Why maternal immunisation is the key to reducing newborn mortality

Maternal immunization has emerged as a promising intervention to prevent infection-related infant deaths in poor countries. There are approximately 600,000 infection-related neonatal deaths per year. While concerted global efforts have led to the steady reduction of under-5 childhood mortality by roughly 5% per year over the past two decades, mortality reduction in newborn infants under 1 year of age has been more gradual, declining on average 3% per year since 1990. Due to this difference, the relative proportion of newborn deaths now accounts for about 44% of the total under-5 mortality, and newborns are projected to make up 55% of all under-5 mortality by 2035.

By providing vaccinations to pregnant women, antibodies are transferred from the mother to the fetus and can provide protection for the baby for several months after birth. Maternal immunization is a way to protect infants during these critical and vulnerable first few months of life, before they can receive most childhood vaccines. In addition to providing protection to newborns and young infants, scientists are trying to better understand other substantial benefits of maternal vaccinations such as potentially preventing pre-term births and stillbirths caused by infectious diseases.

Realizing the potential health impact of maternal immunization, partners gathered in Berlin, Germany earlier this year to bring together global health stakeholders to better understand the challenges, knowledge gaps and potential impact of maternal immunization. Partners addressed the need to align on key next steps toward the eventual implementation of maternal immunization in low- and low-middle-income countries. The convening attracted major donors and more than 100 leaders from academia, vaccine manufacturing, regulatory agencies, multilateral organizations and country-level ministry of health representatives of health from Africa, Asia and South America. The effective implementation of maternal immunization will be dependent upon the close collaboration and synergistic work from all players in the child health arena. Bringing these communities together for the first time to develop a shared strategy for integration and path forward was especially important.

The convening was a great success with the attendees coming to several shared conclusions.

First, stakeholders agreed that a stronger evidence base is needed in developing countries regarding the burden of disease, efficacy and safety and the effects of maternal immunization on morbidity and associated healthcare costs. This will support a robust investment case for manufacturer and donor investment decision making, policy recommendations, vaccine development and country-level uptake.

Second, all agreed that integration of maternal immunization into antenatal care (ANC) services is the preferred delivery strategy. However, ANC and vaccine delivery programs differ by country, therefore a one-size-fits-all approach will not work and should be evaluated on a country by country level. In all cases, integration of immunization into ANC should benefit both the woman and child and serve to strengthen existing healthcare systems rather than fragmenting them or adding undue burden.

Finally, stakeholders realize the potential health benefits of maternal immunization and are committed to take on next steps. These include sharing lessons learned from existing maternal immunization efforts (e.g. MNTE, pertussis in Argentina), funding to improve the maternal immunization evidence base, and accelerate maternal vaccine development, and integrating WHO SAGE vaccine policy with ANC maternal immunization policy guidelines.

A major goal of the 2015 maternal immunization stakeholder convening was to facilitate coordination and collaboration between the Vaccine and Maternal, Newborn and Child Health (MNCH) communities, as well as among stakeholders across functions – e.g. policy makers, regulators, vaccine manufacturers, and MNCH implementers. Due to the cross-platform and cross-functional nature of maternal immunization, such collaboration is essential to creating momentum to achieve an end-to-end path to impact.

This article is published in collaboration with The Bill & Melinda Gates Foundation. Publication does not imply endorsement of views by the World Economic Forum.

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Author: Ajoke Sobanjo-ter Meulen is the Lead for Maternal Immunisation at The Bill & Melinda Gates Foundation.

Image: Lu Libing touches the belly of his pregnant wife, Mu. REUTERS/Alex Lee.