendly.
• Helping individuals understand the value of immunisation services and vaccines and driving demand for vaccination - "Growing awareness of the urgency to improve communication around immunization has led the Regional Office to develop new approaches and materials to support countries...". Through traditional, online, and social media, the Regional Office aims to increase public awareness of immunisation facts and news and to support and highlight the work being done by Member States and our partners to improve immunisation coverage. For example, to minimise damage caused by real or perceived threats, in 2012, WHO developed a guide for countries on preparing for and responding to vaccine-safety-related events. Based on workshops conducted in various countries and consultation with stakeholders, a major revision of the document began in 2015. This project will culminate in 2016 with launch of a theoretical basis document document, web-based library of tools, supporting documents, and a training package. A case story on page 40 the restoring public confidence in immunisation in Kazakhstan describes strategies such as a roundtable briefing held in March 2015 for over 30 journalists in the country to increase knowledge and understanding of the risks of measles and the safety and effectiveness of the vaccine. A case study on page 42 describes European Immunization Week (EIW) in the Republic of Moldova. EIW was celebrated for the 10th time in 2015. Celebration of this milestone drew greater attention to the week and the important messages it promotes. EIW 2015 focused on maintaining commitment to immunisation – at political, professional and personal levels. EIW messages were broadcast by traditional and social media and distributed through many settings, from ministerial conferences to patient waiting rooms. Regional Office staff participated in several national events, including technical conferences in Belarus, Lithuania, and Poland, and press conferences in Albania and Austria. Support for national activities was also provided in the form of a communications package, merchandising, information products in English and Russian, and financial contributions for special projects.
• Developing tailored, innovative strategies to strive toward equitable access - A major area of work in this area is implementation of the Tailoring Immunization Programmes (TIP) approach launched in 2013; a case study on page 45 illustrates the TIP approach in the United Kingdom (UK).
• Strengthening links between immunisation and the overall health system - For example: "Health care workers have significant influence over immunization behaviour, but their understanding of and commitment to immunization can be low and suitable training opportunities may be limited. In response to recommendations of ETAGE [European Technical Advisory Group of Experts on Immunization], the Regional Office together with the European Society for Paediatric Infectious Diseases (ESPID) initiated in 2015 development of training materials on immunization for continuous medical education. The online, interactive course called 'Wiser Immunisers' takes a clinical approach, focussing on a range of vaccine-preventable diseases, vaccines, contraindications, communications and common misconceptions around immunization and vaccines. The ESPID course was piloted September to December 2015 and will launch in English in 2016. The next step will be to translate the materials into other languages and contexts."
• Securing sustainable funding and supply of vaccines - For example: "[T]he Regional Office launched a workbook on advocacy and resource mobilization for immunization in 2015. The workbook encourages immunization programme managers and staff to be aware of their own role and that of decision-makers in ensuring sustainable funding. A web-based immunization advocacy library provides them with the tools they need to engage accordingly with decision-makers. The Regional Office conducted training workshops for countries of the western Balkans and Gavi-supported countries. Plans for 2016 include in-country missions to provide technical support to develop national action plans. This will make it possible to monitor the implementation process at country level."

The report concludes with an annotated bibliography of relevant publications, with links to each for online access.