Global Update of the 2010 GIVS Goals

Transcription

1 Global Update of the 2010 GIVS Goals Global Immunization Meeting New York, Feb 2009 JM Okwo-Bele, WHO P. Salama, UNICEF

2 Projected Changes in Under-5 yr mortality due to VPDs M illio n s Not preventable by Preventable with current pace of progress with coverage improvements Preventable if coverage is scaled up to 90%, impact of campaigns and widespread use of new vaccines %-70% reduction in rate

3 Are we on track to achieve the GIVS goals? 1. By 2010 or earlier - Increase coverage

4 Global DTP3 coverage and projections to reach 90% global goal in % coverage Global African American Eastern Mediterranean European South East Asian Western Pacific Source: WHO/UNICEF coverage estimates , August WHO Member States. Date of slide: 15 February 2008

5 Countries achieving >=90% DTP3 coverage, 2007 Source: WHO/UNICEF coverage estimates , August WHO Member States. Date of slide: 12 February t 2008 >=90% (117 countries or 61%) <90% (76 countries or 39%) 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 All rights reserved

6 Countries with all districts achieving at least 80% DTP3 coverage, 2007 Source: WHO/UNICEF estimates and WHO/IVB database, September WHO Member States. Yes (55 countries or 28%) No (96 countries or 50%) No data (42 countries or 22%) 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 All rights reserved

7 Countries with most unvaccinated infants DTP3 coverage, (in millions) India Nigeria China Indonesia Ethiopia Pakistan Uganda Niger Bangladesh DR Congo Major Concern: Lack of progress to reduce the number of un-reached Source: WHO/UNICEF coverage estimates , August 2008 Date of slide: 21 August 2008

8 "Return Routine Immunization to Issues: the centre stage" (*) Coverage data quality Political support in 'Lagging' Countries Cash support Ways forward: Return to the basics: Annual Planning & Reviews; training; improved monitoring Focus on the un-reached Support the current momentum for HSS/PHC Innovative & local solutions tailored to local needs (*) WHO/AFRO Medium Term Review_08)

9 Are we on track? 2. By 2010 or earlier Reduce Measles Mortality

10 Estimated measles deaths 2000, : deaths 2007 : deaths = 1000 death Dots are randomly distributed in countries. Data source: WHO/IVB, November 2008 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 All rights reserved

11 Status of Measles Control Reaching the 90% global measles reduction goal by 2010 requires : India starts catch up campaigns Improved measles coverage for both routine and follow up campaigns Political support Adequate funding

12 Global TT2 coverage and Estimated PAB % of target group Women with TT2+ in TT SIAs (in millions) WCBA SIA Protected Reported TT2+ cov PAB Estimates

13 Polio Eradication: New Strategic Plan Wild Poliovirus*, 11 Aug Feb 2009 Active conflict Insecurity & governance Wild virus type 1 Wild virus type 3 Political & societal buy-in Optimizing vaccination efficacy Endemic countries Case or outbreak following importation (0-6 months)

14 Critical to achieve soonest the disease initiatives goals Key issues Credibility at stake Waning commitment Ways forward Predictable funding necessary Commit resources for increased routine coverage in the un-reached AEFI risk assessment, prevention and management Expand Case-based surveillance and labnet

15 Are we on track? 3. By 2015 or earlier Introduce new vaccines

16 Global coverage estimates, DTP3, HepB3 and Hib % coverage DTP3 HepB3 Hib3 Source: WHO/UNICEF coverage estimates , August 2008, 193 WHO Member States.

17 Countries having introduced Hib vaccine and infant Hib coverage, 2007 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 All rights reserved Source: WHO/UNICEF coverage estimates , August 2008 Hib3 > 80% (94 countries) Hib3 < 80% (19 countries) Hib vaccine introduced but no coverage data reported (2 countrie Hib vaccine not introduced (78 countries)

18 Implementation of other new vaccines Japanese Encephalitis Yellow Fever Rubella Pneumo (Conjugate vaccines) Rotavirus Diarrhoea Typhoid Fever HPV Mening Conjugate A

19 Issues Accelerating the widespread use of new vaccines Complex decision-making processes Costs of new vaccines, a major barrier Need to reach the un-reached Ways forward Adjust timelines of WHO Recommendations Support routine immunization coverage (cold chain & logistics, planning ) Cost reduction strategies Vaccine presentations / Supply

20 The work ahead of us!

21 World Health Assembly Resolution on GIVS report, 24 May 2008 (WHA61.15) Concerned that many developing countries are not on track to meet health-related MDG Goals, particularly the target of reducing the under-five mortality rate URGES Member States: (1) to implement fully the strategy for reducing measles mortality (2) to improve delivery of high-quality immunization services (and) achieve equitable coverage of at least 80% in all districts by 2010; (3) to stimulate rapid introduction of new vaccines in accordance with national priorities and to expand coverage of these vaccines;

22 In brief, all immunization stakeholders should help to Focus on the "lagging" countries Minimize the imbalance in attention and funding for: Routine Immunization Accelerated Disease Control Initiatives New Vaccines Introduction Improve collaboration in support of the foundation of immunization!

23 END

24 Part 3: Linking Immunization With Other Interventions

25 Getting Results Over the past 50 years childhood deaths have dropped dramatically. The number of children born went up, while the number who died was cut in half. I think this is one of the most amazing statistics ever Bill Gates in his first annual letter on the work of BMGF, January 2009

26 Trends in Global Under 5 Mortality, Number of <5 deaths

27 Annual <5 Deaths Decline to 9.2 Million

28 Where Did Children Die in 2007? 10,000 deaths

29 Coverage Along the Continuum of Care Source: Lancet Countdown Coverage writing group, Lancet Countdown special issue, 2008

30 Malaria Funding By GFATM Round $3,000,000,000 $2,500,000,000 In te n s ifie d UNIC E F a n d p a r tn e r s u p p o rt to p ro p o s a l p ro c e s s $2,000,000,000 $1,500,000,000 $1,000,000,000 $500,000,000 $0 Rd R d Rd

31 Number LLINs Distributed and Projected, Campaign Size Cumulative LLINs GF R8 Ph I funds begin Togo EQ. Guinea Zambia Eritrea Kenya Rwanda S. Leone Ghana Zambia Ethiopia Cameroon Nigeria Madagascar Gabon Equ Guinea Congo-B Angola Burundi DRC Congo Liberia Senegal Tanzania Togo Cameroon Guinea Kenya Zimbabwe CAR Sudan N Niger Gambia Madagascar Benin Note: Data from is estimated and/or being confirmed

32 Trends in ITN Coverage, Swaziland '00 - '06-'07 Côte d'ivoire '00 - '06 Sierra Leone '00 - '05 DRC '01 - '07 Kenya '00 - '03 Niger '00 - '06 Burundi '00 - '05 Uganda '00-'01 - '06 Burkina Faso '03 - '06 Cameroon '00 - '06 Rwanda '00 - '05 CAR '00 - '06 Senegal '00 - '06 Benin '01-'02 - '06 Ghana '03 - '06 Malawi '00 - '06 Tanzania '99 - '07-'08 Zambia '99 - '07 Ethiopia '05 - '07 Togo '00 - '06 Guinea-Bissau '00 - '06 Sao Tome/Principe '00 - '06 Gambia '00 - '06 Source: UNICEF Global Databases, November 2008

33 Trends in Malaria Cases and Deaths in Relation to Interventions, 4 African countries, (NMCP/WHO data)

34 Countries Conducting Child Health Days, 2007 Countries conducting CHD in 2007 twice a year (UNICEF)

35 Coverage with EOS/CHDs VS Routine EPI By Region in Ethiopia, UNICEF 2006 SNNPR Tigray Addis Ababa Amhara Oromiya Harari Afar Dire Dawa Benshangul Gumz Gambella Somali Admn DPT3 coverage Vit A coverage Deworming coverage Measles SIA coverage

36 ACSD Evaluation: Results of Integration of EPI With Other Interventions Benin Ghana Mali Measles * * DPT * * Vitamin A * * * ITNs 6 Source: ACSD evaluation, JHSPH 26 * Increases in coverage across the board in Ghana and Mali; Benin achieved increases for vitamin A * Change was significant at p < and ITNs. * * Key Before ACSD After ACSD

37 Challenges With Child Health Days Too many interventions Some interventions inadequate for campaign delivery Routine dose of antigens are mostly not part of CHD Insufficient monitoring of coverage by intervention Insufficient documentation Funding not yet sustainable

38 % of coverage (IPTi / EPI) Dec IPTi Integration Into EPI Intermittent Preventive Treatment of Malaria at DTP2, DTP3 and measles Jan Mars Madagascar Apr Feb Benin May Ghana Apr Jun Jul Jun Aug Sept Aug Oct Dec Malawi Feb Mali Apr Jun Dec Feb Apr Jun Nov Jan Senegal Mars May Jul Sept IPTi1/ DTP2 IPTi2/ DTP3 IPTi3/ Measles

39 Cotrimoxazole (CTX) for HIV Exposed Infants Initiation of CTX for HIV-exposed infants at DTP1 DTP1 coverage: >90% in most countries CTX Regimen: ¼ to 2 tablets (depending on age and formulation) once per day Child health cards can prompt initiation at DTP1 contact and follow-up

40 Co-trimoxazole Treatment Initiated at DPT1 Contact and Continued for 8 Months EID and CTX, Swaziland, January - August, Number Exposed children 2007: 6% coverage in : 55% coverage at 8 months Early infant diagnosis 600 Testing positive CTX

41 Cause of Deaths Among Under Fives Other, 10% Injuries, 3% HIV/AIDs, 3% Measles, 4% Neonatal, 37% Malaria, 8% Under-nutrition (underlying cause) Diarrhea, 17% Source: 2005 World Health Report Pneumonia, 19%

42 Coverage Along the Continuum of Care GAP 1 GAP 2 GAP 3 Source: Lancet Countdown Coverage writing group, Lancet Countdown special issue, 2008

43 Proportion of Children <5 with Suspected Pneumonia Taken to Appropriate Health Provider Source: DHS, MICS & other national surveys

44 And poorest have least access Bangladesh: Equity in Pneumonia Interventions Between poorest and wealthiest quintiles Excl BF 0-5 mos Measles vaccine Full vaccine coverage Vit A supp (within last 6 mos) Handwashing Careseeking behavior Amoxicillin for pneumonia Source: MICS 3, 2006 Coverage (%) of interventions

45 How Could EPI Contribute to Pneumonia Control? Sustain protection against measles with 2 doses Introduction of new and underutilized vaccines (PCV and Hib) Implementation of integrated package using RED: Focused health system strengthening approach Community-Case Management, Promotion of EBF and Handwashing, Vitamin A Challenges to consider? Joint fundraising/leveraging? Joint planning? Joint supply management of vaccines and antibiotics? Joint monthly monitoring? Integrated surveillance?

46 Optimal Management of Diarrhea Approved in 2003 Recommended for all cases of acute diarrhea: 1. Low osmolarity ORS 2. Oral zinc sulfate 20 mg daily for 14 days 3. Antibiotics in dysentery No country has as yet implemented this strategy at scale

47 Part 4: Global Interdependence

48 Global Interdependence If we lose sight of our long-term priority to expand opportunity for the world s poor and abandon our commitments and partnerships to reduce inequity, we run the risk of emerging from the current economic downturn in a world with even greater disparities in health and education and fewer opportunities for people to improve their lives. Bill Gates, Davos, 2009

49 Price Reduction in DTP-HepB, DTP-HepB: Procured ( ) & PQ offers ( ) -Associated Factors: -Multiple suppliers in the market -Manufacturers from developing country -Long term funding through GAVI Number of doses (millions) $1.40 $1.20 $1.00 $0.80 $0.60 $0.40 USD $ $0.00 Weighted average price PQ products Pipeline products

50 Are the Same Conditions Present for DTP HepB Hib? -Growth in demand -Multiple suppliers -In the pipeline: developing country suppliers -Long term funding through GAVI Weighted average price PQ products Pipeline products

51 GIVS: Total Costs, Poorest Income Countries 45 Low and Middle Income Countries Total $ 27.9 billion $ 30.6 billion $ 58.5 billion Campaign costs (vaccines % operational costs) 3% Additional costs to reach routine targets 20% System costs maintaining current coverage 40% Traditional vaccines (routine) 7% Underused vaccines (routine) 15% New vaccines (routine) 15%

52 GIVS Funding Gap for 72 Poorest Countries Funding Scenario ( ) ** 72 Poorest Countries Best Case Worst Case US$ Bn US$ Bn National Governments* $13.5 $11.0 GAVI Fund* $7.4 $4.6 Mulitlaterals (WHO & UNICEF)* $1.8 $0.6 Other $0.9 $0.4 Funding Gaps $4.4 $11.3 Unmet needs (% of requirements) 15.6% 40.6% * Includes contributions from bilateral agencies ** Extrapolated from the funding scenarios of 50 of the 72 countries based on their 5 year multi-year plan for immunization (cmyp)

53 Conclusions Focus on sustaining gains and reaching the unreached to achieve existing goals Continue to pursue linkages with child survival interventions through pro-poor outreach and facility-based strategies Use introduction of new vaccines as a major opportunity to revitalize programming for pneumonia and diarrhoea Utilize RED approach and EPI planning, supply chain management and monitoring tools for broader systems strengthening goals Integrate with national planning and budget cycles as part of revitalization of PHC