The DoV Collaboration held approximately 20 consultations in Asia, Africa, Americas, Europe, Middle East and Western Pacific regions as well as an online consultation. More than 1,100 people from 142 countries and 297 organizations provided input as part of the consultation process to develop the GVAP. The consultation process was designed to ensure that meaningful input could be solicited from all key stakeholder groups: governments and elected officials, health professionals, academia, manufacturers, global agencies, development partners, civil society, media and the private sector.
Key themes that emerged from the consultations
The DoVC has incorporated, where possible, the themes that emerged into the revised draft GVAP submitted for this meeting. These include:
Country ownership: The GVAP needs to be meaningful to countries. Recommended actions and indicators should be relevant at country level and enable countries to reduce their reliance on external support. Country ownership means ownership by all stakeholders within a country (e.g., CSOs, academia, private sector and other national partners), not just governments.
Community engagement: While ownership at country level is of paramount importance, so is community-level engagement. Consultation participants emphasized that DoV actions must be undertaken with communities and not imposed on them.
CSOs engagement and capacity building: There is an opportunity to strengthen the role of CSOs in vaccines and immunization. CSOs are well positioned to support the implementation of many of the actions recommended in the GVAP if investments are made to build and strengthen CSOs capacity.
Vaccine hesitancy: Health care workers and other immunization champions feel unprepared to address misguided criticism of vaccines and immunization. Research is needed to understand the factors that contribute to vaccine hesitancy and training is needed to enable programme managers and champions to proactively address these factors. The impact and use of social media needs to be understood in this context.
Vaccines as part of comprehensive disease prevention and control: A concerted effort should be made during the DoV to shift from monitoring coverage to monitoring the disease impact of immunization. Immunization plans should be part of the broader national health sector plans. Country-specific immunization targets should be set within the context of national health priorities and morbidity and mortality reduction goals. Country commitment to immunization as a priority should under no circumstances come at the expense of other health programmes.
Coordination rather than integration: Previous GVAP drafts called for the integration of immunization with health systems. Consultation participants expressed concern that integration implied a merger of immunization programmes with other health programmes, which could compromise efficiency and effectiveness of EPI. Further discussions clarified that in many cases, immunization should continue to operate as it has done so-far, but coordination of immunization with other health services (and other immunization programmes in the case of campaigns) should take place at all levels of a country’s programmes.
Identifying the “game changers”: An attempt was made to identify one “game changer” action for each outcome in the GVAP. This attempt revealed that no one action is a silver bullet. Success will rely on multiple stakeholders collectively taking action to deliver on the DoV vision – some of these actions are already happening but additional actions are likely to be needed. For existing actions, there is a need to maintain and intensify progress. For new actions, there is a need to more fully define how to implement these actions and who will be responsible for the task.
Accountability framework: Consultation participants agreed that the establishment of a robust accountability framework for the DoV could be game changing. DoVC progress towards defining an accountability framework is summarized below.
Stakeholder responsibilities: Consultation participants affirmed the high-level stakeholder responsibilities articulated in the GVAP draft (see GVAP Appendix 2). They clarified that the primary responsibility is held by individuals and communities, governments and health professionals, as the recipients and providers of immunization. Other stakeholders also have an important role in achieving the GVAP outcomes and need to coordinate with those mentioned above.
Making the GVAP operational: Consultation participants consistently noted that the GVAP is a very high-level document that will be submitted for endorsement by the WHA in May 2012. They also noted that the process to translate the GVAP into country programmes needs to be clarified. The Delivery working group is taking the lead on this issue. The DoV Collaboration body of knowledge will be available on the DoV website.
What happens after the DoVC sunsets: The positioning of the DoVC as a “time-limited” effort produced mixed reactions. While it was commended that DoVC is not creating additional structures, concerns were raised by consultation participants on how to maintain momentum. Further work is needed to define the accountability framework for the DoV, which will include the definition of a structure and process for monitoring progress during the decade and holding stakeholders accountable.
We would like to thank all the countries and organizations which contributed to the Decade of Vaccines Collaboration effort and the development of the Global Vaccine Action Plan.