GHLS Blog Series: A Brave New Approach Needed to Reverse Global Immunization Declines: Q&A With Sabin Vaccine Institute President Anuradha Gupta

Anuradha Gupta is President, Global Immunization, at the Sabin Vaccine Institute, a Global Health Council member. She joined Sabin in October 2022 after eight years as Deputy CEO of Gavi, the Vaccine Alliance. She will be speaking at the closing plenary of the 2022 Global Health Landscape Symposium on Dec. 8.

The focus of the 2022 GHLS is how global health leaders can best “meet the moment” three years into the COVID-19 pandemic. You have been outspoken about meeting the moment regarding reversing global immunization declines. What do you mean by that?

COVID-19 not only laid bare the deep and persistent inequities between and within countries but exacerbated them perilously. We are witnessing the largest sustained decline in routine immunization in 30 years. Zero-dose children, who have never received a single vaccine shot, have increased by 37% since the onset of the pandemic – increasing the risk of disease outbreaks and preventable deaths. The alarming resurgence of polio and measles among unvaccinated populations, even in countries that have long eliminated these diseases are a reminder that vaccination is not a one-time act. And we have also lost ground on HPV vaccination. The result: More than 85% of young girls have zero protection from a virus that causes more than 95% of cervical cancer cases despite the existence of a highly effective vaccine.

Even before the pandemic hit, global compacts aimed at bringing the full power of vaccines to everyone were losing steam. After decades of rising routine immunization rates, progress stagnated, and millions of children born every year remained zero-dose, having not received any lifesaving vaccinations. Although 1 in 8 children were zero-dose prior to the pandemic, they accounted for nearly half of all vaccine-preventable deaths – an acute vulnerability too grim to be overlooked. Vaccinating these children must be our top priority to defeat disease outbreaks, deaths, and medical impoverishment.

Vaccines must continue to be delivered every day, everywhere, and to everyone to stay ahead of deadly pathogens. This means being brave and bold to prevent further backsliding of immunization and to reach zero-dose and under-vaccinated populations. Business as usual would mean failed goals and lost lives.

What does a brave and bold approach to global immunization look like?

Sabin has embraced a vision we have termed BRAVE as our new strategic framework for urgent action in global immunization:

B – Boost immunization to reverse the declines in routine immunization, ensure sustained vaccine delivery, acceptance and demand, and bolster immunization across the life-course from infancy to adulthood.

R – Reduce the number of zero-dose children through targeted community-based approaches, multisectoral strategies, and advocacy for investments that prioritize reducing immunization inequities, which are often a pointer to other health and socioeconomic deprivations and a fertile ground for disease outbreaks.

A – Accelerate vaccine introduction to ensure all regions, countries, and people can access the benefits of vaccines available today and sustain resilient systems equipped to roll out future vaccines that could avert the next pandemic.

V – Value communities and value women so that immunization programs are tailored to local settings, respond to community needs, pay more attention to gender barriers, and harness communities and women as changemakers.

E – Enhance integration within immunization programs and across the health-enhancing sectors to realize equitable primary health care and improve the effectiveness and efficiency of immunization services.

We believe a BOLD approach focused on the people closest to vaccine delivery and decision-making – which has long been the focus of Sabin’s programs and advocacy – is the only way this BRAVE vision could be fulfilled. It is the anthesis of top-down, one-size-fits-all solutions: B – Bridge the gap between global and local; O – Organize to foster two-way exchanges; L – Listen to understand and co-craft solutions; D – Dynamically distill and disseminate what works.

The best way global leaders and institutions can drive impact is by putting ourselves in the shoes of communities to understand exactly where the shoe pinches and listen to those who we seek to serve.

What gives you hope that the declines in immunization can be reversed?

In my previous role as Deputy CEO of Gavi, I led a high-level Gavi mission to Chad, which was struggling with persistently low immunization coverage. My meeting with the late President Idriss Déby had us thinking outside the box. This led the government to craft solutions that considered community practices – for example, co-delivering immunization for children and livestock in nomadic populations for whom their cattle are extremely valuable. Vaccination coverage in Chad has since risen by 17% from a baseline of just 41% and – though still low in absolute terms – has continued to improve even during the pandemic.

Such bright spots are regularly shared by the thousands of national and sub-national immunization professionals who engage in two-way learning in Sabin’s Boost community, or interdisciplinary researchers engaged in Sabin’s Vaccination Acceptance Research Network.

I have no doubt that if leaders at the top of global health institutions invest more time and money in a BOLD approach to unlock the wisdom, ingenuity, and dedication of these close-to-community professionals, realizing the BRAVE vision is very much possible.

Why is this approach urgently required now?

We are at an inflection point in global immunization. There has never been more attention on vaccines than in the last two years, yet we have seen serious barriers to getting shots in arms because of growing access, acceptance, and demand challenges and inequities. There is also a widening range of vaccines that people and communities can benefit from and that could jumpstart wider health and economic gains. So, this is really the moment to seize.