The comprehensive global strategy to eliminate yellow fever epidemics (EYE) has been developed by a coalition of partners (Gavi, UNICEF and WHO) to face yellow fever’s changing epidemiology, resurgence of mosquitoes, and the increased risk of urban outbreaks and international spread.

Yellow fever epidemics are complex, with multi-factorial and evolving nature of risk and its inherent unknowns.  The threat of yellow fever outbreaks continues to affect countries in Africa and the Americas.The unprecedented urban outbreaks in 2016 demonstrated that despite the advances in immunization activities, challenges remain in ending yellow fever epidemics.The EYE Strategy objectives address these challenges.The strategy aims at building a global coalition of countries and partners to tackle the increased risk of yellow fever epidemics in a coordinated manner and is an opportunity to demonstrate new ways of managing the complex world of re-emerging infectious diseases. Activities supported through the EYE Strategy contribute to the triple billion goal of the Thirteenth General Programme of Work of WHO (GPW13) by implementing large-scale interventions to prevent epidemics.

The strategy was endorsed by all African Member States during the 67th session of the WHO regional committee for Africa and by the PAHO Regional Immunization Technical Advisory Group (RITAG) in 2017.

The EYE strategy is a comprehensive and long-term strategy built on lessons learned that aims at ending yellow fever epidemics by 2026, and consists of three strategic objectives:

1. protect at-risk populations;
2. prevent international spread; and
3. contain outbreaks rapidly.

And five competencies of success:

• affordable vaccines and sustained vaccine market;
• strong political commitment at global, regional and country levels;
• high level governance with long-term partnerships;
• synergies with other health programmes and sectors; and
• research and development for better tools and practices.

Protect at risk populations

Immunization is considered to be the most important and effective measure against yellow fever. A single dose of yellow fever vaccine is sufficient to provide life-long immunity and protection against the disease.

The EYE strategy aims at ensuring universal access to yellow fever immunization so that each and every person in yellow fever at-risk countries is protected against the disease.

To guide these efforts, EYE strategy is structured to evaluate risk to prioritize resources. Risk assessment is useful to guide and equitably implement preventive interventions including preventive mass vaccination campaigns and introduction of yellow fever vaccine into routine immunization.  

At the same time, the EYE strategy engages with vaccine providers and global health partners to increase vaccine production, making it an affordable endeavor. Funding mechanisms are supported to enable the most vulnerable countries to provide yellow fever vaccines through routine immunization or preventive and reactive immunization campaigns.

Prevent international spread

The 2016 Angolan outbreak showed that a large urban outbreak in a transport hub increases the risk of local transmission and can rapidly spread to distant countries (11 cases were exported to China where dengue is endemic and population is immune-naïve for yellow fever). Actions are needed to prevent serious risk of international spread.

Towards this objective, the EYE Strategy aims to protect high-risk workers (e.g. persons involved in extractive industries at risk for sylvatic exposures), strengthen application of International Health Regulations (IHR 2005) (e.g. increase compliance with vaccination requirement verification at points of entry), and support development of resilient urban centres (e.g. development of readiness plans to reduce risk of large-scale yellow fever outbreak and increase vector control measures).

Contain outbreaks rapidly

The risk of large urban yellow fever outbreaks has increased due to a combination of factors including rampant informal urbanization. Outbreaks are unusual events that require additional resources and partner support. Planning is essential for a successful response in conjunction with close coordination of partners. Rapid containment of an outbreak is essential to prevent amplification into devastating epidemics. It is dependent on early detection and confirmation; emergency vaccine stockpiles and rapid response.

The EYE Strategy is working to improve surveillance and diagnostics to facilitate early detection of outbreaks and rapid response to outbreaks. There is ongoing coordination with the International Coordination Group (ICG) for yellow fever vaccine to assure global stockpile is maintained with a stock of 6 million doses at all times.

Keep people safe from outbreaks by addressing three critical global health agendas:

1. International Health Regulations (IHR)

Yellow fever is emerging on the global stage as a significant threat to global health security, with the potential to turn into public health emergency of international concern (PHEIC).

Massive, uncontrolled urbanization and fast air travel between endemic regions and other places around the globe facilitate the migration of persons and has the potential for rapid spread of the disease.

The EYE strategy calls for effective implementation of the  International Health Regulations (IHR) by WHO Member States and for vaccine strategies to be put in place whenever and wherever needed.

2. Global Health Security Agenda (GHSA)

WHO works in combination with the Global Health Security Agenda (GHSA) and International Health Regulations to strengthen country preparedness in disease outbreaks.

Global Health Security Agenda (GHSA) is a group of countries, international organisations, NGOs and private sector companies that have come together to advance a world safe and secure from infectious disease threats - and WHO’s work on International Health Regulations strengthens country preparedness for disease outbreaks.

3. Universal Health coverage (UHC)

Universal Health Coverage (UHC) means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

Health systems and structures are vitally important to preventing and responding to yellow fever outbreaks. The EYE strategy aims to strengthen country capacities in ensuring health system performance can be optimal in both emergency and non-emergency situations.

Expert working groups on laboratory, surveillance, and risk-based prioritization analysis will support country-level efforts to prevent, detect and respond to yellow fever cases.

Annual highlights

Click on the link below to see a review of each year's achievements

Vaccine allocation

EYE.Strategy@who.int