Following devastating outbreaks in Angola and the Democratic Republic of the Congo in 2016 that saw exportation of cases to China, the EYE Strategy  –  a global coalition of over 50 partners in 40 countries  – was launched to accelerate efforts to prevent outbreaks, protect at-risk populations, and save lives across the continent. 

The global strategy addresses several challenges including yellow fever’s changing epidemiology; the worldwide resurgence of the primary vector responsible for urban yellow fever outbreaks (aedes aegypti mosquito), and the increasing risk of international spread.

An independent mid-term evaluation of the EYE Strategy (covering 2017 to 2021), was undertaken by the Euro Health Group –  with guidance from WHO, UNICEF, and Gavi evaluation offices  –  as an opportunity to take stock of the Strategy’s progress to date and to determine how best to move closer to protecting almost 1 billion people in Africa and in the Americas from yellow fever by 2026. 

Since 2017, according to EYE Strategy data, 226 million more people in Africa have been protected from yellow fever via a single-dose vaccine that provides lifelong protection. Under the previous yellow fever initiative, 108 million people were protected in an 8-year period. The EYE Strategy’s global coalition has contributed to the acceleration of vaccination during this period.

“The EYE Strategy has worked closely with Member States and communities through integrated programmes to rapidly respond to outbreaks of yellow fever. This has been done through enhancing vaccine coverage, surveillance, and diagnostics to curb the deadly impact of this disease in Africa and the Americas,” says Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme. “We have seen a resurgence of outbreaks of this disease in previously immunized areas, with risk in urban centres, which tells us the threat is far from over. Evidence shows that we are on the path to eliminating yellow fever epidemics, but our work is not yet done.”  

On the Strategy’s historic immunization milestone Dr Kate O’Brien, Director of WHO’s Department of Immunization, Vaccines and Biologicals states, "The evaluation evidence shows that through collaboration and co-ordinated action, the EYE Strategy has yielded significant results. Yellow fever vaccination campaigns have protected 226 million people in Africa since it was launched in 2017[BAR1] , and most high-risk countries have introduced the yellow fever vaccine into their routine immunization schedules. This has helped to prevent major disease outbreaks in sub-Saharan Africa. However, the numbers of unvaccinated children remain high, and we must continue to work successfully in partnership to ensure those gaps are filled quickly through improvements to essential immunization programmes and vaccination campaigns when needed.”

The evaluation report shows that despite the significant achievements of the Strategy, there are challenges. Key gaps include low prioritization of yellow fever due to competing public health priorities in countries, and the need for increased engagement by governments to implement prevention and control measures, which can include targeted catch-up vaccination campaigns to fill immunization gaps. There also needs to be a continued focus on outbreak preparedness, readiness, and response.

“In July 2023, WHO and UNICEF published updated data for 2022 on the number of children who have missed out on critical vaccinations as part of their country’s routine immunization schedules,” says Dr Ephrem Lemango, Associate Director and Chief of Immunization at UNICEF. “Although we are making good progress after the disruption of the pandemic, there is still work to be done to ensure that governments continue to prioritize yellow fever. It is possible to eliminate these epidemics in our lifetime.”

With climate change and the rise in environmental issues, such as deforestation, yellow fever continues to threaten the health and livelihoods of vulnerable populations, especially in densely populated cities. These factors pose the greatest threat of catastrophic outbreaks and international exportation of the disease, risking multi-country epidemics and putting global health security at risk.  

“The recent rise in outbreaks and the risks they entail are why the introduction of the yellow fever vaccine into routine immunization programmes is so important.” said Dr Kelechi Ohiri, Managing Director of Policy, Programme Design&Delivery Support at Gavi, the Vaccine Alliance. “We will continue to work with countries and partners supporting routine introductions, filling immunization gaps, and improving readiness for outbreak response so that we achieve our common goals.”

Yellow fever is endemic in multiple countries in both Africa and the Americas. A deep dive into best practices and lessons learned in Brazil and Ghana are also included in the report (links in country names). Both countries have a history of yellow fever outbreaks and have implemented preventive mass vaccination campaigns.

The EYE partners are committed to intensifying efforts across both continents to support nations implementing the Strategy and to ensure a world free from yellow fever epidemics by 2026.

Distributed by APO Group on behalf of World Health Organization (WHO).