Maternal and Neonatal Tetanus Elimination by Yes, We Can! Global Immunization Meeting 18 th February 2009

Transcription

1 Maternal and Neonatal Tetanus Elimination by 2012 Yes, We Can! Global Immunization Meeting 18 th February 2009

2 OUTLINE Can we eliminate MNT by 2012? Can MNTE contribute to MDG4? Can TT-SIAs help to deliver more interventions? Can MNTE be sustained? Can we afford the cost?

3 Can we eliminate MNT by 2012?

4 Mix of strategies proven successful in protecting women against tetanus Immunize women ANC Outreach immunization sessions Supplemental Immunization Activities (SIAs) Improve Clean Delivery Coverage Needs structural / system changes Surveillance Case detection and case response

5 Bangladesh has eliminated neonatal tetanus as a cause of neonatal death 100 TT-SIAs Proportion on neonatal death due to tetanus (%) routine Year Source: published survey studies. Includes sub-national studies. TT2+ data from Bangladesh EPI/ JRF

6 37 Countries to be validated for MNT Elimination (28 countries in Africa) Source : UNICEF, WHO. Data as of 25 January 2009

7 Can MNTE contribute to MDG4?

8 78% Reduction in Neonatal Tetanus Deaths Between 1992 and , , , , , ,000 NT deaths PAB , , , , , , , ,000? coverage (%) Source: WHO estimates used for NT deaths and PAB

9 Despite Global Progress, NT remains a major killer in some countries Source: Country Data: Countdown to 2015 The 2008 Report Source: Global Data: WHO Global Burden of Disease 2004 Update 2007

10 Can TT-SIAs help to deliver more interventions?

11 TT-SIAs target the poorest performing districts Myanmar district review Source: Myanmar EPI/ UNICEF Myanmar All data for 2005 So, Why only TT?

12 High coverages have been achieved for multiple interventions Sierra Leone (All 13 Districts) No. of Districts having reached > 80% coverage, per intervention No. of districts Round 1 Round 2 Round 3 Vit A TT Deworming Source: Sierra Leone EPI/ UNICEF Sierra Leone

13 Integrated campaigns may be risky for TT coverage

14 Can MNTE be sustained?

15 Maintaining MNT Elimination and Protecting all against tetanus Recommended doses: DPT before one year 1 Td between 1 and 7 years (school entry) 1 Td between 12 and 15 years (beginning of adolescence) 1 Td at the beginning of adulthood Source: WHO Position Paper on Tetanus

16 Maintaining MNT Elimination and Protecting all against tetanus Recommended doses: DPT before one year 1 Td between 1 and 7 years (school entry) 1 Td between 12 and 15 years (beginning of adolescence) 1 Td at the beginning of adulthood School-Based Immunization Source: WHO Position Paper on Tetanus

17 School Immunization: can reduce the need for adult doses Indonesia Source: NIP Indonesia, Data as of 15 September 2008

18 Primary School Attendance Levels offer opportunities for school-based immunization Sources: UNICEF: State of the World's Children 1999 and 2008

19 Maintaining MNT Elimination and Protecting all against tetanus Recommended doses: DPT before one year 1 Td between 1 and 7 years (school entry) 1 Td between 12 and 15 years (beginning of adolescence) 1 Td at the beginning of adulthood Child Health Days

20 CHDs will be instrumental in maintaining TT protection levels Countries that implemented CHDs or Micronutrient events in 2008

21 CHDs will be instrumental in maintaining TT protection levels Countries that implemented CHDs or Micronutrient events in 2008 Countries that require TT-SIAs to achieve &/ or maintain MNT Elimination

22 Maintaining MNT Elimination and Protecting all against tetanus Recommended doses: DPT before one year 1 Td between 1 and 7 years (school entry) 1 Td between 12 and 15 years (beginning of adolescence) 1 Td at the beginning of adulthood Meningitis A Vaccine

23 Sustaining TT protection through meningococcal A conjugate vaccine in countries at risk Fraction (%) with protective (>.1 IU/ml) anti-tetanus antibody 4 weeks after PsA-TT or PS vaccine Site Mali Niakhar Basse PsA- TT PS Age in years PsA- TT PS PsA- TT PS Total

24 Men A conjugate vaccine introduction will boost TT immunity to all Men A conjugate vaccine introduction

25 Can we afford the cost?

26 3 TT-SIAs at a marginal cost of $1.80 Subunit breakdown of $1.80 (shown as % of total cost) Supervision and monitoring 7% NT surveillance 2% Clean delivery promotion 6% Vaccine & injection supplies 29% Transport 19% Health workers stipends 11% Note: Total cost varies between countries Advocacy & social mobilization 13% Planning and Training 13%

27 TT-SIAs in 18 out of 26 countries fully funded in 2009 Source: WHO UNICEF MNT Collected Data, Data as of February TT-SIAs fully funded TT-SIAs not fully funded MNT Eliminated or TT-SIAs not planned in 2009 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

28 US $241 million shortfall, US $65 million when excluding India and Nigeria US $ (in millions) Funding gap in India and Nigeria Funding gap in all countries excluding India and Nigeria Met Needs 3 Source: WHO UNICEF estimates

29 18 Countries face funding shortfalls today

30 Donor commitment: : US$ 186 million raised Donor UNICEF Nat Coms: Cash (BMGF - $36m, RMHC-$5m) Bilateral Contributions Other contributions, governments UNICEF Discretionary funds GAVI/IFFIm funds BD P&G Pampers: (received) (pledged) TOTAL Amount $ 81.2m $ 66.2m $ 10.2m $ 8.0m $ 5.0m $ 61.6m $15m $ 5.0m $ 15.0m $186m

31 Innovative Approaches in Fund Raising Private-public partnerships Cause-related marketing (1 pack = 1 vaccine) Local Celebrities as Ambassadors for UNICEF Micro-gifts Unprecedented media exposure for MNTE Fund-raising Concerts

32 MNT Elimination by 2012 Yes, We Can!!

33 Alone we can go fast, All together we can go far! National MOH s (African proverb)