How to successfully get a Flu Vaccination Policy accepted and implemented? the Thai experience

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1 How to successfully get a Flu Vaccination Policy accepted and implemented? the Thai experience WHEII, June 5 th, 2012, Intercontinental Hotel, Bali, Indonesia Dr. Suwit Wibulpolprasert Senior Advisor on Disease Control Ministry of Public Health, Thailand

2 Why Flu Vaccination Policy (1)? For prevention of Flu - Cost-effectiveness analysis with clear agreed cut off point, e.g., in Thailand 1-3 GDP/cap/Qualy gain. May need new investment? - Cost of flu immunization is less than cost of treatment analysis of costs on both sides, then transfer of budget - Cross protection children to elderly? - Specific population groups and setting. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand 2

3 Why Flu Vaccination Policy (2)? For maintaining local supply capacity as part of pandemic preparedness plan - Pandemic threats stimulate developing countries to start establishing local Flu vaccine production capacity as part of their pandemic preparedness plan National Bio-security - Local capacity to produce Flu vaccine can not be maintained without local demand Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand 3

4 Thailand Flu Vaccine policy supply side 2004 H5N1 pandemic 1 st Pandemic Preparedness Plan approved in Jan 2005, including R&D on Flu Vaccine. 1 st Proposal for industrial scale IIV investment, based on health benefit, was initially rejected but finally accepted by cabinet in mid 2006, based on National Security reason. WHO GAP started IIV lab scale in 2007 and moved to LAIV after H1N1 2009, IEM support Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand 4

5 Supply side policy (2) $US 42 million budget was approved in to 10 million doses of seasonal IIV by 2015 Thai GPO does not have the technical capacity and no established vaccine company agreed for technology transfer Thanks to the H1N1 pandemic in April 2009 and the Japanese MoHLW supports, Kaketsuken agreed for technology support in Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand 5

6 Demand side policy (1) Started in 2004, after H5N1 pandemic increase from 100,000 (only those affordable high risk) to 400,000 doses to cover H personnel In 2008, Further Increased to million doses cost reduction and prepare the systems to sustain local industrial scale production. Extensive analysis on the cost of vaccination as compare to the cost of treatment and other cost further expand to pregnant women and 0-2 yrs old baby, due to availability of vaccines. Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand 6

7 Cost analysis Cost of treatment for Flu among elderlies and those with 7 chronic diseases $US 35 m plus other related cost from illness $US 45 m per year, a total of $US 80 m/yr. Cost of 4.5 m doses of Flu vaccine plus delivery $US 25 m Presented and approved by the National H Security Board transferred of curative care budget to pay for the Flu Vaccine without requesting for new budget, under UHC fund Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand 7

8 Which vaccine to produce? WHO GAP started to support Thailand GPO to build capacity on IIV in 2007 Move to LAIV in H1N1 pandemic IIV or LAIV? with 65 m people, we need both LAIV with much higher yield for Children and young adult IIV with less yield, for infant and older adult and high risk groups whole, split, subunit? Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand 8

9 What have we achieved so far? Registration of H1N1 LAIV in 2011 with pilot scale production Started Clinical Trial of H5N2 LAIV and planned registration in 2013 (pandemic LAIV) Started formulation of trivalent seasonal LAIV expected to registered in 2013 Capacity building GPO, NRAs, DCD (AEFI) Construction of IIV plant finishes in mid 2013 and start production in 2014 Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand 9

10 What have we achieved so far? Reduced price of vaccine further reduced by 50% to 4 USD per dose Expand to cover also pregnancy women and young children (below 3 yrs of age) in Low up take, now less than 50% of target less vaccine purchase and use for other groups, now 3.5 m and plan 5 m in 2015 Start explore the coverage to school children probably with seasonal LAIV Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand 10

11 Timeline of Flu Vaccine Development in Thailand demand Seasonal IIV for H. personnel 0.4 m Seasonal IIV for elderly & 7 chronic disease 2 m. Further expansion of seasonal IIV to pregnant women and infant (4+ m.) H 5 N 1 H 1 N st PPP (05-07) Flu Vaccine R&D GAP/P1 Lab scale IIV 2 nd PPP (08-10) GAP/P2 R&D H1N1 PLAIV H1N1 PLAIV approved start H 5 N 2 / Seasonal LAIV H 5 N 2 / Seasonal LAIV approved supply cabinet approved industrial scale flu vaccine plant (42 m.$) start construction industtial Flu plant (10-12) start pilot scale seasonal IIV Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand start industrial scale IIV/LAIV (2 m.dose) expansion of IIV/ LAIV (10 m.dose) 11

12 Lessons learnt opportunistic supply plus demand policies and step by step Opportunity prefers only prepared mind 2004 H5N1, WHO GAP support, 2009 H1N1 pandemic Capacity to generate evidence and influence policy Capacity to manage implementation Capacity to R&D, produce and approved Flu vaccine Capacity on AEFI, evaluate the impact Flu vaccine policy is important but costly consider both demand and supply policy need efficient and sustainable management Start small and go big and build up capacity on the way Dr. Suwit Wibulpolprasert, Ministry of Public Health, Thailand 12

Update on A(H1N1) pandemic and seasonal vaccine availability. July 7, 2009

Update on A(H1N1) pandemic and seasonal vaccine availability July 7, 2009 Presentation objectives and approach Presentation Objectives Review production status for 2009-2010 Northern Hemisphere vaccine