19th Meeting of the European Technical Advisory Group of Experts on Immunization (ETAGE)

In Europe, average regional coverage with a first dose of measles-containing vaccine (MCV1) has remained stable around 93-95%, and coverage with a second dose of measles-containing vaccine (MCV2) actually increased from 88% to 91% over the past 6 years. However, 2018 and 2019 saw dramatic increases in the number of confirmed measles cases, and outbreaks have been reported in most of the countries in the European Region. Thus, the World Health Organization (WHO) Regional Office for Europe is working to address causes for inadequate coverage, including vaccine hesitancy, and to ensure equitable access in the Region.

In this context, the 19th meeting of the European Technical Advisory Group of Experts on Immunization (ETAGE) was organised from October 29-30 2019 in Copenhagen, Denmark. The purpose was to inform ETAGE of global and regional immunisation-related developments and activities of the Vaccine-preventable Diseases and Immunization programme (VPI) of the WHO Regional Office and to seek ETAGE advice and guidance on specific ongoing and planned activities. This report captures the proceedings, and the present summary focuses on the major communication elements to emerge.

In part, the meeting reviewed and endorsed the proposed Immunization Agenda 2030 (IA2030) Strategic Framework, which outlines a global vision and strategy for the next decade. Core components of the regional strategy will include an advocacy framework entailing political engagement, a monitoring and evaluation (M&E) framework, and an investment case demonstrating the full public health value of immunisation to national health systems. Guiding principles of the strategy will include: equitable provision and access to vaccination services across age groups in every community; leveraging of existing services and goals to enhance the immunisation agenda; strengthening of national health systems ownership; expansion of the "value proposition" of immunisation; adoption of programmatic and technological innovations, and; strengthening and amplification of partnerships at all levels.

Of note was an outline, during the gathering, of a new area of work being undertaken by VPI in developing guidelines on effective communication of immunisation data. Immunisation programmes use data not only to administer and monitor their own activities, but also to advocate for resources, report to national authorities, inform the public, and build or regain trust in immunisation. It was noted that, for data to be used to inspire, change, educate, and influence, it is necessary to communicate it in a way that audiences will actively absorb. A consultative process to develop the guideline document began in 2018; to view the final version, see Related Summaries, below. The guidance developed by VPI provides insights from behavioural science and advice on shaping messages and numbers, choosing suitable formats, creating appropriate visuals, and disseminating communication products.

Among conclusions and recommendations, ETAGE:

• noted the work that will be involved in the development of the 2030 European regional immunisation agenda and strategy;
• acknowledged the Strategic Response Plan for the measles emergency in the WHO European Region and supported the need for renewed efforts to eliminate measles and rubella across the Region;
• advised countries currently formulating human papillomavirus (HPV) vaccination policies that extending vaccination to age groups other than females before sexual debut and to males may restrict the availability of vaccine;
• recommended that all countries collect, analyse, and use subnational coverage data at the lowest available level, to identify geographic areas with suboptimal coverage, and to collect and use other appropriate data, as needed, that could provide information to identify inequalities;
• encouraged countries to report subnational coverage data annually via the WHO/United Nations Children's Fund (UNICEF) Joint Reporting Form (JRF);
• stressed the importance of the presence and active involvement of national immunisation technical advisory group (NITAG) representatives at the meeting;
• recommended further consultation with NITAGs regarding optimal delivery of training activities, collaboration, use, and sharing of materials going forward; and
• recommended that all countries prioritise strengthening the use of inactivated polio vaccine (IPV) in their national immunisation so as to protect the Region from emergence of circulating vaccine-derived polioviruses (cVDPV).