Johns Hopkins Vaccine Initiative 2013 Vaccine Internship Experience at WHO (VIEW) Sample Internship Descriptions

Transcription

1 Johns Hopkins Vaccine Initiative 2013 Vaccine Internship Experience at WHO (VIEW) Sample Internship Descriptions A. Launching of Updated Malaria Vaccine Technology Roadmap & Associated Activities... 2 B. Support to generate a global coverage estimate of children who have received two doses of measles containing vaccine (MCV1 and MCV2)... 3 C. Supporting the Introduction and Use of Vaccines Through the Collection, Analysis and Reporting of Global VPD Surveillance Data... 5 D. Strengthening the evidence- base of WHO immunization policy recommendations Department of Immunization, Vaccines and Biologicals (IVB), Immunization Policy Unit... 6 E. Economics of vaccines and immunizations... 7 F. Support to analyse survey data and develop an article on experiences with obtaining consent for vaccination of school- going children and adolescents... 8 G. The broader economic impact of vaccines P age

2 A. Launching of Updated Malaria Vaccine Technology Roadmap & Associated Activities Mentor: Vasee Moorthy Background: The Malaria Vaccine Technology Roadmap was launched in 2006 at the WHO Global Vaccine Research Forum and established a shared Vision, Strategic Goal (2025) and Landmark (2015) for development of malaria vaccines. The Roadmap also identified 11 Priority Areas in four categories: research, vaccine development, key capacities, policy and commercialization. Through a WHO consultative process, the Roadmap Vision and Strategic Goal(s) are being updated, culminating in review and endorsement by an appropriate WHO mechanism. The update will likely broaden the Roadmap Vision and Strategic Goal(s) to include: a larger geographic scope; older age groups; species beyond P. falciparum; and the need for the vaccine to reduce or prevent transmission in addition to morbidity and mortality. To maintain the relevance of the Roadmap Vision and Strategic Goal(s) as the epidemiological and malaria control status changes over time and to establish new landmarks as promising malaria vaccine candidates advance in development, the update will also include a description of a process for future Roadmap updates. It is anticipated that the updating process will conclude during the second quarter of 2013, culminating in the launch of an updated Roadmap during the third quarter of Scope of Work: The intern project will include assistance in production of technical and communication materials to assist with the launch of the roadmap on the WHO website, and at 1 or more international conferences (targeting the Multilateral Initiative on Malaria meeting in Durban in October 2013 as the launch meeting) The intern will also assist the focal point with follow- on activities after the launch, particularly planning of a process to agree preferred product characteristics to guide early stage R&D of malaria vaccines for 5-10 year development timeframes, and in line with each of the strategic goals to be agreed in the updated roadmap See Skills Necessary: Skills required: Proficiency in word, powerpoint, excel, basic technical background in malaria vaccine development from reading recent reviews, interest in malaria. Preferable: Proficiency in software for desktop publishing to create communications material, French language would be a bonus. 2 P age

3 B. Support to generate a global coverage estimate of children who have received two doses of measles containing vaccine (MCV1 and MCV2) Mentors: Tracey Goodman, Kaushik Bannerjee Background: In August 2009, WHO issued a new recommendation that reaching all children with 2 doses of measles vaccine should be the standard for all national immunization programmes. 1 With regards to the timing of the second dose of measles containing vaccine (MCV2), the WHO position paper states: In countries with ongoing measles transmission and MCV1 delivered at age 9 months, should administer the routine dose of MCV2 at age months. The minimum interval between MCV1 and MCV2 is 1 month. Providing routine MCV2 to children in their second year of life reduces the rate of accumulation of susceptible children and the risk of an outbreak. In countries with low measles transmission (that is, those that are near elimination) and where MCV1 is administered at age 12 months, the optimal age for delivering routine MCV2 is based on programmatic considerations that achieve the highest coverage of MCV2 and, hence, the highest population immunity. Administration of MCV2 at age months ensures early protection of the individual, slows accumulation of susceptible young children and may correspond with other routine immunizations (for example, a DTP booster). If MCV1 coverage is high (>90%) and school enrolment is high (>95%), administration of routine MCV2 at school entry may prove an effective strategy for achieving high coverage and preventing outbreaks in schools. Countries have adopted different schedules for administering MCV2. In 2010, 136 countries reported that they were providing a routine 2nd dose of measles in 1 country MCV2 was provided at 9 months; 43 countries by 2 years of age; 81 countries by 7 years of age; 11 countries by > 7 years of age). This diversity in schedules has hampered the ability of WHO/UNICEF to aggregate data and determine the global coverage of MCV2. Consequently, unlike the other infant vaccines, to date there has never been a WHO/UNICEF Coverage Estimate for MCV2. In light of the new Measles & Rubella Strategic Plan , the absence of an MCV2 coverage estimate must be redressed in order to monitor progress towards elimination of these diseases in 5 regions by The stated milestone is: To achieve at least 95% coverage with both the first and second routine doses of measles vaccine (or measles- rubella- containing vaccine as appropriate) in each district and nationally. It has been proposed that the diversity of MCV2 schedules and the challenge of estimating global coverage could be handled by calculating the proportion of children who have received two doses of MCV by a certain age. This would be similar to the coverage monitoring method like that developed for HPV vaccine (i.e. by individual age cohorts) and require countries to record and report MCV doses given by each year of age. Scope of Work The WHO Immunization, Vaccines & Biologicals (IVB) Department seeks an intern to work under the supervision of WHO technical staff within the (Expanded Programme on Immunization (EPI) team to support two components of work: 1. Collate the reported country data on MCV2: All member states of the United Nations report their immunization data annually to WHO and UNICEF using the Joint Reporting Form (JRF). Since 2000, countries that have MCV2 in their immunization schedules report the age(s) at which MCV2 is given, the number of individuals targeted (denominator) and the number of individuals vaccinated (numerator). For the 11 year period ( ) for which there are data, the first step of the 1 WHO. Measles vaccines : WHO Position Paper. Weely Epidemiological Record, No. 35, 2009, 84, WHO. Measles and Rubella Strategic Plan: P age

4 assignment will be to extract the country specific data on MCV2 from the JRF database and clean the data by investigating any inconsistencies and information gaps. 2. Analyze the data and build age- specific MCV2 coverage estimates: Transpose the compiled data into age- specific categories and calculate age- specific coverage rates. The person undertaking the work will have to build age- specific coverage tables from the mass of data that is currently available from the JRF but is not organized in a way that lends itself to an analysis of coverage rates. Expected Outcomes of Deliverables: Construct age- specific coverage rates for each country having MCV2 in their immunization schedule; Aggregate the above data to formulate a global coverage estimate of MCV2; Propose any necessary revisions to the JRF that will improve MCV2 coverage calculations in the future; Draft generic monitoring and recording templates for countries to use for MCV2; In a seminar present the preliminary results of the work to the IVB staff for critique and discussion; Collaborate on the drafting of a manuscript on the above work for submission to a peer- reviewed journal. Skills Necessary: Fluency in oral and written English Proficiency with Microsoft Excel and managing large data sets Strong analytical skills Self- initiative with careful attention to detail 4 P age

5 C. Supporting the Introduction and Use of Vaccines Through the Collection, Analysis and Reporting of Global VPD Surveillance Data Mentor: Mary Agocs Vaccines are one of the most cost- effective interventions to improve public health. In addition to the six traditional vaccines against diphtheria, tetanus, pertussis, polio, measles and tuberculosis (BCG), recent years have seen a dramatic increase in the number of new vaccines that can provide additional prevention of untimely deaths and disabilities. These include vaccines against hepatitis B, invasive Haemophilus influenzae type b (Hib) disease, pneumococcus, rotavirus, Human Papilloma Virus (HPV) and rubella. As countries are considering including these new and relatively expensive vaccines into their immunization schedules, decision makers require reliable data to determine how to best allocate their resources in support of public health programmes. Additionally, vaccine coverage monitoring is critical in order to evaluate the effectiveness of vaccine delivery programmes and to evaluate vaccine impact 5-30 years after immunization. During the past several years, various data collection systems have been established to provide surveillance data for decision makers around the introduction of new and underutilized vaccines. These various systems are being transitioned into the WHO surveillance reporting network and are now allowing global comparisons to be made between countries and over time. During this process, due attention is being paid to ensuring that data are collected in a standardized and routine manner for quality assurance and data comparison purposes. Scope of Work for VPD Surveillance: Assist in the development of global standard operating procedures for the invasive bacterial vaccine preventable network; Compare changes over time in reported new vaccines surveillance data for rotavirus and invasive bacterial vaccine preventable diseases (IB- VPD) from 2008 to present to identify any significant changes, globally, regionally or by country; Develop a surveillance performance report card that can be visually used to monitor data quality by country; Assist in developing and implementing a plan to better communicate the surveillance data to partners and Ministries of Health; Develop or further refine a data collection template to allow standardized collection of serotype and genotype data from Regional Reference Laboratories; and Synthesize the existing information to provide recommendations in how to target efforts to strengthen surveillance and to better understand the surveillance data. Note: Discussions would be held with the selected candidate to determine a mutually agreeable and specific scope of work that draws from the above points. Skills Necessary: Languages: Fluency in English. Working knowledge of French desirable. Computer skills: Proficiency with Microsoft Excel, Word, PowerPoint and e- mail. Experience with database software such as Microsoft Access desirable. Professional Experience: An understanding of surveillance systems and their strengths and limitations. Training and experience in quantitative data analysis. Useful, but not required: Experience with collection or analysis of survey data; experience evaluating vaccination coverage. 5 P age

6 D. Strengthening the evidence- base of WHO immunization policy recommendations Department of Immunization, Vaccines and Biologicals (IVB), Immunization Policy Unit Mentor: Philippe Duclos Background: In accordance with WHO s mandate to provide technical guidance to Member States on health policy, the Immunization Policy Unit is charged with developing global immunization policy recommendations. In this context, the Unit carries out the secretariat function for the Strategic Advisory Group of Experts (SAGE) on immunization which is the main global advisory committee on immunization and provides policy recommendations on the use of vaccines. The Unit also publishes a series of vaccine position papers for vaccine preventable diseases that have an international public health impact. The papers follow the recommendations of SAGE and are submitted to an extended review process both inside and outside of WHO prior to publication. During the implementation of the Strategic Plan, IVB convened an independent Stakeholder s Panel representing the global immunization community to determine the impact of policy recommendations and standards set by WHO and formulated by its key advisory committees. The panel concluded that WHO vaccine advisory committees play an increasingly central role in determining global vaccine policy, especially in developing countries, and recommended that WHO take immediate steps to build on this success. In response to the stakeholders' panel recommendations, the Immunization Policy Unit has improved the policy- setting processes and communications, and continues to further strengthen the processes for evidence- base of the policy recommendations work. Scope of Work: The IVB Department is now recruiting an intern to work under the supervision of the Senior Health Adviser within the Immunization Policy Unit to assist in improving the formulation of evidence- based policy recommendations and the functioning of SAGE. The planned activities include: Conducting systematic reviews of literature to assist SAGE working groups with preparation and review of evidence particularly with respect to vaccine efficacy and safety for updated WHO vaccine position papers (most likely in the area of varicella, co- administration of vaccines and/or delayed immunization schedules) Developing GRADE tables by applying WHO guidelines to assess the strength of evidence in support of key recommendations Conducting a survey of practices of the WHO regional technical advisory groups Implement a survey looking at the impact of WHO recommendations Supporting the organization of the SAGE meetings and teleconferences and contribute to adjustments of SAGE standard operating practices The specific activities and project(s) will be agreed with the intern and will depend on period set for the internship, its duration, as well as the skills and interest of the incumbent. Skills Necessary: Proficiency with literature searches on PubMed and preferably other databases Background in epidemiology An understanding of GRADE methodology and its strengths and limitations would be a plus but not a requirement Fluency in English Working knowledge of another official HQ language including Arabic, Chinese, French, Spanish or Russian would be an asset Proficiency with , web and MS Office software (Word, Excel, PowerPoint) Capacity to analyse data Good writing skills Tact and ability to work with people of different technical and cultural backgrounds 6 P age

7 E. Economics of vaccines and immunizations Mentor: Miloud Kaddar, Senior Adviser, Health Economist, WHO/FCW- IVB- EPI. Geneva Background: The WHO Immunization, Vaccines & Biologicals Department seeks an intern to be part of an exciting project on vaccine pricing and to work under the supervision and guidance of WHO technical staff within EPI team on the following topics: Vaccine price and pricing: theory, policies and practices at country and global level Immunization financing and vaccine procurement in low and middle income countries The intern will be part of the Vaccine Product, Price and Procurement (V3P) Project working team and would be expected to conduct the following tasks: 1. Data collection and analysis 2. Review technical notes and reports 3. Interact with experts, teams, countries and partners 4. Consolidate the findings from the various sources, studies and country data and reports 5. Prepare draft notes and papers for discussion and attend meetings with technical WHO & partners staff 6. Update web pages, country fact sheets and databases 7. Attend technical meetings and make technical presentations 8. Participate in workshops and technical seminars at WHO/HQ. Education and skills: Excellent knowledge of statistics and economic concepts and tools Good knowledge of public health concepts and issues Fluency in writing in English is essential. Ability of synthesize information from different sources and consolidate in a meaningful manner. Proficiency with database and excel processing software, Some experience with developing countries and familiarity with global health initiatives and immunizations will be appreciated 7 P age

8 F. Support to analyse survey data and develop an article on experiences with obtaining consent for vaccination of school- going children and adolescents Mentor: Paulus Bloem Background: In 2009, WHO issued a new recommendation on HPV vaccination to 9 to 13 year olds which is a target group outside the normal ages covered by routine immunization in many developing countries. In addition to HPV vaccine, the number of vaccinations that (may) target older children and adolescents is increasing. Examples of other vaccines include Rubella, Measles, DTP booster, Hep B, among others. This presents new challenges for immunization programmes and health workers, such as the issue of consent. In childhood vaccination, one of the parents is normally present when the child is vaccinated and the presence of the parent is considered an expression of consent. When vaccinating older children and adolescents, this often takes place in settings and at times where the parent is not present, such as during school. According to regulations in most health systems, children and adolescents in the ages between 6 and 17, are not themselves allowed to provide consent for vaccination and most other medical interventions. Some process is therefore in place to deal with the issue of informed consent. A recent WHO report on HPV delivery (2012) noted that for younger adolescents (including 9-13 year olds), parents play an important role. Thus, parents need to be fully engaged in decision- making regarding their children s use of health services. This may include taking them to health facilities. In addition, in most countries, parents need to provide consent or approve that their young adolescent may receive health services. The report also noted that there were practical concerns with the informed consent process that may affect the vaccination process and outcomes. Based on these concerns with HPV vaccination and the growing number of vaccines recommended for older children, WHO decided to review and summarize the experience and various options for dealing with obtaining consent for any vaccine given to 6-17 year olds. Between July and December 2012, a key informant survey was carried out among EPI managers in selected countries that had reported to WHO that they provided vaccination to the relevant age group in their schedule. For the European region, where a large number of countries perform vaccinations in older children, the survey questionnaire was expanded and made available for online data entry. By end November 2012 information from 30 countries has been gathered, while information from Africa and Europe is being expected from up to more countries over the coming month. Scope of Work: The WHO Immunization, Vaccines & Biologicals (IVB) Department seeks an intern to work under the supervision of WHO technical staff within the (Expanded Programme on Immunization (EPI) team to support two components of work: 1. Analyse and organize the data collected from the countries: Preliminary data analysis has taken place towards the development of a guidance note. The person will be requested to carry out more in- depth analysis of the whole dataset, including where possible carry out (limited) statistical analysis of relationships between consent methodology, vaccine schedules and coverage levels. 2. Develop an article for a peer review journal on the findings: Based either on the European subset or full set of data, develop an article for a peer review journal. Different stages will include identification of journal and requirements; carrying out a literature review to include relevant references; writing the draft article and incorporate comments from collaborators in WHO HQ and others. Prepare a version of the paper including graphs and literature review that is ready to be submitted to the peer- reviewed journal. Due to the time delay in getting the paper finished, the person is invited to remain involved in the finalization of the article up to the point of final acceptance in the journal and will be co- author. Expected Outcomes of Deliverables: Analyses of full data set organized in background document; 8 P age

9 Seminar presentation on the findings and results of the analysis; Annotated outline of the article based on discussions with authors; First draft article for circulation; Final article ready to submission to a peer- reviewed journal. Skills Necessary: Fluency in oral and written English Proficiency with Microsoft Excel and managing data Strong analytical skills Self- initiative with careful attention to detail 9 P age

10 G. The broader economic impact of vaccines Mentor: Raymond Hutubessy Background: Over the next decade several new vaccines will become available against infectious diseases of major public health importance. Public health decision- makers will need to make choices, between vaccines and between other preventive interventions. New vaccines (e.g. pneumococcal, rotavirus and human papillomavirus vaccines) are more expensive compared to the dollar cents traditional vaccines costs (e.g. diphtheria, tetanus, pertussis, polio, measles and tuberculosis) while countries increasingly have to carry the full costs of vaccination programs. Among other things decision makers need information on the relative cost- effectiveness (CE) of vaccines compared to other preventive interventions. However, traditional view of cost- effectiveness analysis (CEA) is too narrow which may lead to substantial underestimates of the value of some vaccinations. There are several pathways through which vaccinations can affect economic activity both at the individual and population level. Vaccination results in lifetime productivity gains as it prevents diseases that can cause cognitive impairment, lead to physical handicap, or reduce school attendance. As many vaccinations will significantly will reduce child mortality from infectious diseases, fertility rates will be reduced which will lead to decreasing ratio of economically dependent people in a population, which increases the labor force and savings. In order to assist countries in the collection of local evidence WHO is embarking on a broader economic impact of vaccines consultation meeting with the objective 1. to obtain an overview and feedback of existing and innovative measurement methods and tools 2. to propose generic manuals for quantifying the broader economic burden of vaccines for potential users in LMIC. Scope of Work: In preparation to the above mentioned consultation the WHO Initiative for Vaccine Research seeks an intern to work under the supervision of WHO technical staff of the operational research group to undertake a project with the following aims: Assist in synthesizing preliminary results from economic studies of the broader impact of vaccines issued by WHO in 2013 Contribute to the WHO framework and practical tool development of quantifying the broader economic impact of vaccines Facilitate in the preparation of the WHO Consultation meeting in 2013 with health economic experts It is intended that a review publication will arise from this project. Skills required: Fluency in English Proficiency with Microsoft Excel, and word processing software Proficiency with literature searches on PubMed and preferably other databases Training and experience in health economics 10 P age