Life-course immunization: Country landscape report

Immunization is the greatest success story of the twentieth century. Vaccines eliminated most of the childhood diseases that used to cause millions of deaths, making possible a life without disabilities caused by certain communicable diseases like polio for the first time in human history.

In the twenty first century, though, the fruits of modern medicine are not reaching some of the most vulnerable, making global health insecure against vaccine preventable diseases (VPDs) once more.

Vaccines are critical to the prevention and control of many communicable diseases across all ages and therefore underpin global health security. Yet, only a few countries, such as the US, the UK, and Australia, have implemented a life-course approach to immunization (LCI) in line with recommendations in the Global Vaccine Action Plan 2011–2020 [1] (GVAP) and the Immunization Agenda 2030 (IA2030).

While there has been some progress, GVAP goals remain unachieved, and the pandemic has further exposed weaknesses in global immunization policies and most notably, on reaching out to the adult population. The focus on pediatric, maternal vaccination and seasonal influenza will not protect us from future pandemics.

Some progress has been made over the last years, though: the IA2030 explicitly adopts an LCI frame: “A world where everyone, everywhere, at every age, fully benefits from vaccines for good health and wellbeing.”, an important reorientation of immunization goals.

In parallel, WHO has issued the Defeating Meningitis by 2030 global roadmap, aiming to tackle the main causes of all-age acute bacterial meningitis (meningococcus, pneumococcus, Haemophilus influenzae, and groupB streptococcus). Additionally, the United Nations has designated 2021-2030 the “Decade of Healthy Ageing,” to improve the lives of older people and their families and communities. Together, these initiatives offer an opportunity to highlight the importance and value of LCI, especially for adults and older adults.

But there is much to be done in nine years if we are to reach our goals. There are significant operational gaps, as clearly documented in the GVAP 2020 evaluation. Few countries have inclusive national immunization programs (NIPs) and those that do focus more on pediatric immunization with little outreach for adult immunization.

Expanding coverage of adult vaccination will require major shifts in immunization programs to remove barriers to access and uptake. With an aging population, the societal need to prolong healthy living in the face of waning immunity means that new methods will be necessary to deliver integrated, people-centered vaccination services, expand protection with existing vaccines, and incorporate new vaccines as they become available for older age groups. Programs will also have to respond to significant global demographic shifts, which will have a major impact on the design and delivery of immunization services.

This project was commissioned to collect evidence focused on specific LCI policies and priority geographies, to compare available data sets and case studies before and during the COVID-19 pandemic, and to assess the quality of evidence for policy and practice change.