Roadmap for Implementing the

Addis Declaration on Immunization:

Executive Summary

Background
Immunization saves lives, makes
Addis Declaration on
Immunization Commitments
communities more productive,
1. Keeping universal access to immunization at the
and is a core component of forefront of our efforts to reduce child mortality,
strengthening health systems morbidity, and disability, and in doing so helping
our countries achieve their long-term health,
and attaining the Sustainable economic, and development goals.
Development Goals (SDGs). 2. Increasing and sustaining our domestic
investments and funding allocations, including
While Africa has made tremendous gains innovative financing mechanisms, to meet the
cost of traditional vaccines, fulfil our new vaccine
toward increasing access to immunization
financing requirements, and providing financial
in the last 15 years, progress has stagnated, support for the operational implementation of
leaving one in five African children without immunization activities by Expanded Programme
access to life-saving vaccines. As a result, on Immunization programs.
vaccine-preventable diseases continue to claim 3. Addressing the persistent barriers in our vaccine
and healthcare delivery systems, especially in
too many lives.
the poorest, vulnerable, and most marginalized
communities, including the strengthening of
On January 31, 2017, at the 28th African Union data collection, reporting, and use at all levels,
(AU) Summit, Heads of State from across as well as building effective and efficient supply
chains and integrated procurement systems.
Africa endorsed the Addis Declaration on
4. Increasing the effectiveness and efficiency, as
Immunization (ADI), thereby committing to well as changing the approaches as needed,
advance universal access to immunization of our immunization delivery systems as
across Africa. The ADI was initially drafted an integrated part of strong and sustainable
and signed by ministers and other high-level primary healthcare systems.

representatives at the Ministerial Conference on 5. Attaining and maintaining high quality

surveillance for targeted vaccine preventable
Immunization in Africa (MCIA) in February 2016. diseases.
Statements of support have been issued by civil 6. Monitoring progress toward achieving the goals
society organizations, religious leaders from of the global and regional immunization plans.
across faiths, and parliamentarians to support 7. Ensuring polio legacy transition plans are in
countries in the implementation of the ADI. place by end-2016 that will allow future health
programs to benefit from the knowledge and
expertise the polio program has generated
The ADI includes ten commitments to achieve through the eradication initiative.
universal and equitable access to immunization 8. Developing a capacitated African research sector
on the African continent (see sidebar). This to enhance immunization implementation and
roadmap outlines strategies for Member uptake.
States to accelerate progress on the ADI 9. Building broad political will, working with
communities, civil society organizations,
commitments. The roadmap was developed
traditional and religious leaders, health
in close collaboration with the World Health professional associations, and parliamentarians,
Organization’s (WHO) offices in the African for the right of every child and every community
Region (AFRO) and Eastern Mediterranean to have universal access to life-saving vaccines
and by extension the best possible chance for a
Region (EMRO), the AU Commission, and healthy future.
immunization partners. The roadmap builds
10. Promoting and investing in regional capacity
on and complements existing efforts aimed at for the development and production of vaccines
improving immunization in Africa and around in line with the African Union Pharmaceutical
the world, particularly the Global Vaccine Manufacturing Plan, including the strengthening
of national regulatory authorities.
Action Plan (GVAP).
 2015 DTP3
Coverage by
Country

Source: WHO UNICEF Estimates of National Immunization

Coverage (WUENIC) 2015, released July 2016.

Strategies for Expanding Universal Access to Immunization

The ADI roadmap outlines three strategies for Member States to incorporate
into existing efforts to improve immunization coverage.

Roadmap Strategies:
1. G
 enerate and sustain political commitment and funding for immunization through advocacy and
communications
2. A
 ddress gaps in immunization and work with key partners to overcome barriers to access and
utilization of immunization services
3. 
Monitor progress to drive impact and ensure accountability

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 Strategy 1: Generate and Sustain Political Strategy 2: Address Gaps in Immunization and
Commitment and Funding for Immunization Work with Key Partners to Overcome Barriers to
through Advocacy and Communications Access and Utilization of Immunization Services
Member States can use evidence-based advocacy and Beyond political commitment and financing, Member
communications activities to maintain and increase States will need to strengthen technical capacity at the
political will and funding for immunization and build national and local levels to drive universal access to
demand at the community level. vaccines.

The approaches outlined in this section include: The approaches outlined in this section include:
•  evelop Effective Messages: Immunization
D Focus on Improving Access and Equity: Closing
• 
messaging must be accurate and strategic. All the immunization access gap between countries’
stakeholders at the national and sub-national lowest and highest wealth quintiles is essential
levels have an important role to play in ensuring for achieving the ADI commitments and SDGs. To
that evidence-based and culturally-sensitive ensure that vaccine access is equitable, Member
messages reach different audiences — from States must address challenges on both the supply
decision-makers to communities — to maintain side (e.g., weak health infrastructure) and the
political will and drive demand for vaccines at demand side (e.g., low community awareness
the local level. Messages must be tailored for each about immunization). Suggested tactics range from
audience, based on their specific knowledge and improving program planning at the community
beliefs, to ensure resonance. level and investing in strengthening health
systems to ensuring communities are informed of
Identify, Develop, and Engage Immunization
• 
their right to access quality immunization services.
Champions, Particularly National and Sub-
National Leaders: Champions ­— highly influential • I mprove Immunization Program Monitoring
stakeholders, such as Heads of State, ministers, and Vaccine-Preventable Disease Surveillance:
parliamentarians, and state-level leaders, who Improved data quality and strong vaccine-
actively push for policy and programmatic changes preventable disease surveillance can guide
— have a profound impact on immunization in immunization policies and address program gaps.
Africa. National-level leaders can leverage their Member States with poor quality or insufficient
unique positions to champion immunization data on immunization should allocate resources
through various forums at the sub-national, toward improving data collection systems at the
national, regional, and global levels. Significant national and sub-national levels, consider new
efforts should be made to identify other trusted approaches and technologies for monitoring,
champions, such as renowned scientists, service and build stronger capacity to analyze data and
providers, community and religious leaders, and apply data to program management, among other
artists, who can elevate the issue of immunization actions. Additionally, strong surveillance systems
through the media, public-facing forums, and their are needed to measure the impact of diseases
communities. and ensure that immunization targets are being
reached.
•  ngage in Advocacy and Communications
E
Activities at the Community Level: To achieve Efficiently Manage Resources and Prepare for
• 
the ADI commitments, it is necessary to build Upcoming Transitions and Their Impact on
support for immunization within communities. Immunization Programs and Programmatic
Researching and understanding barriers to Sustainability: Over the next few years, all
immunization at the local level, engaging countries should aim to sustainably finance their
influential members of the community to speak immunization programs through a combination of
out in support of immunization, and developing additional resource mobilization and more efficient
targeted communications strategies are all ways to management and use of currently available
increase uptake of existing immunization services resources. Funding for polio eradication will
and raise awareness about new vaccines. gradually ramp down by 2020 and some countries
in Africa are transitioning away from eligibility for
immunization support through Gavi, the Vaccine
Alliance. Member States must begin preparing
early for these significant shifts in financing to
ensure that vaccine access is uninterrupted.

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 Photo: World Health Organization/E. Soteras Jalil

Expand and Invest in Africa-Based Research,

•  reporting mechanisms, 2) document progress toward
Development, and Production of Vaccines: roadmap indicators, 3) coordinate an independent
Signatories to the ADI committed to strengthen review body comprised of representatives from
national regulatory authorities, build clinical trial immunization partner organizations, 4) disseminate
capacity, and promote investments in Africa’s annual regional progress reports to all Member States,
immunization research sector. Additional efforts — and 5) provide and/or coordinate technical assistance
by Member States and regional coordinating bodies for Member States, if necessary.
— are needed in this area to improve research
capacity; enhance regulatory oversight for the
Implementing the ADI Roadmap
development and approval of new vaccines that
meet quality, safety, and efficacy standards; and
This roadmap has been developed with the aim
build manufacturing capacity.
of providing Member States with a framework to
Strategy 3: Monitor Progress to Drive Impact achieve the ADI commitments. While Member States
and Ensure Accountability will take the lead, multilaterals, donors, civil society
organizations, and others have expressed their
Strong monitoring and accountability efforts are
willingness to support and work with countries to
needed to ensure the success of the ADI and achieve
ensure the successful implementation of the ADI.
universal access to immunization in Africa. There
Notably, WHO AFRO, WHO EMRO, and the AUC have
are national, regional, and global monitoring and
proposed the establishment of a secretariat to provide
accountability systems for immunization already
technical assistance and help monitor progress
in place (e.g., WHO AFRO and WHO EMRO regional
toward achieving the ADI commitments.
plans, GVAP progress reports) that can be used to
track Member States’ progress toward and hold them
Working together, Member States and their partners
accountable for the ADI commitments. WHO AFRO,
can make tremendous progress in the coming years
WHO EMRO, and the AUC will build and expand
toward ensuring that all people in Africa have access
on these efforts by reporting annually at the AU
to the vaccines they need to live healthier and more
level on Member States’ progress on a core set of
productive lives, ultimately driving sustainable
ADI indicators that are outlined in the roadmap.
development across the continent.
Specifically, these organizations will: 1) collate and
synthesize Member States’ data through existing

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