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Access to safe, assured-quality immunization services requires a
three-pronged approach: to assure vaccine quality from production to the
point of use, to ensure the safety of vaccine administration in routine and
mass campaigns, and the safe disposal of
immunization waste. The work to establish the causes of any adverse events
following immunization and to address such causes,
is closely linked to this approach, as the findings directly strengthen
quality assurance issues and the ensuring of approved administrative
procedures. This area of work also relates to WHO’s global target to
establish a comprehensive system to ensure the safety of all immunizations
given by national immunization services.
In addition to assuring the quality and safety of the vaccines
themselves, the administration of immunization presents many challenges for
immunization services. A range of activities can support safe procedures
during routine vaccination and mass immunization campaigns. These include
procedures for the proper handling of vaccines, respect for precautions and
contraindications, proper administration routes and techniques, and
limitations on the number of unnecessary vaccinations, investigations into
adverse events following immunization, establishing the causes of the event,
reviewing complaints of quality defects in the vaccines as well as
programmatic errors. The systems used for vaccine delivery are also very
important in terms of ensuring public safety, and include the management of
sharps and waste. The use of autodisable (AD) syringes is making an impact on the
unsafe practice of reusing unsterile injection equipment, however, this useful new technology also
generates increased hazardous waste. Sharps waste disposal policies at the
national or local level are rare and thus WHO and UNICEF have issued a Joint
Statement on Injection Safety (1999) which, among other
recommendations, encourages partners of immunization services and countries
to consider good quality vaccines, AD syringes and safety boxes as three
vital components in national plans for safe immunization injection practices
(known as “bundling”).
Estimates made in 2000 using data from the WHO/UNICEF Joint Reporting
Form and data from injection safety assessments suggest that only
approximately 30% of countries in the Region use sterile injection practices.
GAVI and
its partners, through the Vaccine Fund, have attempted to address this
critical problem by requiring the bundling of AD syringes wherever hepatitis
B vaccine is introduced. Countries
that have received GAVI funds for immunization system strengthening have also
been encouraged to support injection safety in their overall training initiatives. Training materials on this topic has been
developed at WHO headquarters and packaged into a “training toolbox”.
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