Lessons Learned from SIAs:

Transcription

1 Lessons Learned from SIAs: Magnification of the opportunities and risks to routine immunization programmes 4th Annual Global Immunization Meeting, New York 19 February 2009 Rebecca Martin Communicable Diseases Unit, WHO Regional Office for Europe

2 Objectives To share lessons learned from measles and rubella SIAs in the WHO European Region in 2008 To demonstrate that opportunities and risks to routine immunization programmes, including the introduction of new vaccines, are magnified during SIAs 2

3 SIAs conducted in the context of strengthening health systems Stewardship High-level political commitment Health service delivery Creation of demand for services Deliver safe, effective vaccines Health finances Funding Government supported Creation of resources Capacity building of health care workforce Training in programmatic issues and vaccinology 3

4 Why is it important to monitor safety during SIAs? Immunizing a large population in a short period Vaccines can be given outside of routine health care setting Increased potential for programme errors Perception of increased rate of adverse events following immunization (AEFI) Source: Dina Pfeifer WHO/HQ 4

5 UKRAINE Second largest country in Eastern Europe with largest pool of M&R viruses in circulation in Region from MR SIA to start 26 May 2008 to vaccinate 7.5 million people aged years

6 Anti-vaccination atmosphere prior to SIA Known anti-vaccination groups active in Ukraine CD-ROMs and booklets Lack of evidence MR vaccine is an attack on the genetic fund of Ukraine MOH participated in discussion with antivaccination groups in November 2007 Negative press generated 6

7 Communications activities to address SIA issues: conducted and planned Focus groups conducted among students and health care professionals FAQs developed to address concerns of health care professionals and students Trainings planned for journalists, educators, and health care professionals Radio programmes planned: ask the experts Press conference planned for launch with partners to give positive message 7

8 Events aligning Death of a 17 year-old within 15 hours of receiving MR vaccine in advance to the SIA State prosecutor takes case Multiple commissions Legal aspects of vaccine May 13 May 14 May 16 May 17 May 26 Incomplete case investigation, prophylactic hospitalisation of 156 children from the same school, media outburst Campaign suspended: 116,000 immunized (6-16 May) 8

9 Consequences of events Increase in negative, misinformation from media towards immunization, MOH, SII, WHO and UNICEF Generated mistrust SIA, death and vaccine become prominent public issue Detention and questioning of 1 st Deputy Minister of Health and Chief Sanitary Physician Order to quarantine vaccine 9

10 Extremely Hostile Media Response Unscheduled Vaccination: GENIE SET FREE Deadly Vaccine MOH playing Indian Roulette Vaccination 2008 Gain Freedom From All Ills MR Vaccine You can Trust 10

11 Media coverage in Ukraine on MR SIA and AEFI, 12 May 2 June Number of articles Neutral Positive Negative May Date June 11

12 What was the medical community doing? Widespread confusion Lack of information General mistrust Anti-vaccine position held by several high level persons in academia Pseudo-experts threatened to sue MOH, WHO, UNICEF Pro-vaccination voice barely heard 12

13 MOH response to crisis Limited attempts to state vaccine was safe Suspension/firing of staff 1 st Deputy Minister head of communicable diseases heads of the two institutions involved in vaccine importation Lack of communication with the public Mixed messages 13

14 Partners support Ukraine MOH International technical experts Technical advice on death/hospitalized cases Vaccine storage Pro-immunization media messages High level meetings Geneva: WHO Director General, Ukraine Minister of Health, India Minister of Health Ukraine: RD of WHO/EURO and UNICEF RO 14

15 Risks to routine immunization programme Temporary gains made by anti-vaccination movement Public belief in vaccination as an effective public heath intervention was lost Negative shift in risk perception affecting healthseeking behaviours Threat of measles and rubella outbreak exists 15

16 Strategies to rebuild trust in immunization in Ukraine Conducted KAPB surveys Maintain high level of political advocacy Develop and implement long-term strategy to restore public trust in immunization Scenarios to immunize susceptible population Provide competent and independent sources to media, public and different Government bodies Reinforce technical and communication capacity Build pro-vaccine coalition 16

17 Georgia MR SIA conducted 20 October 12 December Targeted 980,136 persons aged 6-29 years

18 Events aligning AEFIs reported majority in adolescents, predominantly in females the most frequent clinical manifestations: fainting and other symptoms related to emotional reaction (psychogenic) after vaccination AEFIs identified during the SIA do not differ from those of MR campaigns conducted in the European region in

19 The Indian medicine used for the injections of measles and rubella is not registered in Georgia... Rustavi 2 broadcast 22 October 2008 Twelve teenagers were taken to the resuscitation department of the first clinical hospital due to extreme worsening of their health conditions in sequence of the injections.. Measles and rubella virus vaccination started in Georgia 19

20 Immunization coverage by region October 2008, Republic of Georgia Percentage Rustavi 2 story on vaccine from India Tbilisi awara samegrel o imereti kaxeti Sida qartli qv. qartli samcxejavax. guria Date rawa, 20

21 Alia Kronika 28 October 2008 Fatal expe rimen carrie ts wit d out h me on G asles eorgi - r ube an ch lla va ildren ccin Note that Big Scale is the name of the experiment initially determined for the Ukrainian population. As the experiment failed in Ukraine, it was introduced in Georgia. 4th Annual Global Immunization Meeting, New York 19 February e

22 MOH response to AEFIs Intense monitoring and analysis of AEFI National Committee of Experts on AEFI review reports Feedback to sub-national level Frequent positive press releases by MOH and NCDC Extended SIA through 12 Dec % national coverage achieved 22

23 Magnification of the opportunities and risks to routine immunization programmes 23

24 Lessons learned from SIAs Political commitment and trust are key Conduct a situational analysis: Knowledge, attitudes, practices, and beliefs of health care professionals and general population Anti-vaccine movement AEFI surveillance must be operational and risk management strategy developed prior to SIA or introduction of new vaccine Develop a preventive communication plan Educate and work with the media Document and share experiences among countries and Regions 24

25 Source: Dina Pfeifer WHO/HQ 19 February th Annual Global Immunization Meeting, New York 25

26 Acknowledgements Ministries of Health Ukraine Georgia WHO Country Offices UNICEF Country Offices WHO Regional Office UNICEF Regional Office UNICEF Supply Division Yalda Momeni WHO Headquarters Dina Pfeifer Peter Strebel Nora Dellapiane de Rey Patrick Zuber UNICEF Headquarters Dragoslav Popovic Edward Hoekstra US CDC Steve Wassilak Nino Khetsuriani Amra Uzicanin 26

27 Thank you

28 Focus groups conducted Health care professionals: Why vaccinate 2 years after the epidemic? Did the vaccine pass clinical trials? Where has it been used? What complications occurred afterwards? High school and university students: Why vaccinate when there was a large outbreak? Is there any risk of mutations for me or my children if I get vaccinated? Where has vaccine been used before are we going to serve as lab animals? Can we refuse vaccination? 28