Governments meeting at the World Health Organisation (WHO) Executive Board this week has been urged to seize the opportunity to improve "serious shortcomings" in the Global Vaccine Action Plan, the document that will drive the global community's vaccine response over the next few years.

If they fail to do so, key reasons why children continue to be missed by immunisation programmes will be left unaddressed, warns the international medical aid organisation Medecins Sans Frontieres (MSF).

The 132nd session of the Executive Board, which runs in Geneva during January 21-29, will discuss the monitoring and evaluation framework that will assess the success and steer the activities of the Global Vaccine Action Plan, which was established as part of the Decade of Vaccines declared by the global health community in 2010, with the aim of "working to realise a 10-year vision to extend the full benefits of immunisation to all people, regardless of where they live."

However, while high vaccine prices pose a considerable threat to the sustainability of vaccine programmes, the Plan contains no measures to monitor prices, says MSF.

“The cost of vaccinating a child has risen by 2,700% over the last decade, so it is puzzling that the vaccines blueprint for the next decade does not have a goal to bring prices down," said Manica Balasegaram, executive director of MSF's Access Campaign.

"Governments in countries where we work are increasingly worried about how they will foot the bill for vaccines when donor support tapers off. A strong pricing indicator would show at a minimum that legitimate concerns about pricing are being taken seriously," he added.

In 2001, the cost of vaccinating a child was $1.37 for the basic vaccines package with BCG, polio, diphtheria, tetanus, pertussis and measles. With the addition of more vaccines - and particularly two new vaccines against pneumococcal disease and rotavirus, which together account for nearly 75% of the cost of vaccinating a child - the cost per child has risen to at least $38.80, with many countries paying much higher prices, says MSF.

"Much more attention needs to be paid to getting vaccine prices down, for example by speeding up the market entry of emerging producers which would foster competition. The Decade of Vaccines is expected to cost around $50 billion, and the cost of the vaccines themselves will swallow a large chunk of that money. Simply ignoring this fact is not on," said Dr Balasegaram.

Equally worrying is the Action Plan's lack of ambition in terms of tackling the fact that many vaccines are ill-suited for use in developing countries today, MSF goes on. Over the last five years, 112 million children have not received even the basic package to protect them against childhood killer diseases, in large part because the current vaccines are difficult to use in remote or rural areas. For example, they have to be kept cold, they require trained health workers to administer injections, or they must be given in multiple doses, requiring several clinical visits, it says.

This need is urgent, yet the Action Plan has the "unambitious" goal of having just one new adapted vaccination technology in use by 2020, even though several new technologies are on the cusp of receiving WHO quality approval. One, for example, would deliver the vaccine needle-free, through a mask or with air pressure.

"Even for an organisation with the logistical clout of MSF, vaccinating children in hard-to-reach places with vaccines that need to be kept cold is a serious challenge, and it means children are falling through the net," commented Kate Elder, vaccine policy advisor for MSF's Access Campaign.

"We need more products that make vaccinating children easier. We need a clear signal that this is a critical objective for the next 10 years," she stressed.

- The goals of the Decade of Vaccines are, by 2020, to: - achieve a world free of poliomyelitis; - meet global and regional elimination targets; - meet vaccination coverage targets in every region, country and community; - develop and introduce new and improved vaccines and technologies; and - exceed the Millennium Development Goal IV target for reducing child mortality.

Endorsing the Plan, the World Health Assembly last year said that achievement of these goals by 2020 wuld require continuous progress towards the following six strategic objectives: - all countries commit to immunisation as a priority; - individuals and communities understand the value of vaccines and demand immunisation as both their right and responsibility; - the benefits of immunisation are equitably extended to all people; - strong immunisation systems are an integral part of a well-functioning health system; - immunisation programmes have sustainable access to predictable funding, quality supply and innovative technologies; and - country, regional and global R&D innovations maximise the benefits of immunisation.