Edwin J. Asturias, MD Department of International Health Johns Hopkins Bloomberg School of Public Health. University del Valle in Guatemala

Transcription

1 Vaccines: A Way to Achieve Better Health and Wealth in the Americas Edwin J. Asturias, MD Department of International Health Johns Hopkins Bloomberg School of Public Health And University del Valle in Guatemala

2 History of Immunizations in Latin America Expanded Immunization Program Expansion from the Smallpox Strategy Launched in 1974: 4 vaccines for 6 diseases Universal coverage in 1980 s Hepatitis B included by WHO in 1992 Hib at TAG in 1996 Rotavirus and Pneumococcus since 2005

3 Measles interepidemic periods and impact of immunization, Chile Rate per population % vaccinated years years 9 years years 4 years Incidence Coverage of Measles vaccine * Cobertura en niños <1 de edad Fuente: HVP/OPS OPS

4 Achievements in health in Latin America through the use of vaccines Eradication of smallpox Elimination of Wild Poliovirus (1991) 98% Control of Measles Elimination of Congenital Rubella 90% Reduction of Neonatal tetanus

5 3 rd dose of Hepatitis B vaccine coverabe globally ll by 2006

6 Trends in introduction of Hib vaccine globally ll by 2008

7 Trends in Immunization Schedules in Latin America Esquema PAI Esquema PAI plus Esquemas Nacionales Ampliados 2010 BCG DTPc OPV Sarampion BCG DTPc OPV Sarampion Hepatitis B Hib BCG DTPc/Pa OPV/IPV Sarampion Hepatitis B Hib Varicela Rotavirus Neumo-7v URU, CRC Most countries MEX, CRC

8 National and International Aid expenditures in Immunization Programs in Latin America National 400 Internacional laid a a b a) Includes Polio Eradication Initiative b) Includes Measles Elimination Cost Yearo PAHO

9 Alternative Health Strategies that compete with ih vaccines in Latin America Vaccine Rotavirus Papilloma Virus Alternative Strategy* Sanitation, ORT Papanicolau Neumococcus IMCI, antibiotics Dengue, malaria Vector control, bed nets Hepatitis A Sanitation *Alternative strategies= equivalent and NOT replaceable

10 Socio economic context for the growth of health in Latin America Latin America has achieved sustained economic growth in last decade (least hit by 2008 world economic crisis) Political environment more stable Increased dlife expectancy and mortality Unequal and poorly funded health systems Increase in the burden of chronic noninfectious illneses

11 Comparative Infant Mortality in Latin America by 2000 and distance from 2015 goal

12 Map of Incidence of Neumonia globaly l according to WHO 2008

13 Infant Mortality Rate in Indigenous Populations of Latin America by 2000

14 Principles of Socioeconomic Development through Health Improve workers productivity Decrease economic burden of infections However, we have not counted on: Prevention of childhood mortality and disease Healthy children get better educated More survivors to enter productive age Investing in the demographic dividend (Bloom & Canning, Harvard University)

15 Projected trends in the Working Age Population in different countries

16 Incidence of Hib invasive disease by year and health system before and after introduction of Hib vaccine in Guatemala Asturias, EJ. Unpublished data. JHBSPH 2010

17 Changes in Childhood Diarrhea Incidence in Nicaragua after 3 Years of Universal Infant Rotavirus Vaccination i

18 Potential Impact of New Vaccines in Infant Health in Latin America Hib vaccines: 80 90% Hib Meningitis 20% of severe pneumonia Rotavirus vaccines: 50 60% diarrheal hospitalizations infant and child mortality Pneumococcal vaccines: 15 20% severe pneumonia

19 Future of Vaccines in Latin America: Towards Goal Oriented Schedules Vaccines programs efficacious to meet the Millennium Developmental Goals 2015 Rotavirus, pneumococcus Vaccines to secure the achievements MMR, IPV, dtap, combination vaccines Vaccines to contain the emergent and chronic diseases HPV, malaria, dengue, influenza

20 Public Health Equity as a Paradigm for Immunization Programs and Wealth Governmental emphasis in economic route can create more health disparity Strategies than can provide widespread health with best evidence Focus should be in the more vulnerable groups and countries ti Political will for health as engine for social and economic development

21 The Upcoming Challenges of Vaccines in Latin America Slowed rates of vaccine coverage, especially in most vulnerable populations Declining funding Slow incorporation of new technologies (mobile phones, web, informatics) i Public perception of vaccination Vaccines for chronic and adult diseases

22 How Vaccines create health and wealth? Prevention of high burden infections reducing high morbidity and mortality Most equitable preventive strategy after implementation Cost effectiveness not above ethical and transforming public health Indirect triggers of future economic development

23 Gracias!