The Jordan University Hospital, Amman, Jordan

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1 The Jordan University Hospital, Amman, Jordan

2 Pneumococcal vaccine and overcoming the immunization rift Najwa Khuri-Bulos JUH Amman, Jordan February

3 Pneumococcal disease burden 1.6 million deaths world wide 1 million deaths in children less than five years of age An effective vaccine Challenge is to scale up the uptake of this vaccine to as many as possible around the world Can we do it???

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5 Pneumonia causes almost 1 in 5 child deaths The leading cause of infectious death in children <5 years of age Neonatal causes Pneumonia HIV/AIDs Diarrheal Diseases Measles Malaria Injuries Other 3% 8% 4% 17% 10% Under-nutrition (underlying cause) 53% 3% 19% 36% Source: WHO 2005 World Health Report

6 Subjects to be discussed Gaps in vaccine recommendations between the different countries and regions Challenges for introduction of new vaccines to the immunization schedules Decision making process for vaccine introduction and their influence on vaccine uptake Opportunities to move the agenda of vaccination further Conclusions

7 Subjects to be discussed Gaps in vaccine recommendations between the different countries and regions Challenges for introduction of new vaccines to the immunization schedules Decision making process for vaccine introduction and their influence on vaccine uptake Opportunities to move the agenda of vaccination further

8 Vaccines in use for children worldwide Diptheria Tetanus Pertussis Polio (OPV) Measles, Mumps Rubella Hemophilus influenza Hepatitis b BCG IPV Chickenpox Pneumococcus Rotavirus Hepatitis a Influenza vaccine Meningococcal vaccine HPV vaccine Acellular pertussis vacine Zoster vaccine

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10 Disparities in vaccines Not only in number but also in type of antigen Disparities not only between major regions but even in the same region between rich and poor countries Disparities in the same community between rich and poor segments of the population Examples Acellular pertussis vaccine Polio eradication and the end point for polio

11 Low income Mauritania Classification of the economic status of Arab countries Low middle income Algeria High middle income Lebanon High income Bahrain Somalia Egypt Libya Kuwait Sudan PNA Oman Qatar Yemen Iraq Saudi Arabia UAE The comorros Jordan Djiboti Morocco Syria Tunis

12 Percent LBW, Neonatal, infant and underfive mortality In Arab Countries, Algeria Bahrain Comoros Djibouti Egypt Eritrea Iraq Jordan Kuwait Lebanon Libyan Arab Jamahiriya Mauritania Morocco Occupied Palestinian Territory Oman Qatar Saudi Arabia Somalia Sudan Syrian Arab Republic Tunisia United Arab Emirates Yemen % of infants with low birthweight, * Neonatal mortality rate, 2000 Infant mortality rate (under 1), 2005 Under-5 mortality rate, 2005 Unicef 2006

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15 Subjects to be discussed Gaps in vaccine recommendations between the different countries and regions Challenges for introduction of new vaccines to the immunization schedules Decision making process for vaccine introduction and their influence on vaccine uptake Opportunities to move the agenda of vaccination further

16 Challenges for introducing new vaccines in developing countries Decrease in recent years in the uptake of already existent vaccines Divergence in vaccine products Lack of incentive for vaccine manufacturers to develop needed vaccines Increased cost of clinical development of vaccines while not being sure of the market Vaccines seem not to perform as well in developing country set up Lack of appreciation of differences in decision making process of vaccine introduction between the different regions

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18 Challenges for introducing new vaccines in developing countries Decrease in recent years in the uptake of already existent vaccines Divergence in vaccine products Lack of incentive for vaccine manufacturers to develop needed vaccines Increased cost of clinical development of vaccines while not being sure of the market Vaccines seem not to perform as well in developing country set up Lack of appreciation of differences in decision making process of vaccine introduction between the different regions

19 Subjects to be discussed Gaps in vaccine recommendations between the different countries and regions Challenges for introduction of new vaccines to the immunization schedules Decision making process for vaccine introduction and their influence on vaccine uptake Opportunities to move the agenda of vaccination further

20 Tools for Decision Making Vaccine Introduction Preparedness Policy decision Programme issues Financing Priority Cost-effectiveness Burden

21 Subjects to be discussed Gaps in vaccine recommendations between the different countries and regions Challenges for introduction of new vaccines to the immunization schedules Decision making process for vaccine introduction and their influence on vaccine uptake Opportunities to move the agenda of vaccination further

22 Opportunities Push mechanisms to help vaccine manufacturers overcome the difficulties Pull mechanisms (GAVI) Mobilize local expetise of experts ( academicians and other local scientists) Foster regional cooperation between different countries (Example of PAHO) Include health economists in the decision making process Seek local funding no matter how small Change the way that vaccines are obtained Vaccines to be purchased through the ministry of defense budget (akin to defense shield)

23 Push mechanisms These push mechanisms have been infused with increased funding partly because of the recognition that infectious diseases are major threats to global security, that infectious diseases can spread rapidly from the tropics to the industrialized world and that several diseases of importance to the developing world are also potential bioterrorism threats Clemens and Jodar 2005

24 Opportunities Push mechanisms to help vaccine manufacturers overcome the difficulties Pull mechanisms (GAVI) Mobilize local expertise (academicians and other local scientists) Foster regional cooperation between different countries (Example of PAHO) Include health economists and market experts in the decision making process Seek local funding no matter how small Change the way that vaccines are obtained

25 New paradigm Since infectious diseases are increasingly recognized as major threats to global security and are potential bioterrorism threats, would it not be arguable that vaccines are in fact necessary for national defense?? Vaccines to be bought by the Ministry of Defense

26 Is there enough money for that??

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30 So can we afford it??

31 YES WE CAN!!!

32 Conclusions Pneumococcal disease is a major killer of both children and also adults all over the world A vaccine exists that can prevent the occurrence of this disease Pneumococcal vaccine should be bundled along with other pneumonia preventing (HIB) and diarrhea prevention vaccines (rotavirus) for introduction into the vaccine schedules The challenge is to overcome the growing rift between the different populations in access to vaccines

33 Conclusions The new paradigm should not be can we do it?? but rather that yes we can

34 Thank you