Policy Tag: Vaccination

Adopted by the 229th WMA Council Session, Montevideo, Uruguay, April 2025

PREAMBLE

Health care all over the world is under threat. Funding that has improved health by securing vaccines, medicines and health care professionals is being cut back or even completely dismantled. This creates a huge health risk, not only for those that cannot afford the costs themselves but also because this will increase the spread of communicable diseases like HIV, TB and malaria, and so puts everyone at risk. This is in addition to the threat that is caused by armed conflicts.

The WMA calls upon the leaders of the world to restore basic health care funding together. If the world sits back, we shall be confronted with a large increase of diseases and deaths.

Countries like the USA have made huge efforts in the last decades. Now, all nations shall have to contribute together to rescue our basic health system for those in need. 

RECOMMENDATION

The World Medical Association urges world leaders to contribute together to the funding of public health facilities that improve health by securing vaccines, medicines and health care professionals and by doing so, help prevent a potential increase in the spread of communicable diseases like HIV, TB and malaria, which pose a risk to everyone. Nations have to contribute together to rescue basic healthcare systems for those in need.

Adopted by the 64th General Assembly, Fortaleza, Brazil, October 2013
and revised by the 75th WMA General Assembly, Helsinki, Finland, October 2024

 

PREAMBLE

Human papillomavirus (HPV) vaccination presents a unique and valuable opportunity for physicians to substantially prevent morbidity and mortality from certain cancers in all populations, and to improve maternal health. This may result in economic benefits for countries who achieve widespread HPV vaccination in their population in the current move towards preventive and promotive healthcare. The HPV vaccine therefore merits consideration by the World Medical Association (WMA) separately from other vaccines.

HPV is, for the most part, sexually transmitted virus and is so common that most sexually active adults become infected at some point in their lives. Most infections are asymptomatic and resolve without medical intervention. However, HPV is the cause of nearly 100% of cervical cancer cases. Thirteen of the 40 types of HPV are oncogenic and, when they cause a persistent infection can produce cervical cancer as well as cancer of the vagina, vulva, anus, penis, the head and neck, oropharynx and anogenital area.

Few diseases reflect global inequities as much as cancer of the cervix. It is the fourth most common cancer in females globally, and most cervical cancer cases and deaths are in low and middle-income countries.

HPV vaccines protect against infections caused by targeted HPV types. All available vaccines afford protection against types 16 and 18, which are the most oncogenic types and can also offer protection against anogenital warts. HPV vaccination is recommended for females and males from 9-45 years of age and the immunocompromised people. HPV vaccines are safe, effective, and well tolerated.

WHO recommends a one or two-dose schedule HPV vaccination for females between 9-14 and 15-20 years old. Females older than 21 years require two doses with a 6-month interval.[1] Benefits of vaccinating young males include protection against genital warts and cancer in addition to preventing transmission of HPV to sexual partners.

In 2020 the World Health Assembly adopted the Global Strategy for cervical cancer elimination. To achieve accelerated elimination of cervical cancer, by 2030, 90% of girls will be fully vaccinated with the HPV vaccine by the age of 15, screening programs using a high-performance test will be running to screen 70% of women by the age of 35 and again by the age of 45 and 90% of women with invasive cancer will be managed.

School-based vaccination or systematic community programs are strategies that will increase vaccine accessibility to the appropriate age groups, particularly targeting youths prior to the commencement of sexual activity to ensure maximum benefit.

 

RECOMMENDATIONS

  1. Reaffirming its Statement on Access of Women and Children to Healthcare and its Statement on the Prioritisation of Immunisation, the WMA insists on the rights of all women, children, and indeed all people to adequate, safe medical care and urges governments to commit resources to immunisation programs.
  2. The WMA encourages expedited development and funding of programs to make safe, high quality HPV vaccines widely available to both females and males.
  3. The WMA strongly advocates for the provision of reliable, fast, and accessible cervical cancer screening programs for the detection and treatment of precancerous lesions in all countries, especially in those that have high mortality rates from cervical cancer.
  4. WMA clearly points out that HPV vaccination should not replace cervical cancer screening programs.
  5. WMA advises that cancer treatment and palliative care should be accessible to all individuals diagnosed with cervical cancer.
  6. A key recommendation is for school-based vaccination or systematic community programs to increase vaccine accessibility to the appropriate age groups, particularly targeting youths prior to the commencement of sexual activity to ensure maximum benefit.
  7. The WMA urges national health authorities, in collaboration with health professionals’ associations and other relevant health actors, to carry out intensive education and advocacy to:
  • In all individuals regardless of sex, improve awareness and understanding of HPV and associated diseases (such as, but not limited to, cervical cancer, head and neck cancer, anal cancer, and genital cancer), the availability and efficacy of HPV vaccinations, and the need for routine HPV related cancer screening in the general public;
  • Improve awareness that condoms do not provide sufficient protection against HPV infection because they do not cover the entire anogenital area and that HPV also causes cancers of the oropharynx, anus and penis;
  • Communicate the availability and efficacy of HPV vaccines to educate the population about the importance of getting the HPV vaccination;
  • Recommend HPV vaccination and routine cervical cancer screening and treatment for all eligible people regardless of the socioeconomic, cultural, or religious background, including those that are hard to reach (including for example those with disability, refugees and asylum seekers, and people of diverse sexual orientation and gender identity);
  • Support the availability of the HPV vaccine and routine cervical cancer screening for patient groups that benefit most from preventive measures, including but not limited to low-income and pre-sexually active populations;
  • Integrate HPV vaccination (either primary or catch-up immunisation) into all appropriate health care settings and visits involving eligible people; Routine cervical examination (whether vaccinated or not against HPV) should also be incorporated;
  • HPV vaccination and routine cervical cancer screening should also be offered to people who are incarcerated;
  • Integrate and understand the crucial need for routine cervical cancer screening in all appropriate health care settings and visits, and the enhanced sensitivity and effectiveness of HPV based screening compared with Pap smears, VIA (visual assessment with acetic acid), and VILI (visual assessment with lugols iodine);
  • Integrate HPV cancer prevention methods, early detection, early screening, diagnosis, treatment and palliative care into existing programs and pre-service training. Such training will leverage existing support for HPV programs and help to increase vaccination efforts;
  • Fund research aimed towards discovering screening methodology and early detection methods for other non-cervical HPV associated cancers;
  • Encourage and provide training for cervical cancer survivors to advocate for HPV vaccination and screening;
  • Sustain vaccination efforts to work towards and raise awareness of the WHO’s 90-70-90 Global Strategy to accelerate the elimination of cervical cancer as a public health problem;
  • Support and promote advocacy for HPV vaccination campaigns.
  1. The WMA urges physicians to educate themselves and their patients about HPV, associated diseases, HPV vaccination and routine cervical cancer screening.

 

Adopted by the 73rd WMA General Assembly, Berlin, Germany, October 2022

 

PREAMBLE

SARS-COV-2 Pandemic caused more than 400 million cases and nearly 6 million deaths. It is quite comforting that vaccines that ensure protection from the disease have been produced, and data relating to the course of the pandemic in countries with high vaccination coverage is promising. 62.3% of the world population has received at least one dose of a COVID-19 vaccine. Only 11.4% of people in low-income countries have received at least one dose. Deep inequalities in access to vaccines are still observed globally and failure to achieve collective immunity leads to the -further spread of new, more contagious and immunity-evading variants of the disease through mutation. Worldwide application of vaccines is of critical importance in terminating the Covid-19 pandemic. Every minute of delay in vaccinations means further spread of the disease at global scale and more lives lost. It is not sufficient to immunize all citizens in any given country; immunization has to reach a sufficient level in the world as a whole to effectively combat and control the pandemic.

 

RECOMMENDATIONS

The WMA urges all parties to:

1.Remove barriers to promote equity of access to COVID-19 vaccines that are globally proven to be safe and effective;

2. Work with governmental and appropriate regulatory bodies to encourage prioritization of equity when providing COVID-19 pandemic-related resources such as diagnostics, free medications, therapeutics, vaccines, raw materials for vaccine production, personal protective equipment, and/or financial support, and guarantee universal accessibility and free distribution;

3. Establish vaccination strategies that consider the specific peculiarities, challenges and vulnerabilities of each region, prioritising the most vulnerable people, including health professionals;

4. Insist on the importance of vaccination and take action to achieve maximum coverage and protect the population in need;

In this context,

5. Confront vaccine hesitancy by providing evidence-based guidance on the safety and necessity of vaccines;

6. Share of knowledge required for vaccine production to the COVID-19 Technology Access Pool created by WHO to ensure that vaccines are produced at as many centres as possible and sharing of this knowledge;

7. Allocate public funds to improve the capacity of vaccine production centres and increase the channels of safe distribution so as to ensure fair access, to provide equitable and efficient vaccine supply and distribution;

8. Design national vaccine programmes that take into account a global analysis rather than only national considerations;

9. Promote sustainable solutions to patent issues. This may include the temporary lifting of patents on COVID-19 vaccines under the Trade-Related Aspects of Intellectual Property Rights (TRIPS) and similar agreements to promote equity of access in global emergency situations, while ensuring fair compensation for the intellectual property of the patent holders if asked, global investment in manufacturing sites, training of personnel, quality control, and the transfer of knowledge, technology and manufacturing expertise;

10. Support WHO efforts and initiatives to increase production and distribution of therapeutics and vaccines necessary to combat COVID-19 and future pandemics in order to provide vaccine doses to low and middle-income countries with limited access, including:

  • technological transfers relevant for vaccine production;
  • other support, financial and otherwise, necessary to scale up global vaccine manufacturing; and
  • measures that ensure the safety and efficacy of products manufactured by such means.

11. Call on governments and the United Nations to take all necessary measures to facilitate equitable access to vaccines throughout the world by supporting and promoting the sharing of all vaccine-related processes for combating pandemics (R&D, patenting, production, licensing, procurement and application).

 

 

Adopted by the 63rd WMA General Assembly, Bangkok, Thailand, October 2012
and reaffirmed by the 212th WMA Council Session, Santiago, Chile, April 2019

 

PREAMBLE

Vaccination use to prevent against disease was first done successfully by Jenner in 1796 when he used cowpox material for vaccination against smallpox.  Since then, vaccination and immunisation have been acknowledged as an effective preventive strategy for several communicable diseases and are now being developed for the control of some non-communicable diseases.

Vaccine development and administration are some of the most significant interventions to influence global health in modern times.  It is estimated that immunisation currently prevents approximately 2.5 million deaths every year, saving lives from diseases such as diphtheria, tetanus, whooping cough (pertussis) and measles. Approximately 109 million children under the age of one are fully vaccinated with the diphtheria-tetanus-pertussis (DTP3) vaccine alone.

Mostly the ultimate goal of immunisation is the total eradication of a communicable disease.  This was achieved for smallpox in 1980 and there is a realistic goal for the eradication of polio within the next few years.

The Global Immunisation Vision Strategy (GIVS) 2006-2015 was developed by the WHO and UNICEF in the hope of reaching target populations who currently do not have immunisation services or who do not have an adequate level of coverage.

The four strategies promoted in this vision are:

  • Protecting more people in a changing world
  • Introducing new vaccines and technologies
  • Integrating immunisation, other linked health interventions and
  • Surveillance in the health systems context
  • Immunizing in the context of global interdependence [1]

Vaccine research is constantly revealing new possibilities to protect populations from serious health threats.  Additionally, new strains of diseases emerge requiring the adaptation of vaccines in order to offer protection.

The process of immunisation requires an environment that is resourced with appropriate materials and health workers to ensure the safe and effective administration of vaccines.  Administration of vaccines often requires injections, and safety procedures for injections must always be followed.

Immunisation schedules can vary according to the type of vaccine, with some requiring multiple administrations to be effective.  It is vitally important that the full schedule is followed otherwise the effectiveness of the vaccine may be compromised.

The benefits of immunisation have had a profound effect on populations, not only in terms of preventing ill health but also in permitting resources previously required to treat the diseases to be redirected to other health priorities.  Healthier populations are economically beneficial and can contribute more to society.

Reducing child mortality is the fourth of the United Nation’s Millennium Development Goals, with immunisation of children having a significant impact on mortality rates on children aged under five. According to the WHO, there are still more than 19 million children who have not received the DTP3 vaccine. In addition, basic health care services for maternal health with qualified health care personnel must be established.

Immunisation of adults for diseases such as influenza and pneumococcal infections has been shown to be effective, not only in decreasing the number of cases amongst those that have received immunisation but also in decreasing the disease burden in society.

The medical profession denounce any claims that are unfounded and inaccurate with respect to the possible dangers of vaccine administration.  Claims such as these have resulted in diminished immunisation rates in some countries.  The result is that the incidences of the diseases to be prevented have increased with serious consequences for a number of persons.

Countries differ in immunisation priorities, with the prevalence and risk of diseases varying among populations. Not all countries have the same coverage rates, nor do they have the resources to acquire, coordinate, distribute or effectively administer vaccines to their populations, often relying on non-governmental organizations to support immunisation programmes.  These organizations in turn often rely on external funding that may not be secure.  In times of global financial crisis, funding for such programmes is under considerable pressure.

The risk of health complications from vaccine-preventable diseases is greatest in those who experience barriers in accessing immunisation services. These barriers could be cost, location, lack of awareness of immunisation services and their health benefits or other limiting factors.

Those with chronic diseases, underlying health issues or other risk factors such as age are at particular risk of major complications due to vaccine-preventable diseases and therefore should be targeted to ensure adequate immunisation.

Supply chains can be difficult to secure, particularly in countries that lack coordination or support of their immunisation programmes.  Securing the appropriate resources, such as qualified health professionals, equipment and administrative support can present significant challenges.

Data collection on vaccine administration rates, side effects of vaccines and disease surveillance can often be difficult to achieve, particularly in isolated and under-resourced areas. Nevertheless, reporting incidents and monitoring disease spread are vital tools in combating global health threats.

 

RECOMMENDATIONS

The WMA supports the recommendations of the Global Immunisation Vision Strategy (GIVS) 2006-2015, and calls on the international community to:

  • Encourage governments to commit resources to immunisation programmes targeted to meet country specific needs.
  • Recognise the importance of vaccination/immunisation through the continued support and adoption of measures to achieve global vaccination targets and to meet the Millennium Development Goals, especially four (reduce child mortality), five (improve maternal health) and six (combat HIV/AIDS, malaria and other diseases).
  • Recognise the global responsibility of immunisation against preventable diseases and support work in countries that have difficulties in meeting the 2012 targets in the Global Polio Eradication Initiative [2].
  • Support national governments with vulnerable populations at risk of vaccine-preventable diseases, and the local agencies that work to deliver immunisation services and to work with them to alleviate retrictions in accessing services.
  • Support vaccine research and development and ensure commitment through the adequate funding of vital vaccine research.
  • Promote vaccination and the benefits of immunisation, particularly targeting those at-risk and those who are difficult to reach. Comply with monitoring activities undertaken by WHO and other health authorities.Promote high standards in the research, development and administration of vaccines to ensure patient safety. Vaccines need to be thoroughly tested before implemented on a large scale and subsequently monitored in order to identify possible complications and untoward side effects. In order to be successful, immunisation programmes need public trust which depends on safety.

In delivering vaccination programmes, the WMA recommends that:

  • The full immunisation schedule is delivered to provide optimum coverage.  Where possible, the schedule should be managed and monitored by suitably trained individuals to ensure consistent delivery and prompt appropriate management of adverse reactions to vaccines.
  • Strategies are employed to reach populations that may be isolated because of location, race, religion, economic status, social marginalization, gender and/or age.
  • Ensure that qualified health professionals receive comprehensive training to safely deliver vaccinations and immunisations, and that vaccination/immunisations are targeted to those whose need is greatest.
  • Educate people on the benefits of immunisation and how to access immunisation services.
  • Maintain accurate medical records to ensure that valid data on vaccine administration and coverage rates are available, enabling immunisation policies to be based upon sound and reliable evidence.
  • Healthcare professionals should be seen as a priority population for the receipt of immunisation services due to their exposure to patients and to diseases.

The WMA calls upon its members to advocate the following:

  • To increase awareness of national immunisation schedules and of their own (and their dependents) personal immunisation history.
  • To work with national and local governments to ensure that immunisation programmes are resourced and implemented.
  • To ensure that health personnel delivering vaccines and immunisation services receive proper education and training.
  • To promote the evidence base and increase awareness about the benefits of immunisation amongst physicians and the public.

 

References

[1] World Health Organization and United Nations Children’s Fund. Global Immunisation Vision and Strategy, 2006-2015. Geneva, Switzerland: World Health Organization and United Nations Children’s Fund; 2005.  Available at: http://www.who.int/immunisation/givs/related_docs/en/index.html

[2] World Health Organization. Global Polio Eradication Initiative: Strategic Plan 2010-2012. Geneva, Switzerland: World Health Organization; 2010. Available at: http://polioeradication.org/who-we-are/strategy/