Transcript Global Vaccination Goals Fully immunize 90 percent of

PROGRESS IN VACCINATIONS
FRANCIS K. NKRUMAH, MD, MPH,FGA
PROFESSOR EMERITUS
FORMER DIRECTOR, NOGUCHI MEMORIAL
INSTITUTE FOR MEDICAL RESEARCH,GHANA
Global Vaccination Goal
 Fully immunize 90 percent of children
under one year of age in every country,
with at least 80 percent coverage in every
district by 2015. (United Nations General
Assembly Special Session and MDG
2002).
EPI VACCINES
Current Vaccines
New Vaccines
Tuberculosis
Pneumococcal conjugate
(childhood pneumonia)
Diphtheria
Pertussis (whooping cough) Rotavirus (childhood
diarrhoea)
Tetanus
Poliomylitis
Measles
Yellow Fever
Hepatitis B
Hib (haemophilus
influenza type B)
Human pappiloma Virus
(cervical cancer)
Meningococcal A conjugate
(epidemic meningitis)
Immunization (EPI) Strategies

Routine Immunization (delivered within the
first year of life)

Supplementary Immunization (mass
preventive campaigns)

Case-based Surveillance (epidemiologic,
laboratory, integrated)

Social Mobilization / Communication /
Advocacy)

Immunization Systems Support (cold chain.
logistics, injection safety)
Operational Components of
Immunization System
Vaccine Supply &
Quality
Logistics
Service
delivery
Surveillance
Advocacy &
Communication
ARE WE ON TRACK TO REACH OUR COVERAGE GOALS?
Global Immunization 1980-2007 and projections 2008-2010 to reach 90% global coverage
goals in 2010
DTP3 coverage
100
% coverage
80
60
40
20
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
1980
1981
1982
1983
1984
1985
1986
1987
0
Global
A f ric an
A meric an
Eastern Mediter ranean
Wes ter n Pac ific
European
South Eas t A s ian
Source: WHO/UNICEF coverage estimates 1980-2006, August 2007
193 WHO Member States. Date of slide: 15 February 2008
100
DPT3 & MCV1 Reported coverage/WHOCoverage stagnation
UNICEF best estimates
RED Approach introduction
90
80
70
60
50
40
30
20
10
0
2000
2001
2002
2003
reported coverage DPT3
best estimates DPT3
2004
2005
reported coverage MCV
best estimates MCV
2006
2007
DPT3 coverage in the AFR, Jan – Aug 2007/8
2007 DPT3
2008 DPT3
≥ 90%
80 - 89%
50 - 79%
< 50%
EMRO
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an
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Er
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Un-immunized children (DPT3)
1800000
80% of un-immunized
children in 8 countries
100.00%
1400000
1200000
80.00%
1000000
60.00%
800000
600000
40.00%
400000
20.00%
200000
0
0.00%
Unimmunized children
cumulative %
Cumulative % (Un-immunized children)
Un-immunized children with DPT3 in
AFR, 2007
120.00%
1600000
The RED Approach : Operational
components

Re-establishment of outreach services;

Supportive supervision;

Community links and involvement with
service delivery

Monitoring and use of data for action;

Planning (micro planning) and
management of resources.
EPI Diseases for Accelerated Disease
Control in Africa
Disease
Goal
1. Polio
Eradi cation
2. Measles
Mortality
reduction/Elim ination
3. MNT (tetanus)
Elimin ation
4. Yellow Fever
Control
Strategies
Routine immunization
(OPV3)
SIA (NI Ds; SNDs; Mop-up)
AFP Surveillance
Certification
Routine immunization
Second opportunity (SIAs)
Case based surveillance
Vit. A
Routine immunization
TT2+ in pre gnant women
SIA (WCBA)
Case based Surveillance
for NT
Routine immunization
Prevent mass SIA
Case based surveillance
Emergency response
2008
Wild Poliovirus Case Distribution
2006 - 2008
2007
Luanda
2006
Luanda
WPV Type 1
WPV Type 3
EMRO
2008
920 WPV cases in 13 countries
806 (88%) in Nigeria
2007
339 WPV cases in 5 countries
240 (78%) in Nigeria
2006
1189 WPV cases in 9 countries
1122 (94%) in Nigeria
Wild Poliovirus*, 30 Sep 2008 – 29 Sep 2009
Wild virus type 1
Wild virus type 3
Wild virus type 1/3
Endemic countries
Case or outbreak following importation (0 - 6 months)
Case or outbreak following importation (6 - 12 months)
*Excludes viruses detected from environmental
surveillance and vaccine derived polioviruses
Data in WHO HQ as of 29 Sep 2009
The boundaries and names shown and the designations used on this map do not imply
the expression of any opinion whatsoever on the part of the World Health Organization
concerning the legal status of any country, territory, city or area or of its authorities, or
concerning the delimitation of its frontiers or boundaries. Dotted lines on maps
represent approximate border lines for which there may not yet be full agreement.
 WHO 2009. All rights reserved
Challenges of Polio Eradication in
Africa

Maintaining the political commitment at all levels
to successfully interrupt WPV transmission in
Nigeria

Achieving and/or sustaining certification level
AFP surveillance at sub-national levels in all
countries

Contributing to improvement in routine
immunization coverage in countries with
infrastructural and systemic problems

Mobilizing funds for timely and adequate
outbreak response particularly at country level
Measles Control Strategy

Provide every child with a dose of measles
vaccine by 12 months of age;

Give all children from nine months to 15 years of
age a second opportunity for measles
immunization;

Establish effective surveillance ; and

Improve clinical management of complicated
cases, including vitamin A supplementation.
Estimated reduction in measles mortality (all
ages) in the African Region, 2000-2007*
600000
500000
400000
300000
89 %
reduction
200000
100000
0
2000
2001
2002
2003
2004
2005
* Same period; 74% reduction of measles deaths globally
2006
2007
In 1999, when MNTE Initiative was launched, 37
countries in Africa had not eliminated MNT
Today:
-
8 countries have eliminated MNT
-
13 countries are expected to be validated in 2009
-
12 are expected to be validated in 2010 & 2011
-
2 are expected to be validated in 2012 or later
Yellow fever Vaccine in EPI: Coverage
performance in the African region 2000-2008*
25
100
90
80
70
15
60
50
10
40
30
5
20
10
0
0
20 00
20 01
20 02
20 03
No. countries
* 2008 data only up to August
20 04
20 05
20 06
# countries at parity
20 07
20 08
Admin.cov (%)
Vaccination cov %
No of countries
20
Status of HepB/Hib vaccine introduction: as of 03
Dec. 2008
Hep. B
Hib
Cape Verde
HepB in 44/46 (96%)
STP
EMRO
EMRO
COM
Hib in 38/46 (83%)
Hib introduced
/approved
Hib not introduced
Hep.B introduced
Hep.B Birth dose
Hep.B not
introduced
MAU
NEW VACCINES OF INTEREST IN
THE AFRICA REGION

Pneumococcal conjugate (childhood
pneumonia)

Rotavirus (childhood diarrhoea)

Human pappiloma Virus (cervical
cancer)

Meningococcal A conjugate (epidemic
meningitis)
Targets of the 2006 – 09 EPI
Strategic Plan (1)
• By the end of 2009:
– At least 80% countries: 90% DPT3 nationaly
– At least 80% countries: 80% DPT3 all districts
– No wild poliovirus associated with AFP
– 90% reduction in measles mortality: < 52,000
measles deaths per year
– At least 80% countries will achieve MNTE
Targets of the 2006 – 09 EPI Strategic Plan (2)
 By the end of 2009:
– All countries at risk: 80% YF national cover.
– HepB in all countries’ routine
– Hib in 80% countries’ routine
– AD syringes or equally safe syr. in all countries
– At least 80% countries: anti-helminthics, vit. A, ITNs
& others integrated with immunization.
Immunization Challenges in the
Africa Region

Financial sustainability

Reaching the unreached

Introduction of / access to new vaccines

Integrated into Health Systems

Political commitment
Some Financial Mechanisms for
Immunization

Vaccine Revolving Fund (Pan American Health
Organization)

Vaccine Independence Initiative (UNICEF)

Poverty reduction strategic plans (World Bank)

Global Fund for Children’s Vaccines (GF)

Global Alliance for Vaccines (GAVI)

Bilateral Direct Donor Support

International Financing Facility for Immunization
(GAVI)