VIMS Print and Fly: AFGHANISTAN

WHO Region: EMRO World Bank Income Group: Low-income GAVI Eligible: Countries in WHO Region: GAVI Phase III Eligible AFGHANISTAN, BAHRAIN, DJIBOUTI, EGYPT, IRAN, ISLAMIC REPUBLIC OF, IRAQ, JORDAN, KUWAIT, LEBANON, LIBYAN ARAB JAMAHIRIYA, MOROCCO, OMAN, PAKISTAN, QATAR, SAUDI ARABIA, SOMALIA, SUDAN, SYRIAN ARAB REPUBLIC, TUNISIA, UNITED ARAB EMIRATES, YEMEN Demographics & Disease Burden Indicator Value Year Population (thousands) 28,398 2010 Birth Cohort (thousands) 1,092 2009 Surviving Infants (thousands) 1,227 2011 <5 Population (thousands) 5,030 2010 Infant Mortality Rate (per 1000 live births) 75 2009 <5 Mortality Rate (per 1000 live births) 104 2009 GNI per capita, Atlas method, US$ 470 2011 Expenditure on Health as % of Total Government Expenditure 3 2011 Hib Death Rate (per 100,000 <5) 361 2000 S. pneumoniae Death Rate (per 100,000 <5) 787 2000 Rotavirus Death Rate (per 100,000 <5) 474 2008 %DTP3 Coverage Estimates: Years DTP3 2012 71 2011 68 2010 66 Generated by VIMS on: 10/09/2013 1

Immunization Data: National Immunization Schedule: Vaccine Bacille Calmette-Guérin vaccine (BCG) Diphtheria and tetanus toxoid with whole cell pertussis, Hib and HepB (DTwPHibHep) Measles Oral Polio Vaccine (OPV) Pneumococcal conjugate vaccine (Pneumo_conj) Schedule birth; 6, 10, 14 weeks; 9, 18 months; birth; 6, 10, 14 weeks; 9 months; 6, 10, 14 weeks; Tetanus toxoid (TT) 1st contact; +1, +6 months; +1, +1 year; 2009 63 2008 64 2007 63 2006 58 2005 58 2004 50 2003 41 2002 36 2001 33 2000 24 Generated by VIMS on: 10/09/2013 2

Introduction Status: Vaccine Status Program Type Planned Introduction Hib Pneumo Hep B Introduced into national immunization program GAVI approved/approved with clarification Introduced into national immunization program Actual Introduction Universal 1/1/2009 (Exact) 1/11/2009 (Exact) None Universal 11/1/2013 (Day Unknown) Rota GAVI plan to apply None 1/1/2014 (Month Unknown) 1/1/2006 (Month Unknown) End Key Details: (Hib) Source: Hib Status Sheet April 2009 Key Details: (Pneumo) Key Details: (Hep B) Plans to introduce PCV13 in Nov 2013. Source: WHO Internal Source, 25 Sep 2013 'Start ' is actual completion date for universal regional introduction. Source: SIMS Status Sheet June 2009 Key Details: (Rota) Source: WHO Internal Source, 25 Sep 2013 Generated by VIMS on: 10/09/2013 3

Application History: Pneumo Vaccine Planned App Actual App Outcome Details 8/1/2012 Approved Fully approved in 2013 5/1/2011 5/15/2011 Conditional Approval Planned application in next round (expected May 2011), for introduction in 2012-2013. 1/1/2009 Planned application for 2009, now uncertain. Application History: Hib Vaccine Planned App Actual App Outcome Details 2/1/2008 Approved 9/1/2007 Conditional Approval 4/1/2007 Resubmission Requested waiver for co-financing. Application History: Rota Vaccine Planned App Actual App Outcome Details 1/1/2012 Plans to apply in the next round after May, 2011 Application History: Hep B Vaccine Planned App Actual App Outcome Details Generated by VIMS on: 10/09/2013 4

Relationship with GAVI Alliance: GAVI Funding Stream VIMS Print and Fly: AFGHANISTAN Year HSS ISS INS Hib Mono HepB Mono MenA Measles Pneumo Penta Tetra Yellow Fever CSO Vaccine Intro Grant 2000 $0 2001 $0 2002 $0 2003 $519,500 $519,500 2004 $519,500 $1,026,500 $1,546,000 2005 $1,039,000 $650,000 $1,689,000 2006 $2,791,180 $6,178,912 $100,000 $9,070,092 2007 $6,700,000 $2,850,620 $3,724,721 $13,275,341 2008 $4,595,000 $4,726,000 $8,136,881 $100,000 $404,000 $17,961,881 2009 $7,318,000 $9,195,088 $1,018,000 $17,531,088 2010 $8,157,346 $1,410,000 $12,255,01 1 Totals $1,165,000 $22,987,357 2011 $3,180,000 $8,282,115 $458,400 $11,920,515 TOTAL $29,950,34 6 $13,855,80 0 $1,676,500 $0 $0 $0 $0 $0 $37,869,09 5 $9,903,633 $0 $2,741,400 $504,000 $96,500,774 Other Active Donors in Country: AusAID, Austrian Development Agency, DANIDA, Finland Development Cooperation, German BMZ, JICA, Sida, SDC, DFID, USAID, IDRC, Finland Department for International Development Cooperation, AFD, GTZ, Dutch Development Cooperation, AECID, Poland's Development Cooperation, TIKA Co-Pay Table Start Year Category CoFinancing Obligation 2012 Low-income US$ 0.20 per dose (no annual increase) 2008 Fragile GAVI Grouping: Fragile. Country will pay 10 cents per dose of the 1st vaccine, and 15 cents per dose for 2nd and 3rd vaccines. Generated by VIMS on: 10/09/2013 5

Decision Makers & Key Government Information: Year(s) of Last DHS Survey: 2010 Latest cmyp: 2011-2015 Year(s) of Last Government Change: 2004, 2005, 2009, 2010 Details: President Hamid KARZAI (7 December 2004), Presidential election last held on 20 August 2009 (next to be held in 2014) National Assembly election last held on 18 September 2010 (next election expected in 2015) Has this Country Ever Served on the GAVI Board? No If so, when? n/a Key Advisory Groups Interagency coordinating committee Regional Body Responsible for Recommendations on New Vaccines National Body Responsible for Recommendations on New Vaccines Details MOPH, SCA, UNICEF, WHO. Regional Technical Advisory Group (RTAG). Members: Not Available Technical Advisory Group on Afghanistan. Members: not available Generated by VIMS on: 10/09/2013 6

Methods: This report has been generated by the Vaccine Information Management System (VIMS) database developed and maintained at the Johns Hopkins Bloomberg School of Public Health for use by the International Vaccine Access Center (IVAC) and its affiliated projects and partners. VIMS provides a centralized, web-based warehouse for key information related to IVAC s work. Information was gathered from internationally recognized sources, such as UNICEF, World Health Organization, vaccine manufacturers, ministries of health and news media. Projected introduction dates for GAVI countries are taken from the most recent publicly available AVI Strategic Demand Forecast. For non-gavi countries, the World Health Organization and a variety of other sources are used. If you have run a Vaccine Experience Custom Report and used the "Historical" option, the GAVI eligibility status reflected will be the most recent status within the time window you selected. Information on a particular country s GAVI application status or projected introduction dates may be sensititve and is not for public circulation without prior consent from VIMS personnel. If data is used in a presentation, it should include a statement indicating this. Sources: GAVI Eligibility Status Demographic and Disease Burden Table Population (thousands) UN Population Division. World Population Prospects: The 2012 Revision. Last accessed July 2013 at http://esa.un.org/wpp/excel-data/interpolated.htm. Birth Cohort UN Population Division. World Population Prospects: The 2012 Revision. Last accessed July 2013 at http://esa.un.org/wpp/excel-data/interpolated.htm. <5 Population (thousands) UN Population Division. World Population Prospects: The 2012 Revision. Last accessed July 2013 at http://esa.un.org/wpp/excel-data/interpolated.htm. Infant Mortality Rate (per 1000 live births) UN Population Division. World Population Prospects: The 2012 Revision. Last accessed July 2013 at http://esa.un.org/wpp/excel-data/interpolated.htm. <5 Mortality Rate (per 1000 live births) UN Population Division. World Population Prospects: The 2012 Revision. Last accessed July 2013 at http://esa.un.org/wpp/excel-data/interpolated.htm. GNI per capita, Atlas method, US$ Expenditure on Health as % of Total Government Expenditure Death Rate due to Hib (per 100,000 <5) World Bank. Development Data and Statistics. 2012. Last accessed Jan, 2013 at: http://data.worldbank.org/indicator. World Health Organization. National Health Accounts: Global Health Expenditure Database. Accessed 19 Aug 2013 at: http://apps.who.int/nha/database/predataexplorer.aspx?d=1 Watt J.P., Wolfson L.J., O'Brien K.L., Henkle E., Deloria-Knoll M., McCall N., Lee E., Levine, O.S., Hajjeh, R., Mulholland, K., Cherian, T. and the Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates (2009) The Lancet, 374 (9693), pp. 903-911. Data set last accessed on February 10, 2013 located at: http://www.who.int/entity/immunization_monitoring/burden/gdb_hib_sp_results_database.xls Generated by VIMS on: 10/09/2013 7

Death Rate due to Rotavirus (per 100,000 <5) World Health Organization. Estimated rotavirus deaths for children under 5 years of age: 2008, 453 000. Last accessed on February 10, 2013 at: http://www.who.int/immunization_monitoring/burden/rotavirus_estimates/en/index.html Death Rate due to S. pneumoniae (per 100,000 <5) O'Brien K.L., Wolfson L.J., Watt J.P., Henkle E., Deloria-Knoll M., McCall N., Lee E., Mulholland, K., Levine, O.S., Cherian, T. and the Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates (2009) The Lancet, 374 (9693), pp. 893-902. Data set last accessed on February 10, 2013 at: http://www.who.int/immunization_monitoring/burden/pneumo_hib_estimates/en/index2.html % of Under 5 deaths due to... World Health Organization. World Health Statistics 2012. Last accessed January, 2013 at: http://www.who.int/gho/publications/world_health_statistics/2012/en/index.html Surviving Infants (in thousands) National Immunization Schedule (Table) UNICEF. Immunization Summary (2013 Edition): A Statistical Reference Containing Data through 2011. Last accessed Feb, 2013 at: http://www.childinfo.org/immunization.html. World Health Organization. WHO Vaccine-Preventable Diseases Monitoring System (Joint Reporting Form). Last updated 13 Jul 2013. Accessed 23 Aug 2013 at: http://www.who.int/immunization_monitoring/data/data_subject/en/index.html % DTP1 and DTP3 Official Coverage (Table) WHO/UNICEF Estimates of National Immunization Coverage: 2012 Revision. (Country Reports). Data as of 30 Jun 2013. Accessed 21 Aug 2013 at: http://www.childinfo.org/immunization_countryreports.html Introduction Status Table VIMS Print and Fly: AFGHANISTAN Gathered from various sources, such as the GAVI Alliance, WHO, UNICEF, ministries of health, the news media and IVAC partners/contacts. Introduction dates prior to 2000 rely primarily on: World Health Organization. Immunization Schedules. 2009. Last accessed November 23, 2009 at http://www.who.int/entity/immunization_monitoring/data/year_vaccine_introduction.xls. Application History Table Communication with GAVI Alliance. http://www.gavialliance.org/ Funding Summary Table Co-pay Table GAVI Disbursements by Country. GAVI Alliance. GAVI disbursements to countries by type of support and year (2000-September 30, 2012). Last accessed February 10, 2013 at http://www.gavialliance.org/results/disbursements/ We draw this information from a variety of sources; however, GAVI is our primary source. GAVI Cofinancing Policy Brief, August 2008. Decision Makers and Key Government Information Table Year of Most Recent DHS Survey Demographic and Health Surveys. Country List. Accessed 27 Aug 2013 at: http://www.measuredhs.com/countries/ Generated by VIMS on: 10/09/2013 8

Year of Most Recent cmyp Years of Last Government Change GAVI Board Membership (Has Country Ever Served on GAVI Board) Key Advisory Groups Other Active Donors in Country Country Visits Table World Health Organization. WHO Vaccine-Preventable Diseases Monitoring System (Joint Reporting Form Estimates). Last updated 14 Jul 2013, data as of 12 Jul 2013. Accessed 22 Aug 2013 at: http://apps.who.int/immunization_monitoring/globalsummary/indicators CIA World Fact Book. CIA. Last accessed June 1, 2011 at https://www.cia.gov/library/publications/the-world-factbook/ GAVI Alliance. GAVI Board Members. 2011. Last accessed August 2011 at http://www.gavialliance.org/about/governance/gavi-board/members/ We rely on a variety of sources, such as SIVAC, NITAG Resource Center, WHO, UNICEF, GAVI Alliance, ministries of health, the news media and IVAC partners/contacts. For more information, please contact vims@jhsph.edu. We rely on a variety of sources, such as SIVAC, NITAG Resource Center, WHO, UNICEF, GAVI Alliance, ministries of health, the news media and IVAC partners/contacts. For more information, please contact vims@jhsph.edu. This information comes from Trip Reports located in VIMS. Generated by VIMS on: 10/09/2013 9

Selected Key Words: Any definitions not provided below can be found in the Glossary located in the Help section in VIMS Introduced into national immunization program: the vaccine has been incorporated into the national government s immunization program, either for all children, an at-risk subset, or for a regional program and it may include programs that are being phased in over time. This status can apply to any country, regardless of GAVI eligibility. Regional: local government immunization programs, but the national government has not included the vaccine in its immunization program. Widespread coverage through private market: most (over half) of the target population is receiving the vaccine through private market use. Risk: program for this vaccine only covers children in specific high risk groups this may include children with health conditions, those of vulnerable socioeconomic statuses or ethnic groups, or those living in regions of high risk. GAVI approved/approved with clarification: the country s application to GAVI for New and Underused Vaccines Support (NVS) financing for this vaccine has been approved or approved with clarifications. Approved: the application meets all the criteria and is approved for GAVI support. Approved with clarifications: The application lacks specific pieces of data, which must be provided generally within a month. Data must be received before the application is considered officially approved for GAVI Support. GAVI conditional approval to introduce: The application to GAVI for New and Underused Vaccines Support (NVS) for this vaccine does not fulfil specific or significant application requirements. Missing requirements must be provided in a subsequent round to complement the original application. Conditional approvals will be valid for 12 months. If the conditions are not met within one year of the first submission, re-submission of a new application is required. GAVI Resubmission: The New and Underused Vaccines Support (NVS) application for this vaccine is incomplete and a full application should be submitted in a future round. GAVI application submitted under review: The country has submitted a New and Underused Vaccines Support (NVS) application for this vaccine and is awaiting GAVI evaluation. GAVI plan to apply: Country has made a public statement (through government or other recommending body on vaccines) that they plan to introduce the vaccine and apply for GAVI New and Underused Vaccines Support (NVS), but has not yet submitted an application. Non-GAVI Planning Introduction: A country which is not eligible for GAVI support has indicated plans to introduce the vaccine into its national immunization program, and has taken steps to initiate its program, such as contacting the vaccine manufacturer. No Decision: The country has not indicated a firm decision to introduce the vaccine into its national immunization program or to apply for GAVI New and Underused Vaccines Support (NVS) for the vaccine. Unknown: sources differ or are unclear on whether this country has a national program or not. Vaccine Licensed for Use in Country: At least one pneumococcal conjugate vaccine is licensed for use in children by the national vaccine regulatory agency in this country. Generated by VIMS on: 10/09/2013 10