The World Health Organisation (WHO) and the European Commission has organised a Global Vaccination Summit in Brussels on 12 September 2019. The aim of the event was twofold: to accelerate global action to stop the spread of vaccine-preventable diseases and to advocate against the spread of vaccine misinformation worldwide. We were represented by Brigitte Haider, Chair of our Supervisory Board. This summit was one of the rare events putting the important role of parents in the focus of the presentations and considerations as well as their needs, worries, expectations and hopes. Being present there was a first step in approaching this topic on a large scale and the main outcome from Parents International’s perspective is that we have managed to establish a collaboration with WHO and the next step on the journey together will most probably be the WHO Vaccination Confidence Forum. You can read some highlights of the conference in the detailed report below.

Jean-Claude Juncker, President of the European Commission, said: “It is a noble aim to save human lives and not to accept fatalism. It is inexcusable that in a world as developed as ours, there are still children dying of diseases that should have been eradicated long ago. Worse, we have the solution in our hands, but it is not being put to full use. Vaccination already prevents 2-3 million deaths a year and could prevent a further 1.5 million if global vaccination coverage improved. Today’s summit is an opportunity to address this gap. The Commission will continue to work with the EU’s Member States in their national efforts and with our partners here today. It is important to re-establish trust. This is a global challenge we must tackle together, and now.”

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, said: “After many years of progress, we are at a critical turning point. Measles is resurging, and 1 in 10 children continues to miss out on essential childhood vaccines,” said Dr Tedros, “We can and must get back on track. We will only do this by ensuring everyone can benefit from the power of vaccines – and if governments and partners invest in immunization as a right for all, and a social good. Now is the time to step up efforts to support vaccination as a core part of health for all.”

Opening the summit, President Juncker and Dr Tedros called for an urgent intensification of efforts to stop the spread of vaccine-preventable diseases such as measles. In the past 3 years, 7 countries, including 4 in the European region, have lost their measles elimination status. New outbreaks are the direct result of gaps in vaccination coverage, including amongst teenagers and adults who were never fully vaccinated. So far in 2019, reported measles cases have reached the highest numbers seen globally since 2006. Misinformation is as infectious as measles itself. To tackle vaccination gaps effectively, the summit addressed the multiple barriers to vaccination, including rights, regulations and accessibility, availability, quality and convenience of vaccination services; social and cultural norms, values and support; individual motivation, attitudes, and knowledge and skills.

The WHO has declared vaccine hesitancy, including complacency and lack of confidence and convenience, one of ten threats to global health in 2019. Vaccines are safe and effective and are the foundation of any strong Primary Health Care system.

Worldwide, 79% of people agree that vaccines are safe and 84% agree that they are effective, according to the Welcome Global Monitor on how people around the world think and feel about science and major health challenges. Yet, the State of Vaccine Confidence in the EU report shows that vaccine refusal has been increasing in many EU member states linked to low confidence in the safety and effectiveness of vaccines worldwide. This lack of confidence contributes significantly to lower coverage rates, which are essential to ensure herd immunity and are leading to increases in disease outbreak.

According to a Eurobarometer from April this year, almost half of the EU public (48%) believes that vaccines can often produce serious side effects, 38% think they can cause the diseases against which they protect and 31% are convinced that they can weaken the immune system. These figures are also the result of an increased spread of disinformation about the benefits and risks of vaccines through digital and social media.

The executive director of UNICEF sent a video message: Vaccinations can save 5 children per day, nevertheless, every 10^th child is not completely immunized. In the case of the Ukraine it took 10 years to catch up with the deficits. Main reasons for vaccination hesitancy are scepticism, poverty, distrust and misinformation. Therefore, it is of upmost importance to provide excellent information for worried parents. This information has to be offered in easy to understand language, evidence based and built on scientific sources.

After the official statements listing the facts and setting out the scope of this issue it was a real pleasure listening to the other inputs high lightening the important role of parents in this field. Parents were not blamed, but they were seen as partners who have to be approached on eye-level, given adequate information and support as well as time to take meaningful and informed decisions. It is out of question that every parent wants the best for their children. Health professionals play an exceptional and most responsible role. They have to be vaccinated themselves and need to be trained.

Laetita Rispel, President of the World Federation of Public Health Association gave a remarkable statement HOW to build trust and empathy. Her 3 key messages for health providers are:

• Health providers should use any opportunity to communicate with the parents – from pregnancy until the first 6 years of the child.
• Health providers have to overcome their own preconceptions towards parents. Parents are often accused to be ignorant and do not act in the best interest of the child.
• Health providers have to improve their communication skills – in basic training as well as in CPD.

Trust building is not an easy task. You have to listen to parents – their worries and their needs. They need time to find out different opportunities and consequences. You have to give them time to reconsider their opinion. Another important fact is to reflect on the opening hours of health professionals, whether they are in line with the availability of parents.

Maud Sacquet, policy manager of Mozilla, and Jason Hirsch, policy manager of Facebook, are quite aware about their role in spreading misinformation. Disinformation is a complex problem and complicated topic. It is important to empower people in critical thinking. They should find out who is posting and who is benefitting of disinformation campaigns. Partnerships are very important in reducing misinformation. Providers should increase their cooperation with reliable experts. GDPR may also help.

Elhadj As Sy, secretary general international federation of red cross, noticed “where is the most need, there is often not a doctor, even not a government, even not a health system”. So, the main question is “how to do normal things in abnormal situations”. He called on to listen AND act on the issues raised! Trust building means being there all the time – before, during and after campaigns. Community resistance is often rooted in misunderstanding: people feel like guinea pigs or abused for the sake of others, like “I have to be immunized to protect you”.

Stefan Swartling Peterson, chief of health section of UNICEF, declared a paradigm shift: “We need to deliver for clients, not for diseases!” UNICEF procures with half of the worldwide vaccines. It is crucial to respect the perspectives of parents. He invited the audience “to put you in the shoes of parents”. Any health system should meet the needs of the local population. In many countries primary health care centres are urgently needed.

Dr Tedros Adhanom Ghebreyesus closed the summit with

TEN ACTIONS TOWARDS VACCINATION FOR ALL

Everyone should be able to benefit from the power of vaccination.

Despite the availability of safe and effective vaccines, lack of access, vaccine shortages, misinformation, complacency towards disease risks, diminishing public confidence in the value of vaccines and disinvestments are harming vaccination rates worldwide. Vaccination is indisputably one of public health’s most effective interventions. We must endeavour to sustain vaccination’s hard-won gains but also aim to do more and to do better, in view of achieving effective and equitable health systems and reduce the harm that is caused as a result of the illness and suffering that is otherwise preventable. This also includes making the necessary R&D investments to address unmet medical needs by developing new vaccines and improving existing ones.

Lessons from the day and actions needed towards vaccination for all and elimination of vaccine preventable diseases:

1. Promote global political leadership and commitment to vaccination and build effective collaboration and partnerships -across international, national, regional and local levels with health authorities, health professionals, civil society, communities, scientists, and industry- to protect everyone everywhere through sustained high vaccination coverage rates.
2. Ensure all countries have national immunisation strategies in place and implemented and strengthen its financial sustainability, in line with progress towards Universal Health Coverage, leaving no one behind.
3. Build strong surveillance systems for vaccine-preventable diseases, particularly those under global elimination and eradication targets.
4. Tackle the root-causes of vaccine hesitancy, increasing confidence in vaccination, as well as designing and implementing evidence-based interventions.
5. Harness the power of digital technologies, so as to strengthen the monitoring of the performance of vaccination programmes.
6. Sustain research efforts to continuously generate data on the effectiveness and safety of vaccines and impact of vaccination programmes.
7. Continue efforts and investment, including novel models of funding and incentives, in research, development and innovation for new or improved vaccine and delivery devices.
8. Mitigate the risks of vaccine shortages through improved vaccine availability monitoring, forecasting, purchasing, delivery and stockpiling systems and collaboration with producers and all participants in the distribution chain to make best use of, or increase existing, manufacturing capacity.
9. Empower healthcare professionals at all levels as well as the media, to provide effective, transparent and objective information to the public and fight false and misleading information, including by engaging with social media platforms and technological companies.
10. Align and integrate vaccination in the global health and development agendas, through a renewed Immunisation agenda 2030.