WASHINGTON, DC, USA — Building on decades of high vaccination rates and recent advances in introducing new vaccines, ministers of health from throughout the Americas have pledged to extend the full benefits of immunisation to all by 2020.

The Plan of Action on Immunisation, approved at the 54th Directing Council of the Pan American Health Organization (PAHO) this week, aims to protect such historic achievements as the elimination of smallpox, polio and rubella while addressing a recent rise in vaccination coverage gaps and tackling new immunisation goals.

“The Americas is a leader in controlling and eliminating disease through the introduction of new vaccines,” said Cuauhtemoc Ruiz, chief of PAHO/WHO’s Comprehensive Family Immunisation Programme. “But while we are close, we must not stop now. There are still children who become ill because they are not vaccinated, still communities where vaccines are not available or not accepted, and still areas where the cost of vaccines is too high. These are problems we still need to address.”

The Americas was the first region in the world to eliminate smallpox, polio, rubella, and congenital rubella syndrome (CRS) and to control the endemic transmission of measles. The new Regional Immunisation Action Plan lays out a roadmap to continue strengthening the operational base of immunisation programmes to protect these key achievements, which have saved countless lives and prevented disabilities in people throughout the Americas.

These historic public health gains were hard won by the region’s thousands of public health workers. These workforces need continuous training and support to face the challenges of extending immunisation gains into the next decade. The plan also calls for strengthening immunisation programmes through the creation of legislative frameworks, the establishment of technical advisory committees, the implementation of action plans and the continued annual celebration of Vaccination Week in the Americas.

Since 2006, national immunisation programmes have prevented the deaths of approximately 174,000 children under age five in Latin America and the Caribbean. Despite the challenges of achieving universal vaccination, countries have continually worked toward that goal and have implemented targeted strategies to reach the most vulnerable and difficult-to-access populations.

Yet, many areas continue to have incomplete access to the comprehensive health care that leads to high vaccination rates, resulting in continued inequality in coverage, both between and within countries. In 2013, for example, out of nearly 15,000 municipalities in Latin America and the Caribbean, 8,250 (55 per cent) reported less than 95 per cent vaccination coverage with the third dose of the diphtheria, pertussis and tetanus vaccine (DTP3). Under the new plan, countries will work to identify and quantify factors that contribute to low vaccination coverage and will aim to reach DPT3 coverage rates of at least 95 per cent.

The plan also sets the goal of eliminating neonatal tetanus as a public health problem in Haiti by 2020, bringing it into line with the rest of the region.

Historically, low-cost vaccines have made immunisation one of the most cost-effective public health interventions. Rising costs and a more complicated menu of vaccines, however, have brought new challenges for the sustainable introduction of new vaccines. Still, countries in Latin America and the Caribbean have consistently invested public funds to adopt new vaccines and technologies at the same pace as many high-income countries.

In 2014, 32 countries in the Americas introduced new vaccines, including rotavirus, pneumococcus and human papillomavirus vaccine, or HPV, which guards against cervical cancer. Under the new plan, countries will continue to review available evidence, particularly regarding cost-effectiveness, to inform decisions about introduction and to ensure that newly introduced vaccines are sustainable over time.

The health ministers agreed that universal health coverage should be the framework for strengthening health and immunisation services for all, particularly the poorest and most isolated. PAHO’s Revolving Fund for Vaccine Procurement will help to ensure that countries of the region receive uninterrupted access to quality vaccines and supplies at affordable prices. Other strategies that countries will incorporate into their immunisation plans include the combination of vaccination with other health interventions (such as deworming and vitamin A supplementation), ensuring data quality at different levels of management and strengthening health information systems.

“PAHO will continue to provide technical cooperation to help national immunisation programmes reach these goals,” said Ruiz. “We have made extraordinary progress, but we still have a lot of work to do.”