Transcript Historical perspective of vaccination

Global
vaccination issues & action
Poverty, inequity and inadequate social & health conditions are a
reality for many people in developing countries.
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Investing in health care is an important contributor to reduce
poverty
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Failure to immunise the world’s children results in ~ 3 million
deaths per year
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Over the last 30 years nearly all countries with per capita incomes
over $US 600 have made the most of vaccination, poorer countries
have not
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The Global Alliance for Vaccines & Immunisation (GAVI) is
an unincorporated public-private partnership launched in
2000.
It comprises partners, including UNICEF, WHO, the Gates
Foundation, the World Bank, developing country
governments, donor country governments, the vaccine
industry, civil society groups, and research and technical
health institutes.
A secretariat, based in Geneva, coordinates Alliance activities
of policy development and country support.
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Members of the partnership GAVI Board
GAVI Board is currently made up of representatives from
• Developing country govts: Armenia, Ethiopia, Rwanda, Vietnam &
Yemen
• Industrialised country govts: Italy, USA, UK, Netherlands, France
• International Vaccine Institute:
• Industrialised country vaccine industry: GlaxoSmithKline
• Developing country vaccine industry: Serum Institute of India,
Ltd
• Civil society organisations
• Bill & Melinda Gates Foundation
• WHO
• UNICEF
• The World Bank Group
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• The Bill & Melinda Gates Foundation is a founding partner of the
GAVI Alliance.
• Its initial grant helped establish GAVI and it continues to support its
work.
• It has committed more than $1.5 billion to GAVI, of which GAVI has
received US $988 million, as at December 2007, to support global
health efforts in two priority areas:
• Accelerating access to existing vaccines, drugs, and other tools to fight
diseases common in the developing world
• Supporting research to develop new health solutions that are effective,
affordable, and practical for use in developing countries
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UNICEF is the world’s largest purchaser of vaccines for
developing countries and a key partner in global immunisation
efforts.
Its supply division, based in Copenhagen, is responsible for global
purchasing, including some $100 million per year spent on
vaccines and safe injection equipment
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The World Bank Group
• The World Bank is a partner in the GAVI Alliance
• It is owned by more than 180 member countries
• Is the world’s largest source of development assistance,
providing nearly $30 billion in loans annually to its client
countries.
• Works with ministries of finance and health in developing
countries to value immunisation and new vaccine development
• Makes loans and credits in support of immunisation
• Consults with public and private sector partners to create new
financing options to accelerate the development of critical
vaccines for HIV/AIDS, malaria and TB
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Global
Immunization
Vision and
Strategy (GIVS)
• UNICEF and WHO have developed the Global Immunization
Vision and Strategy (GIVS) for the period 2002-2015.
• The GAVI Alliance is funding the vaccine program to achieve
GIVS
• Goal is to reduce vaccine-preventable illness and death by two
thirds compared to 2000 levels, thus achieving the Millennium
Development Goal for child health.
• This equates to the saving of more than 40 million lives
• Targets eight countries that account for 2/3 of the world's unimmunised children. (India, Nigeria, Indonesia, Pakistan,
Ethiopia, DR Congo, Sudan, Philippines)
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supported by a $37 million
4-year grant from GAVI/The
Vaccine Fund
• Haemophilus influenzae type b (Hib) is a bacterium which can cause
meningitis and severe pneumonia
• 3 million cases of serious illness and 400,000 deaths each year in
children under 5 years of age from Hib
• In 2006, only 26% of children worldwide received Hib vaccine
• 1/3 of the countries eligible for funding from the GAVI Alliance (i.e., Gross
national income/capita <$1000 per year) are using Hib vaccines
• The Hib Initiative focuses on coordination, communication and research.
Hib
Initiative
Activities
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Movie obtained from
http://www.hibaction.org/resource
s.php
HibPromo2.mp4 (3.30mins)
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Percentage decline in incidence Hib following vaccine
introduction
120%
Finland
Netherlands
UK
Ireland
Israel
100%
80%
60%
40%
20%
0%
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0
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Year relative to introduction
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Hib-containing
Vaccines
The GAVI Fund enables eligible countries to purchase Hib containing
vaccine for a small co-payment of 15 to 30 cents per dose, depending
on country grouping
A number of vaccine manufacturers have Hib-containing vaccines
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11 Hib-containing vaccines currently WHO pre-qualified for purchase
At July 2008, vaccines are usually available for about of $US 2.50 per dose.
In July 2008, the WHO pre-qualified Easyfive™ and Shan5™, two Hib-containing
pentavalent vaccines:
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Easyfive™, manufactured by Panacea Biotec, India, is a fully liquid combination
pentavalent vaccine (DTwP-HepB-Hib) Each dose contains : Diphtheria Toxoid, Tetanus
Toxoid, Inactivated w-B.pertussis, Hepatitis B surface Ag, H.influenzae type b oligosaccharides)
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Shan5™ pentavalent (DTP-HepB-Hib), manufactured by Shantha Biotechnics
Private Ltd., India. (diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenza type B)
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Developing Country Vaccine Manufacturers
Network
Developing Country Vaccine Manufacturers Network (DCVMN)
represents a voluntary, public health-driven alliance of
enterprises – state-owned and private, large and small – from
developing and middle-income countries.
Members:
Bio Farma, Indonesia
Bio Manguinhos/Fiocruz, Brazil
Centre for Genetic Engineering and Biotechnology, Cuba
Haffkine Bio-Pharmaceuticals Corp Ltd, India
Institut Pasteur Dakar, Senegal LG Life Sciences Ltd, Korea
Panacea Biotec, India
Serum Institute of India Ltd, India
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Developing
countries
are
producing
their own
vaccines
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Local strategies proven to deliver
vaccines
Immunisation programs need effective in country systems
to ensure that children receive vaccines
These must work at the local level to ensure the routine immunisation
systems
work with the people and health infrastructure for that country
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Types of strategies
Bringing immunisation closer to the community
Information dissemination to increase demand for vaccination
Changing practices in fixed sites
Innovative management practices
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1.
Bringing immunisation
closer to the community
Non-health workers can encourage people to seek immunisation
Valuable to involve community members in immunisation delivery &
education
These are some examples:
• INDIA - Women in the community provide health information & track
immunisation
• PNG- Vaccines given by trained Aid Post Orderlies at local health
posts in rural communities
• NIGERIA- Convenient locations and times with more parent education
• SOUTH AFRICA -Local village health workers visit and maintain
immunisation records, they keep cards for each child
• BANGLADESH- Follow up of defaulters using low-literacy urban
volunteers, uses a colour coded tracking system
• MOZAMBIQUE- Outreach service to areas affected by conflict
bushplanes to gain access, incentives to bring children in, house to 21
house visits
Example - mid-wives in Sri Lanka
When new mothers leave
hospital, midwives from
the Family Health Bureau
make regular house visits.
For five years, the midwife
will follow mother and
child’s progress, providing
health education and
ensuring they don't miss
vaccinations.
Vaccines are even delivered
behind the frontlines of
northern parts held by the
Liberation Tigers of Tamil
Eelam.
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2. Information
dissemination to
increase
demand for
vaccination
Demand for vaccination is increased without changing service
delivery.
Communication campaigns relevant to the people & place
Here are some examples:
• WEST BANK- Development of staffed village resource rooms
• PHILIPPINES- Communication of measles information via mass
media campaign
• BANGLADESH- Advocating by an NGO credit program for
women to use immunisation services
• KENYA -Outreach immunisation services & information delivery
located in schools, school children provide the education to their
own communities
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Example: Nigeria - support of local
leaders
At an Immunisation Day
Plus held at the fixed
immunisation post in
Isawa village,
Muhammed Sabo
Abdulkadir, the district
head of Giade (right)
and Yaya Abubakar, the
village head of Isawa
(left), are seen by
members of the
community to be
endorsing vaccination.
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3.
Changing
practices in
fixed sites
Improving the quality of health facility increases access &
efficiency
The aim is to get close to what the people normally do
Examples:
1. SUDAN- Move vaccination location closer to physicians consulting
rooms
2. NIGERIA- Re-organising health centres to have a quick
immunisation line
3. MEXICO- Screening hospitalised children for vaccination status
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4. ETHIOPIA- Reminder stickers and health education to reduce
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Innovative
management
practices
Can be to improve record keeping, education, vaccine delivery
Think smart to achieve local effect
Examples here:
1. NICARAGUA- Food incentives to improve attendance at child
health clinics
2. INDONESIA- Train nurses in under-performing health centres
using low cost on the job peer training
3. CAMBODIA - Using contractors to increase immunisation
coverage & equity
4. MADAGASCAR- Use auto-disable syringes for increased safety,
health workers more likely to vaccinate when it is easy
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Value of local
people
Non-health workers can provide numerous services and
have been proven to be very successful
• They have community knowledge
• Can be respected by the community
• May gain access to community members not reached by mass
media
• Successful at motivating parents to use vaccination services
Locally sensitive and relevant strategies complement existing
health systems
and international programs to provide vaccines
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Example: health worker Ajebush
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Ajebush Wakalto (right) is one of
Ethiopia’s 30,000 10th-grade
graduates who has become a
health extension worker, having
received 12 months of training.
Health extension workers are
trained to provide basic services in
almost 15,000 communities.
Improving health at community
level, including providing services
such as immunisation, frees the
time of qualified personnel.
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Global results for
GAVI
Further information on GAVI
http://www.gavialliance.org/
WHO projections for the period 2000-2007 show GAVI
support has:
• prevented 2.9 million future deaths
• protected 36.8 million additional children with basic
vaccines (against diphtheria, tetanus, and pertussis)
• protected 176 million additional children with new and
underused vaccines
• 158.6 million additional children have been immunised
against hepatitis B
• 28.3 million additional children have been immunised
against Haemophilus influenzae type b (Hib)
• In 2006 almost 30% of all the vaccine doses
purchased by UNICEF for the GAVI Alliance came
from developing country manufacturers.
H.influenzae
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