Duclos Philippe, Okwo-Bele Jean-Marie, Gacic-Dobo Marta, Cherian Thomas
Department of Immunization, Vaccines and Biologicals, World Health Organization, 20 Ave Appia, CH-1211 Geneva 27, Switzerland.
BMC Int Health Hum Rights. 2009 Oct 14;9 Suppl 1(Suppl 1):S2. doi: 10.1186/1472-698X-9-S1-S2.
Vaccines have made a major contribution to public health, including the eradication of one deadly disease, small pox, and the near eradication of another, poliomyelitis.Through the introduction of new vaccines, such as those against rotavirus and pneumococcal diseases, and with further improvements in coverage, vaccination can significantly contribute to the achievement of the health-related United Nations Millennium Development Goals.The Global Immunization Vision and Strategy (GIVS) was developed by WHO and UNICEF as a framework for strengthening national immunization programmes and protect as many people as possible against more diseases by expanding the reach of immunization, including new vaccines, to every eligible person.This paper briefly reviews global progress and challenges with respect to public vaccination programmes.The most striking recent achievement has been that of reduction of global measles mortality from an estimated 750,000 deaths in 2000 down to 197,000 in 2007. Global vaccination coverage trends continued to be positive. In 2007 most regions reached more than 80% of their target populations with three doses of DPT containing vaccines. However, the coverage remains well short of the 2010 goal on 90% coverage, particularly in the WHO region of Africa (estimated coverage 74%), and South-East Asia, (estimated coverage 69%). Elements that have contributed to the gain in immunization coverage include national multi-year planning, district-level planning and monitoring, re-establishment of outreach services and the establishment of national budget lines for immunization services strengthening.Remaining challenges include the need to: develop and implement strategies for reaching the difficult to reach; support evidence-based decisions to prioritize new vaccines for introduction; strengthening immunization systems to deliver new vaccines; expand vaccination to include older age groups; scale up vaccine preventable disease surveillance; improve quality of immunization coverage monitoring and use the data to improve programme performance; and explore financing options for reaching the GIVS goals, particularly in lower-middle income countries.Although introduction of new vaccines is important,this should not be at the expense of sustaining existing immunization activities. Instead the introduction of new vaccine introduction should be viewed as an opportunity to strengthen immunization systems, increase vaccine coverage and reduce inequities of access to immunization services.
疫苗对公共卫生做出了重大贡献，包括根除了一种致命疾病天花，以及几乎根除了另一种疾病脊髓灰质炎。通过引入新疫苗，如针对轮状病毒和肺炎球菌疾病的疫苗，并进一步提高疫苗接种覆盖率，疫苗接种可显著促进实现与健康相关的联合国千年发展目标。世界卫生组织（WHO）和联合国儿童基金会（UNICEF）制定了《全球免疫远景与战略》（GIVS），作为加强国家免疫规划的框架，通过扩大免疫接种范围，包括将新疫苗接种到每一个符合条件的人，来保护尽可能多的人免受更多疾病的侵害。本文简要回顾了全球公共疫苗接种计划的进展和挑战。最近最显著的成就是将全球麻疹死亡率从2000年估计的75万例死亡降至2007年的19.7万例。全球疫苗接种覆盖率趋势持续呈积极态势。2007年，大多数地区三剂含百白破疫苗的接种覆盖率达到了目标人群的80%以上。然而，覆盖率仍远低于2010年90%覆盖率的目标，特别是在WHO非洲区域（估计覆盖率74%）和东南亚（估计覆盖率69%）。促成免疫接种覆盖率提高的因素包括国家多年规划、地区层面的规划和监测、恢复外展服务以及设立用于加强免疫服务的国家预算项目。 remaining challenges include the need to: develop and implement strategies for reaching the difficult to reach; support evidence-based decisions to prioritize new vaccines for introduction; strengthening immunization systems to deliver new vaccines; expand vaccination to include older age groups; scale up vaccine preventable disease surveillance; improve quality of immunization coverage monitoring and use the data to improve programme performance; and explore financing options for reaching the GIVS goals, particularly in lower-middle income countries.Although introduction of new vaccines is important,this should not be at the expense of sustaining existing immunization activities. Instead the introduction of new vaccine introduction should be viewed as an opportunity to strengthen immunization systems, increase vaccine coverage and reduce inequities of access to immunization services. 其余挑战包括需要：制定和实施针对难以接触人群的策略；支持基于证据的决策，以确定优先引入的新疫苗；加强免疫接种系统以提供新疫苗；扩大疫苗接种范围以涵盖老年人群体；扩大疫苗可预防疾病监测；提高免疫接种覆盖率监测质量并利用这些数据改善项目绩效；探索实现GIVS目标的融资选择，特别是在中低收入国家。虽然引入新疫苗很重要，但这不应该以牺牲维持现有免疫接种活动为代价。相反，引入新疫苗应被视为加强免疫接种系统、提高疫苗接种覆盖率和减少免疫服务获取不平等现象的一个机会。
