Strengthening evidence-based decision making for new vaccine introduction: PAHO s ProVac Initiative
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1 Strengthening evidence-based decision making for new vaccine introduction: PAHO s ProVac Initiative Cara Bess Janusz Immunization, PAHO 1 st Regional Dengue Symposium 3-4 November Rio de Janiero
2 Landscape for global, regional and national immunization policymaking 1985: regional technical advisory body is established to guide efforts towards polio elimination goals in the Region 1999: global level body is established to provide evidence-based guidance on immunization policy (i.e. WHO vaccine position papers) 2000+: in recognition of diverse national contexts and policymaking processes, national advisory bodies are established to adapt global and regional recommendations to local needs/contexts SAGE TAG NITAG WHO PAHO MOH, EPI
3 ProVac s Goal: strengthen national capacity to make informed, evidence-based decisions regarding vaccine introduction BMGF Financing to PAHO for period Current focus on 4 vaccines: Rotavirus Pneumococcal conjugate HPV Influenza (in the future: dengue, meningococcal, second generation & others)
4 Objectives of the ProVac Initiative Objective 1 Strengthen infrastructure and processes for decision making NITAG strengthening Legal frameworks South-south academic network Objective 2 Develop tools for EE and provide training to multidisciplinary teams Cost-effectiveness models Program costing model Regional training workshops Objective 3 Collect data, perform analysis and gather the framework of evidence Direct country support Methodological guidelines Objective 4 Advocate for evidence based decision-making Results presented to authorities Technical reports & policy briefs Objective 5 Support an effective & sustainable NUVI Costing exercises to inform new vaccine intro
5 ProVac s technical cooperation Countries have requested technical support from PAHO to help integrate economic studies into the national decision-making process for immunization Directing Council resolution (CD47.R10) Ministry of Health ProVac at PAHO (Washington DC) National Advisory Committee Surveill. Officers Nat l Consultant EPI Manager ProVac National Team Clinician PAHO Country Office Health Economist ProVac Centers of Excellence National level Regional level 4
6 ProVac s technical cooperation Countries have requested technical support from PAHO to help integrate economic studies into the national decision-making process for immunization Directing Council resolution (CD47.R10) Ministry of Health ProVac at PAHO (Washington DC) National Advisory Committee Surveill. Officers Nat l Consultant EPI Manager ProVac National Team Clinician PAHO Country Office Health Economist ProVac Centers of Excellence National level Regional level 5
7 ProVac s technical cooperation Countries have requested technical support from PAHO to help integrate economic studies into the national decision-making process for immunization Directing Council resolution (CD47.R10) Ministry of Health ProVac at PAHO (Washington DC) National Advisory Committee Surveill. Officers Nat l Consultant EPI Manager ProVac National Team Clinician PAHO Country Office Health Economist ProVac Centers of Excellence National level Regional level 6
8 Considerations for new vaccine policymaking at country-level Technical EVIDENCE PACKAGE Operational & Programmatic Social Source: Andrus, JK., Toscano, CM., Lewis, M., Oliveira, L., et al. 2007, A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO s ProVac Initiative, Public Health Reports, 122(6):
9 Considerations for new vaccine policymaking at country-level Disease burden Vaccine characteristics Immunogenicity Efficacy/effectiveness Duration of protection Type-specific protection Dosage Safety and adverse events (harms) Cost-effectiveness Technical EVIDENCE PACKAGE Operational & Programmatic Social Source: Andrus, JK., Toscano, CM., Lewis, M., Oliveira, L., et al. 2007, A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO s ProVac Initiative, Public Health Reports, 122(6):
10 Considerations for new vaccine policymaking at country-level Technical Vaccine supply Logistics & operational issues Financing strategies Partnerships EVIDENCE PACKAGE Operational & Programmatic Social Source: Andrus, JK., Toscano, CM., Lewis, M., Oliveira, L., et al. 2007, A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO s ProVac Initiative, Public Health Reports, 122(6):
11 Considerations for new vaccine policymaking at country-level Technical EVIDENCE PACKAGE Acceptability Perception of risk Political will Equity Operational & Programmatic Social Source: Andrus, JK., Toscano, CM., Lewis, M., Oliveira, L., et al. 2007, A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO s ProVac Initiative, Public Health Reports, 122(6):
12 Step-wise calculations to estimate vaccine impact (effectiveness): Example childhood vaccine Number of life-years in target population x Incidence of cases in target population per 100,000 per year x % of cases by age x Efficacy by dose (dose + booster) x Vaccine Type Coverage & replacement effects x Coverage by dose (+booster) x Timeliness by dose (+booster) x Relative coverage (% of coverage reaching high risk children) x Decrease in protection due to Waning x Herd Effect multiplier
13 TRIVAC: Impact/CEA of Hib, RV and PCV
14 CERVIVAC: impact/cea of HPV vaccine and/or screening
15 Scenario 1 Scenario 2 Scenario 3 CEA/impact not considered (political decision) Agency-led CEA/impact (Hib vaccine in India) MoH-led CEA/impact (ProVac) (PCV in Argentina) lide courtesy of Andrew Clark, ProVac Modeller TRIVAC model used Outside agency presented to NITAG Outside agency led publication of results No MoH training GAVI finance available but significant delays in adoption TRIVAC model used MoH presented to NITAG MoH-led publication of results MoH trained and led subsequent CEA of RV/HPV PCV quickly financed/adopted 14
16 ProVac in other regions of the world: the ProVac International Working Group To transfer ProVac tools and methods to other WHO Regions: o AFRO: 1 regional workshop & 3 country-led analyses o EMRO: 1 regional workshop & 2 country-led analyses o EURO: 1 regional workshop & 4 country-led analyses Two-year pilot phase ( ) funded by BMGF Partners:
17 ProVac supported country studies globally Belarus Ukraine Croatia Albania Azerbaijan Uzbekistan Iran Egypt Guatemala Belize El Salvador Honduras Nicaragua Costa Rica Panama Bahamas Jamaica Brazil Senegal India Ecuador Peru Bolivia Paraguay Uruguay Argentina Kenya Uganda
18 Available online: ect.com/science/journa l/ x/33/supp/s1 this supplement features country-led research to support real-time policy making, including, inter alia, costeffectiveness, program costing, and analyses of financial flows. It highlights the work undertaken by partner organizations collaborating in the ProVac International Working Group, as well as the Bill and Melinda Gates Foundation-led Expanded Program on Immunization Costing and Financing(EPIC) project.
19 What have we learned? Though cost-effectiveness data is not the only input to policymaking, the process of generating this data contributes to a framework for systematically reviewing other data considerations With the reflection of decision makers preferences and local data in ProVac tools, country teams can better understand, use and defend evidence for informed policy making. There is a high demand from MICs and GAVI-graduating countries; greater need for weighing the economic and health benefits for NUVI decisions in resource constrained settings. Need to strengthen country capacity to link technical discussion to resource allocation decisions
20 METHODS methods MODELS models DATA data VACCINE PROGRAM COSTING MODEL COSTVAC.xls CEA MODEL UNIVAC.xls TREATMENT COSTING MODEL COSTCARE.xls TEMPLATES Report.doc Slides.ppt Policybrief.doc
21 Future direction Further development of Univac Complement CEA and impact models with other tools to populate models (i.e. vaccine program costing, disease treatment costing, etc). Launch toolkit in March 2016 Collaborate with patners to extend the lessons of ProVac to other Regions 20
22 How can I learn more about ProVac? For general information, technical documents and articles go to: To request for direct technical support contact: provac@paho.org
23 10 years of supporting evidence based immunization policy in the Americas and beyond: More PAHO demand: PAHO s ProVac Initative ECU, URU 1 st ProVac Workshop with key partners: Prevention effectiveness, WDC nd ProVac Workshop: Costeffectiveness of PCVs, Paraguay 2007 Establishment of ProVac Network of Centers of Excellence rd ProVac workshop: Cost-effectiveness of RVs, Nicaragua More countries join the Initiative: ELS, GUT 2011 Launch of the ProVac International Working Group, support to WHO AFR, EMR and EUR initiated th ProVac workshop: integrating immunization program costing and planning More PAHO demand: BEL, BAH, HON 2 nd PAHO Directing Council resolution to institutionalize and expand ProVac support to Member States Mandate from PAHO Member States (CD47.R10) Country teams initiate studies: ARG, PAR, NIC Multi year BMGF grant awarded to PAHO 4 th ProVac Workshop: Cost-effectiveness of HPVs, Colombia More demand: JAM, COR, PER BMGF commissioned external evaluation More PAHO demand: BRA support from immunization program costing launched
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