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Global Immunization Strategic Framework 2011–2015: Framework Format

CDC is committed to work with global partners toward achieving six overarching goals proposed in the framework during the next 5 years:

Figure 6. CDC working with global partners and spreading the importance of health and immunizations to children and adults.

Figure 6. Spreading the importance of health and immunizations to children and adults.

Goal 1: Control, eliminate, or eradicate targeted VPD disability and death globally (NVP Goal 5/Objective 5.2)

Goal 2: Strengthen capacity and enhance performance of health systems to sustainably deliver routine immunization services (NVP Goal 5/Objective 5.2)

Goal 3: Strengthen VPD health information and surveillance systems to enhance decision-making capacity for immunization programs (NVP Goal 5/Objective 5.1)

Goal 4: Increase the appropriate development, introduction, and use of new and underutilized vaccines (e.g., Hib, pneumococcal, rotavirus, HPV, MenA, HepB birth dose, rubella, JE , cholera, typhoid, malaria, yellow fever) to prevent diseases of global and regional public health importance (NVP Goal 5/Objective 5.3)

Goal 5: Promote synergies between immunization and other public health interventions to strengthen health systems and contribute to decreased maternal and child mortality and morbidity (NVP Goal 5/Objective 5.2)

Goal 6: Build and strengthen partnerships that maximize coordination and synergy in meeting immunization goals (NVP Goal 5/Objective 5.6)

Specific objectives provide realistic targets that measure the accomplishment of each goal. To help monitor progress over time, every objective also includes at least one key measure of success. Achievement of these goals and objectives will require inputs by multiple partners, national governments, and CDC. The strategies articulated in the framework outline broad activity areas where CDC can make specific contributions.

Goal 1

Control, eliminate, or eradicate targeted VPD disability and death globally (NVP Goal 5/Objective 5.2)

Objectives

Figure 7. CDC working with global partners and spreading the importance of health and immunizations to a young girl.

Figure 7. Spreading the importance of health and immunizations to a young girl.

  1. Achieve, certify, and maintain polio eradication

    Key measures of success:

    Cessation of all wild poliovirus transmission by end 2012 Certification of global polio eradication by end 2015

    Strategies:
    1. Conduct technical assessment and epidemiologic analysis to monitor the progress in reaching global eradication goals outlined in the Strategic Plan for Global Polio Eradication 2010–2012.[6]
    2. Provide technical and financial support for supplemental immunization activities to interrupt indigenous and re- established poliovirus transmission, limit international spread, and stop new outbreaks.
    3. Provide technical and financial support to maintain and enhance epidemiologic and laboratory-based surveillance for polioviruses and integrate with surveillance for other VPDs and communicable diseases as appropriate. (See also Goal 3, Objectives 1 and 2.)
    4. Contribute to the development and implementation of a research agenda to accelerate polio eradication, identify and evaluate new immunization and surveillance strategies, and identify safeguards to minimize poliovirus risks in the post-eradication period.
  2. Decrease global measles mortality and morbidity

    Key measure of success:

    By 2015, reduce estimated global measles mortality by 95% or more in comparison with 2000

    Strategies:
    1. Provide technical and financial support to achieve and sustain measles mortality reduction and elimination goals by achieving and sustaining high 2-dose measles vaccination coverage.
    2. Provide technical and financial support to maintain and enhance case-based, laboratory-supported measles surveillance. (See also Goal 3, objectives 1 and 2.)
    3. Contribute to the development and implementation of a research agenda to strengthen the scientific basis for achieving and maintaining measles mortality reduction and elimination goals, identify optimal measles immunization and surveillance strategies, identify and aid in the development of new laboratory methods to support global measles control programs, and address scientific questions regarding the feasibility of measles eradication.
  3. Accelerate global rubella control and congenital rubella syndrome (CRS) prevention

    Key measure of success:

    By 2015, at least two of six WHO regions achieve and sustain rubella/CRS elimination

    Strategies:
    1. Provide technical and financial support to develop and implement rubella immunization plans, monitor rubella/CRS disease burden, and achieve and sustain control/elimination goals.
    2. Provide technical and financial support to establish, maintain, and enhance case-based, laboratory-supported rubella and CRS surveillance that is appropriately integrated with measles surveillance when possible. (See also Goal 3, Objectives 1 and 2.)
    3. Contribute to the development and implementation of a research agenda to strengthen the scientific basis for achieving rubella and CRS control and elimination goals, identify optimal rubella immunization and surveillance strategies, and identify and aid in the development of new laboratory methods to support global rubella control programs.
  4. Decrease global burden of hepatitis B

    Key measure of success:

    By 2015, all countries in at least two of six WHO regions have reduced hepatitis B surface antigen prevalence to less than 2% among children under 5 years of age.

    Strategies:
    1. Provide technical assistance on developing and implementing hepatitis B immunization plans.
    2. Provide technical assistance on developing and monitoring progress toward achieving hepatitis B control goals.
    3. Contribute to the development and implementation of a research agenda to identify optimal hepatitis B immunization strategies, strengthen the scientific basis for achieving hepatitis B control and elimination goals, and identify laboratory methods to support global hepatitis B control programs.
  5. Achieve neonatal tetanus (NNT) elimination in all countries

    By 2015, NNT elimination (<1 case per 1000 live births in all districts) is achieved in all countries

    Strategies:
    1. Provide technical assistance to countries and partners to improve TT coverage by strengthening routine immunization programs and improving the quality of supplemental immunization activities.
    2. ii. Provide technical assistance to countries and partners to strengthen and maintain quality tetanus surveillance and conduct assessments to validate elimination. (See also Goal 3, Objectives 1 and 2.)
  6. Decrease morbidity and mortality of other VPDs of global or regional importance

    Key measure of success:

    By 2015, epidemics of serogroup A meningitis are eliminated in the Africa meningitis belt

    Strategies:
    1. Provide technical assistance and financial support for planning, implementing, and monitoring SIAs, enhancing surveillance, and monitoring impact and effectiveness for MenA in appropriate countries to prevent serogroup A meningitis outbreaks.
    2. Provide technical assistance and financial support for planning, implementing, and monitoring influenza SIAs.
    3. Evaluate the impact of JE vaccination and provide technical assistance to strengthen JE surveillance and control programs.
    4. Provide technical assistance designed to strengthen pertussis surveillance and control programs.
    5. Provide technical assistance on evaluating HPV vaccine introduction among adolescent girls.
    6. Evaluate the effectiveness of implementing cholera and typhoid SIAs to prevent or control diarrheal disease outbreaks.

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Goal 2

Strengthen capacity and enhance performance of health systems to sustain delivery of routine immunization services (NVP Goal 5/Objective 5.2)

Figure 8. CDC working with global partners and spreading the importance of health and immunizations Mothers and children.

Figure 8. Spreading the importance of health and immunizations Mothers and children.

Objectives

  1. Increase percentage of fully immunized children[7] by 12 months of age

    Key measure of success:

    By 2015, all countries achieve 90% coverage for fully immunized children nationally and at least 80% coverage in every district

    Strategies:
    1. Provide technical and financial support for building and strengthening capacity to plan, implement, and evaluate immunization programs at national, regional, and global levels.
    2. Support countries in increasing community involvement in immunization services, and work with partners to identify and implement strategies for increasing demand for vaccines and addressing issues related to vaccine refusal.
    3. Identify, evaluate, and facilitate implementation of existing and new technologies that are designed to strengthen immunization systems and approaches to enhancing vaccine supply and delivery.
    4. Contribute to the development and implementation of a research agenda to strengthen the scientific basis for vaccination strategies to reach more children, identify populations with low coverage, and develop new strategies to improve coverage, including strengthening links between routine immunization and supplemental immunization activities.
  2. Increase immunization coverage with appropriate traditional and new vaccines among older-age children (>1 yr), adolescents, and adults

    Key measure of success:

    By 2015, all countries that routinely provide a second dose of measles vaccine achieve 90% 2-dose MCV coverage nationally and at least 80% coverage in every district

    Strategies:
    1. Develop standardized process indicators and reporting tools for measuring program performance in reaching children older than 1 year of age.
    2. Provide technical assistance that supports country efforts in defining appropriate target populations, developing policies, and implementing plans for vaccination of older children, adolescents, and adults.
    3. Contribute to the development and implementation of a research agenda to establish the scientific basis for vaccination strategies for reaching children beyond infancy, and conduct operations research to assess feasibility of implementing new vaccination strategies.
  3. Increase the percentage of countries with a well-functioning (based on WHO criteria) National Immunization Technical Advisory Group (NITAG) with capacity to make evidence- based decisions on immunization policy and programs, including epidemiologically appropriate introduction of new and underused vaccines.

    Key measure of success:

    By 2015, 50% of countries have a well-functioning NITAG

    Strategies:
    1. Provide training for NITAG members and opportunities for them to develop appropriate knowledge and experience.
    2. Partner with WHO IVB and WHO Regional Offices to provide balanced policy advice and information to national decision makers to foster priority setting on new and underused vaccines.
    3. Establish evidence-based mechanisms to evaluate the functioning of NITAGs and to gather and share country experiences on national decision making.
  4. Promote safe immunization injection practices and develop country capacity to monitor and effectively investigate adverse events following immunization (AEFI)

    Key measure of success:

    By 2015, 50% of middle- and lower-income countries will conduct a National Regulatory Assessment to guide implementation of post-marketing surveillance for AEFI

    Strategies:
    1. Provide technical assistance designed to introduce, evaluate, and improve vaccine safety monitoring and surveillance programs.
    2. Provide technical assistance in responding to and evaluating vaccine safety signals arising from monitoring systems or other sources.
    3. Provide technical assistance on conducting ad hoc vaccine safety studies to evaluate vaccine safety concerns.
    4. Provide technical assistance on addressing emerging vaccine safety issues and communicating vaccine risks effectively and transparently to the public, health care providers, and other stakeholders.
    5. Provide technical assistance to countries on introducing, sustaining, and monitoring recommended safe injection practices for all vaccinations, including vaccines administered during routine immunization and supplemental immunization activities.
  5. Support the development of sustainable vaccine financing and procurement mechanisms to maintain adequate supplies of vaccines at global, regional, and national levels

    Key measure of success:

    By 2015, 75% of low- and low-middle income countries have a specific national budget line allocated to vaccine purchase and immunization program support

    Strategies:
    1. Provide technical assistance to regions and countries on developing sustainable vaccine procurement and financing mechanisms.
    2. Collaborate with partners to analyze global trends and conduct economic analysis on vaccine pricing and immunization program financing.

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Goal 3

Strengthen VPD health information and surveillance systems to enhance decision-making capacity for immunization programs (NVP Goal 5/Objective 5.1)

Objectives

Figure 9. Two women completing out immunization paperwork.

Figure 9. Two women completing out immunization paperwork.

  1. Increase the number of countries with access to proficient laboratory networks for vaccine-preventable diseases

    Key measure of success:

    By 2015, all countries have access to a high-quality (e.g., WHO accredited) national or regional laboratory that can accurately diagnose viral and bacterial VPDs

    Strategies:
    1. Strengthen national and regional public health laboratories in target countries by providing the training, equipment, reagents, and quality control procedures needed to sustain high-quality diagnostics for VPDs, with the objectives of monitoring disease burden, detecting outbreaks, detecting emerging variants, and monitoring impact of new vaccines.
    2. Conduct operational research to evaluate and improve diagnostic and specimen-handling processes critical to functional laboratory networks, and to develop and introduce new diagnostic and specimen-handling technologies to meet evolving VPD surveillance needs.
    3. Serve as global reference laboratory for selected VPDs, and provide technical assistance and funding support for global and regional VPD laboratory network coordination.
  2. Increase the number of countries with VPD surveillance systems that meet the minimum quality criteria required for program impact

    Key measure of success:

    By 2015, all countries have case-based measles surveillance and report at least 2 non-measles cases per 100,000 population

    Strategies:
    1. Provide technical assistance on developing global, regional, and national VPD surveillance policies and guidelines, including quality standards.
    2. Provide technical assistance on developing national capacity for VPD surveillance systems linked to VPD laboratory networks, including capacity to interpret and use information generated.
    3. Conduct national and sub-national reviews of VPD surveillance systems.
  3. Increase the number of countries with information systems meeting the minimum quality criteria required to effectively monitor and manage immunization programs
    Key measure of success:

    By 2015, 75% of countries have published information system policies and guidelines pertaining to the immunization program

    Strategies:
    1. Provide technical assistance on developing global, regional, and national immunization program information system policies and guidelines, including quality standards.
    2. Build national and regional capacity to sustain, improve, and monitor immunization program information systems that will ensure high-quality data collection, data management, information exchange, and use of standard operating procedures.
    3. Develop tools and methods for tracking immunization program targets and performance and for validating performance (e.g., improved methods for vaccine coverage surveys).
    4. Provide technical assistance on monitoring and evaluating national immunization programs, to include linking VPD surveillance reviews where appropriate.

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Goal 4

Increase the appropriate development, introduction, and use of new and underused vaccines (NUVs) (e.g., Hib, pneumococcal, rotavirus, HPV, MenA, HepB birth dose, rubella, JE vaccine, cholera, typhoid, influenza, malaria, yellow fever) to prevent diseases of global and regional public health importance (NVP Goal 5/Objective 5.3)

Objectives

Figure 10. Spreading the importance of health and immunizations to Mothers and children from around the world.

Figure 10. Spreading the importance of health and immunizations to Mothers and children from around the world.

  1. Increase the percentage of the global birth cohort that has access to NUVs as part of a national immunization schedule and, within 5 years of introduction, achieve the same vaccination coverage level for NUVs as for other vaccines given at the same age
    Key measures of success:

    By 2015, 45 GAVI-eligible countries have introduced PCV

    By 2015, 33 GAVI-eligible countries have introduced rotavirus vaccine

    Strategies:
    1. Support national decision making on NUV introduction by providing technical assistance on evaluation of disease burden, surveillance capacity, economic analysis methods, program implications, and vaccine impact.
    2. Integrate the introduction of NUVs into each country’s comprehensive multiyear plan, and provide the technical assistance necessary for successfully incorporating NUVs into routine immunization programs; link routine immunization programs with disease-specific control programs.
    3. Provide technical assistance to countries on assessing NUV effectiveness, impact on reducing childhood morbidity and mortality, and impact on immunization programs, and on evaluating barriers to achieving full coverage.
  2. Increase the number of new vaccines, improved vaccines, and combination vaccines that are prequalified by WHO for use in national immunization programs

    Key measure of success:

    By 2015, one cell-based influenza vaccine and one additional LAIV vaccine will be prequalified by WHO

    Strategies:
    1. Support development of vaccine reference strains and candidate vaccines against diseases of public health importance, especially to aid in response to emerging infections.
    2. Conduct studies on, and develop surveillance and laboratory capacity for, determining the disease and economic burden of targeted VPDs.
    3. Conduct and support research to evaluate efficacy and effectiveness of new formulations, dosing schedules, and alternative routes of administration for available vaccines.
    4. Develop laboratory methods and standards for evaluating immunogenicity and correlates of immunity for existing and new vaccines.

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Goal 5

Promote synergies between immunization programs and other public health interventions to strengthen health systems and contribute to decreased maternal and child mortality and morbidity (NVP Goal 5/Objective 5.2)

Figure 11. DC working with global partners and spreading the importance of health and immunizations to a Father and his two sons.

Figure 11. CDC working with global partners and spreading the importance of health and immunizations to a Father and his two sons.

Objectives

  1. Increase the number of countries that have developed, implemented, and evaluated comprehensive national maternal and child health plans of action that appropriately integrate immunization with other priority health interventions

    Key measure of success:

    By 2012, at least three GHI countries integrate immunization services with at least one other priority health intervention

    Strategies:
    1. Provide technical assistance on developing guidelines and standards for global and national plans of action for integrated disease control programs that address diarrhea, pneumonia, and other major causes of VPD-related mortality.
    2. Provide technical assistance at the national and sub-national level on appropriately using routine childhood immunization programs as a platform for the delivery of other priority health services.
    3. Develop standardized methods and tools for monitoring and evaluating the efficiency, effectiveness, and impact of combined public health interventions.
    4. Contribute to the development and implementation of a research agenda to strengthen the scientific basis for integration of immunization with other priority health interventions.
  2. Increase the number of countries that use immunization system capacity to provide information needed to make sound decisions on other priority health interventions

    Key measure of success:

    By 2012, at least two GHI countries integrate monitoring of immunization services with at least one other monitoring system for a priority health intervention

    Strategies:
    1. Develop tools and methods for linking the monitoring of immunization program performance and vaccine delivery with monitoring of programs that deliver other priority health interventions.
    2. Provide technical assistance on creating and enhancing integrated VPD surveillance and laboratory systems as a part of comprehensive communicable disease surveillance capacity.
    3. Build national and sub-national capacity for data analysis and program management by linking epidemiology, outbreak control, and management training for immunization program staff and other public health decision makers.
    4. Contribute to the development and implementation of a research agenda to strengthen the scientific basis for integration of immunization monitoring with monitoring of other priority non-vaccine health interventions.

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Goal 6

Build and strengthen partnerships that maximize coordination and synergy in meeting immunization goals (NVP Goal 5/ Objective 5.6)

Figure 12. Mothers and children receiving vaccines and healthcare.

Figure 12. Mothers and children receiving vaccines and healthcare.

Objective

  1. Increase the capacity of global, regional, and national partnerships to effectively plan, coordinate, fund, and implement strategies for reaching global immunization goals

    Key measures of success:

    By 2012, build and sustain the operation of a global partnership that has a concrete plan of action and champions the strengthening of routine immunization programs and achieving priority global immunization targets. By 2012, develop a Meningitis Initiative partnership to ensure coordination, sufficient funding, and technical resources to implement MenA campaigns in all countries in the Africa meningitis belt by 2017 and to monitor the elimination of serogroup A meningitis epidemics

    Strategies:
    1. Participate in and provide technical assistance at global, regional, and national forums on establishing global immunization goals, objectives, priorities, and policy.
    2. Support development and sustainability of external partnerships to reach key global immunization goals.
    3. Provide appropriate economic analyses and program evaluations to determine financial resource requirements, identify funding gaps, and develop plans for meeting resource requirements and successfully implementing global immunization programs.
    4. Develop key communication messages and implement advocacy measures to gain political and financial support for meeting immunization objectives.
    5. Work with global partners to rapidly detect and respond to emerging infections and global VPD outbreaks, including securing and maintaining adequate stockpiles or strategic reserves of appropriate vaccines.
    6. Strengthen partnerships within the USG to support global immunization goals as part of a comprehensive plan for enhancing maternal and child health.

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  • Page last reviewed: January 7, 2012 (archived document)
  • Content source: Global Health
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