Expert advisory group reviews strategies to reach immunization goals in Europe


The ETAGE meeting was conducted simultaneously in English and Russian.

The independent European Technical Advisory Group of Experts on Immunization (ETAGE) assessed the broad portfolio of activities undertaken in the past year by WHO/Europe’s Vaccine-preventable Diseases and Immunization programme (VPI) at its 16th annual meeting on 12–13 October 2016. ETAGE applauded the progress made, while recognizing ongoing challenges in the Region and advising VPI on strategic priorities for the coming year.

ETAGE is made up of independent experts in a range of fields, including epidemiology, clinical medicine, laboratory surveillance and psychology. Its role is to review and advise on the work and direction of VPI.  “WHO has become more visible in the Region in the past year, contributing to stronger immunization systems and high demand for vaccines. Looking ahead, the importance of these tasks will only increase as we get closer to regional elimination of measles and rubella and global eradication of polio,” said Adam Finn, ETAGE chair.  

The 16th annual meeting began a new chapter for ETAGE, with 2 veteran members stepping down from the Group (Pierre van Damme and Christian Peronne) and 3 new members attending their first meeting  (F. Nur Baran Aksakal, Alenka Kraigher and Roman Prymula). This year’s annual meeting was also attended by Jon Abramson, Chair of the global Strategic Advisory Group of Experts on Immunization (SAGE), as well as representatives of national immunization technical advisory groups (NITAGs) from Albania, Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Tajikistan and Uzbekistan. This brought together the three tiers of independent advisory committees (global, regional and national) that contribute to evidence-based policy making on immunization.

The ETAGE meeting was followed by a meeting for all attending NITAG representatives to review the status of the NITAGs, outline the common challenges and shortfalls, and share best practices in making evidence-based recommendations on national immunization policy and practice. The NITAG meeting included a question and answer session with the Chair of ETAGE and the Chair of SAGE on developments related to pertussis and human papillomavirus (HPV) vaccines.

Both meetings were conducted simultaneously in English and Russian.

Highlights of WHO/Europe activities

VPI provides technical support to Member States in joint pursuit of the goals and objectives of the European Vaccine Action Plan (EVAP). Mr Robb Butler, Programme Manager, and his staff presented activities of the past year, stressing the importance of the programme’s strategic partnerships with international partners and donors and its close collaboration with health authorities at national and local levels.

Outbreak prevention and response

Among other activities, Mr Butler detailed VPI’s efforts to support immunization of children in conflict areas within Syria through the WHO office in Gaziantep, Turkey. This work is carried out in collaboration with the Turkish authorities, the United Nations Children’s Fund (UNICEF) and other partners.

Outcomes of a 12-month assessment of the 2015 polio outbreak in Ukraine led by the chair of the Regional Certification Commission for Polio Eradication (RCC) were also presented. This assessment concluded that the outbreak announced in September 2015 was considered over; however due to persisting immunity gaps Ukraine is still considered at high risk for polio transmission in the event of an importation.

Supply and pricing

Two fatal cases of diphtheria (one in Spain and the other in Belgium in 2015 and 2016 respectively) highlighted the challenges countries in the Region face in obtaining diphtheria antitoxin (DAT), the required treatment against toxigenic bacteria. ETAGE expressed concern regarding this and other supply challenges, requesting that VPI engage further in investigating and addressing these issues.

Encouraging progress was reported in the increase and impact of vaccine pricing transparency. Of the 40 countries that contributed data to the global Vaccine Product, Price and Procurement (V3P) project in 2015, 30 are in the European Region. In the period since data has been collected through this project, large discrepancies between vaccine prices paid by individual countries have begun to decrease, and an overall trend of declining vaccine prices has been observed. ETAGE was encouraged by these developments and also requested that VPI pay close attention to market forces to be aware of any adverse effects that transparency might have for individual countries.  

Middle-income countries strategy

With fewer resources than higher-income countries, and less donor support for immunization than low-income countries, middle-income countries have fallen behind in immunization progress. ETAGE endorsed VPI’s plan to develop a comprehensive middle-income countries strategy to address their specific needs in a cost-effective manner in the coming years.

Education, advocacy and tailored delivery to sustain high immunization coverage

WHO is acutely aware of the important role played by health workers in preventing transmission of vaccine-preventable diseases by being fully immunized themselves and accurately informing parents and patients about vaccines, including contraindications. VPI is therefore working on several projects to increase awareness through training, continuing education for health professionals and also a school-based curriculum for young people – the vaccine decision-makers of the future. ETAGE encouraged further development and an impact evaluation of these activities.

As vaccine-preventable diseases become less visible thanks to immunization, maintaining high demand for vaccines critically depends on the public’s trust in vaccines and health authorities. VPI provides technical assistance to national programmes to adequately address vaccine safety concerns, ranging from capacity building to investigate suspected adverse events following immunization to facing vocal vaccine deniers in a public debate.

WHO/Europe has led the way in advocating for tailored solutions to immunization challenges. The Tailoring Immunization Programmes (TIP) approach has been implemented in several countries and adapted to address influenza immunization, antimicrobial resistance and contexts beyond the European Region.  A robust evaluation of the approach is ongoing, and expected to culminate in a second edition of the publication in 2017.  

Other topics covered during the 2-day meeting included rotavirus sentinel surveillance, oral polio vaccine switch, poliovirus containment and the remaining steps to achieve measles/rubella elimination throughout the European Region. The latter includes closing immunization gaps, especially among the susceptible adult population – a traditionally difficult target group to reach with supplemental immunization efforts. 

The conclusions and recommendations of ETAGE’s 16th annual meeting will be posted on the WHO/Europe website in English and Russian.