Regional Immunization Technical Advisory Group (RITAG) Meeting

Submitted by sarkisn on Tue, 12/11/2019 - 12:05
Opening remarks by WHO Regional Director for Africa, Dr Matshidiso Moeti


Good morning everybody, bonjour, tout le monde,

My dear sister Helen Rees, the Chair of the Regional Immunization Technical Advisory Group,

Current and past RITAG members,

My other sister, Rose Leke, who chairs the Africa Regional Certification Commission for Polio Eradication,

Dear colleagues from partner organizations and colleagues from WHO – AFRO, headquarters and countries.

A very good morning to all of you:

It really is my great pleasure to join you briefly this morning and to welcome all of you to Brazzaville for this RITAG meeting.

From the outset I have to apologize that every time I have agreed on a date for a RITAG meeting, something comes up. We are in a very intense phase of transformation at the global level of WHO, to which we are aligning in the Region. One of the things happening is that we are having a series of bilateral meetings with our main partners and donors, and yesterday I had to attend a meeting with one of the big donors who is working closely with us in the African Region – so apologies once again, for having missed this meeting.

I am really impressed by the diversity of backgrounds and skills and competencies, and the very high level of skill, of the RITAG. So, thank you very much for agreeing to share your time and your expertise with us in the Region.

Helen, I very much agree with the approach of being a group that adds value. There is no point us having a group that will simply agree to everything we are doing and thinking. Please be assured that your constructive criticisms are very much welcome, this is the only way we are going to improve on the work we are doing. So really, I would like to thank you all for investing all this time, for sharing with us your expertise, all in the interests of improving the health and lives of children and other people who need vaccines in the Region.

Following a comment made by Helen, I missed this BBC story, but we know that we do continue to face many challenges in immunization in the African Region.

Sadly, routine immunization coverage has stagnated in the Region over the past 10 years.

One of my tasks when I was the Deputy Regional Director was to compile the Report of the RD to the Regional Committee every year and I remember the first line in the chapter on immunization always used to be “the immunization coverage rate is such and such” and I used to notice with dismay that this number is not changing, this number is not reaching the 90 per cent that we are supposed to reach. So, it really is a cause for concern and we very much welcome your advice and your support to help us make a difference here, because it means that millions of children in the Region are not being immunized for various reasons and also due to limitations in service delivery systems.

Our population in the African Region is continuing to grow, and the expectation and the hope is that the pace of immunization should match population needs. This means there is a need to find innovative solutions that enable us to reach every child, particularly those who are marginalized and hard-to-reach.

We must seek to know in detail and in every country, who these children are who are missed, where they are, what are the factors driving their lack of access to one of the most effective public health interventions, which would make such a difference to their health and to the health of other children as well in their communities.

Because it is largely due to low immunization coverage that we are facing outbreaks in several countries, in situations that can be describe almost as an emergency in the Region. For example, the Democratic Republic of the Congo is experiencing a huge measles outbreak, with more than 230 000 suspected cases and over 4500 deaths – nearly all of them children. 

We have to remind ourselves that we are very preoccupied at the moment with helping the Government to control an Ebola outbreak, but in fact the number of measles deaths is way over the number of people that have died from Ebola. We have other examples, for instance, earlier this year, Madagascar and Nigeria, were also experiencing measles outbreaks.

Putting a stop to outbreaks of vaccine-preventable diseases requires that we strengthen routine immunization as part of primary health care and our collective action to achieve universal health coverage. This is one of the key themes in the Immunization Agenda 2030 framework that you will be looking at during this meeting.

So, we have to ask ourselves some questions: What do we need to do differently? For example, in the context of humanitarian crises, conflict situations and in what are called fragile or vulnerable states, where we find protracted humanitarian crises. How can we ensure that children there get vaccinated despite the challenges, because we know that it in these contexts we find large numbers of children not being reached, in the same way that we find other health problems are exacerbated, for example maternal deaths. We need to be able to work within the context of humanitarian interventions to ensure that all children, who unfortunately are having to live under these circumstances, also get reached by these services.

Also, we often assume that it is only in remote, rural areas that children get missed, but are realizing more and more that in urban and low-income areas there are also gaps in coverage of essential health services, including immunization. What do we need to do to change this ironic and sad situation as well?

So, while we face significant challenges, in the past year, we have also seen key breakthroughs and are on track to celebrate an historic milestone, which is the certification of wild poliovirus eradication in the African Region – which we hope and expect will happen early next year. This will be a tremendous achievement for the Member States of the African Region, and I would like to thank you all for your contributions along the way, the advice that you have given, the support to Member States as they have implemented their polio interventions. including their polio campaigns.

We also note that through the polio programme, we have built a capable workforce, and implemented some best practices and innovations, and going forward I would like to ask for your ideas to ensure that we maximize these investments to benefit routine immunization and other public health priorities.

We have been talking about polio transition for many years, certainly before I became the Regional Director. Again, I would like to note that we started with our polio programme to work with our Member States, I would say 17 or more years ago, to start to plan for this transition and we are now at a stage where we have transitioned out staff in some countries. We need to see a much more intense attempt to ensure that we don’t lose these polio assets, particularly those who are working to support some key interventions in routine immunization.

And as we work to finish polio once and for all, it is imperative that we rapidly address outbreaks of circulating vaccine-derived poliovirus, now present in 12 African countries, and frankly putting a damper on our current celebration of polio eradication certification.

Again, this is partly due to low immunization coverage and it also means that we need to be maintaining strong surveillance, improving immunization coverage, implementing effective emergency response procedures, and ensuring communities have adequate water and sanitation. We have talked a lot about improving our collaboration with the water and sanitation sector in the context of polio eradication and in child health in general.

This year Ghana, Kenya and Malawi have all started piloting the world’s first malaria vaccine, RTS,S – with positive reports to date, although we know the vaccine is of limited efficacy, so we need to explore how this would be integrated as part of the wider malaria interventions. We will be very interested to get your views and your guidance on expanding the use of this vaccine to other high-burden countries as soon as we have the results of this field testing.

In addition to this, the use of the investigational vaccine in the response to the Ebola outbreak in the Democratic Republic of the Congo, has made a significant difference in the number of cases and deaths in this outbreak that is taking place in a very difficult and challenging context. It would be helpful to have your recommendations on the future use of these investigational vaccines in outbreak response. I am aware that the Merck vaccine was licensed just yesterday for use, so this is news hot off the press, as you will be deliberating on this and seeking to advise on the use of these Ebola vaccines.

Finally, earlier this month, nine middle-income countries agreed to work towards pooled procurement mechanisms by first sharing vital information on their vaccine purchasing practices, including the prices that they pay, and information on their suppliers.

We know that the issue of countries, which are not Gavi-eligible, or countries that are transitioning from Gavi support, has been of great concern in ensuring that those countries are able to introduce new vaccines, are able to pay for vaccine supplies, to manage their programmes, and to keep up with the rest of the countries in reaching every child with vaccination. I think that this is an extremely timely intervention by these countries and by partners. Countries have been expressing their concern and asking for support for a number of years.

Sharing information and ultimately pooling their orders will better leverage their individual purchasing power and thus strengthen vaccine security and increase access to affordable life-saving vaccines for children in their countries. We need to share with these countries the experience and several attempts to do pooled procurement of medicines in other settings, and make sure that children in these countries do get all the vaccines they need, similarly to children living in low-income countries.

We are also seeing a very exciting push on innovation in the Region, and I was glad to hear from one of the members of the RITAG that they are interested in innovations in vaccine delivery. In the African Region, we can promote, and support innovations, and also prepare our countries and work with them to adopt and integrate innovations into service delivery as soon as possible. This is something that it would be interesting to hear from you about, perhaps not in this meeting as it is not in the agenda, but in subsequent meetings.

In closing, I have some expectations to express of the RITAG during this meeting:

First, is to provide us with strategic advice in all the areas that you are going discuss in the next three days. This includes taking into consideration the comparative advantages and roles of our partners – many of whom are present at this meeting.

Secondly, we would very much appreciate your advice on actions WHO can take to build on the momentum of the Addis Ababa Declaration on Immunization that was adopted by Heads of State at the African Union Summit in 2017. How can we leverage this political declaration and help to translate it into action in each and every one of the countries? And here I think the role of the NITAGs that are participating in this meeting and others will be very critical, as will be the role of our colleagues and partners who are operating at the country level.

This will include briefing Heads of State at the African Union summit next year. I have asked the Minister of Health of Ethiopia to work with us in helping to table this item on the agenda of the AU Summit, so that we follow-up and we see, and we remind the Heads of State of their commitment and share with them how they are doing in delivering on the promises implied in this declaration.

Thirdly, I’d like to emphasize integration of immunization activities so that they benefit from the ongoing efforts to strengthen health systems in countries in the Region. We must ride on the intense momentum of universal health coverage including following the high-level event at the United Nations General Assembly in September, which was attended by a significant number of Heads of State, as well as Ministers of Health, and Ministers of Foreign Affairs. Many of whom made statements, and all of whom then signed on to the declaration that came out of that high-level event. We are observing that this time, not only are Heads of State making declarations in summits, they are also instructing their Ministers of Health to take action on universal health coverage.

At WHO at the moment, we are quite frankly overwhelmed by the number of requests for support from Member States. For example, to revise their health financing strategies so that they are more equitable, to reduce the financial burden on families, and to support them to deliver better services in a more decentralized way, to improve the capacity at the district level to manage service delivery to reach every person, including to reach every child.

So, children under-five and adolescents and others who need vaccination can be addressed through these methods, in ways that work for them, and in ways that ensure we cover the gaps that we are continuing to see in the coverage of vaccination services. We need to take advantage of this ongoing work as well as ensure that routine immunization contributes to strengthening health services and systems in countries and to achieving universal health coverage.

Again, I would like to say, I look forward to working with you to implement the recommendations arising from your deliberations, and I hope that this meeting will accelerate our collective action to ensure immunization does reach every child.

In concluding, I would like to pay tribute to those RITAG members who have declared that they are transitioning out of the RITAG. Again, thank you so much for everything you have done to advise us and to enable us to play our role in advising and supporting Member States to reach every child, and every person, with vaccination and immunization services.

If you don’t mind I’d like to pay a special tribute to two members of the RITAG who have been with us for decades. First, my older brother-in-law Dr Mohamed-Mahmoud Hacen, who has declared that he has gone back to Mauritania and is engaged in public health there, and also Daniel Tarantola who is an old, old colleague, who happened to have worked with my mother, who passed away a month and a half ago unfortunately, but who was very much an admirer of Daniel.

I would like to thank all of you, really, for the support you are providing to us, for the valuable advice that you give us, and I hope that this will be a very productive meeting that you are starting on now.

Thank you very much.