WHO PERSPECTIVES: WHICH PRIORITIES FOR SA? - Dr. M. Eshetu and Dr. F. Daniel WHO/IST ESA; 30 April 2014 - NICD
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WHO PERSPECTIVES:
WHICH PRIORITIES FOR SA?
Dr. M. Eshetu and Dr. F. Daniel
WHO/IST ESA; 30 April 2014
“Vaccination, a gift for life”
24-30 April 2015
Presentation outline Immunization success stories & some progress in VPD control in AFR The Decade of vaccines Global Vaccine Action Plan Regional Strategic Plan for Immunization General and specific Considerations for SA 2|
Immunization success stories & progress in some vaccine preventable diseases in AFRO 3|
Global Smallpox eradication & certification in 1979
1966, the 19th WHA decided to create
the smallpox eradication programme
Somalia, 1977: Ali Maalim, last recorded http://www.cdc.gov/od/ogh/smallmaa.htm
case of naturally-caused smallpox
The Expanded Programme on Immunization
(EPI) is a direct result of smallpox eradication
and it in turn serves as the foundation for
primary health care
Nous, membres de la commission mondiale
Lead to WHA resolution to eradicate de la certification de l’éradication de la
variole, certifions que l’éradication de la
variole a été réalisée dans le monde entier.
Polio - 1988 Genève, déc. 1979
Summary of progress in some VPDs control,
elimination and Eradication in AFR
Progress in Polio eradication MNT elimination
– Global No WPV type 2 since 1999 – Elimination achieved in majority
– latest WPV 3 type 3 in Nov 2012 – 7 countries likely to miss target
– Latest WPV1 case in AFR 9 mths of 2015
back
Men A
Measles pre-elimination to – In Meningitis belt countries use
elimination by 2020 of Men A vaccine allowed for
– 84% mortality reduction in 2013 reduction of Men A from75% in
compared to 2000 2009 to 2% in 2014 as
proportional cause of bacterial
– Addressing rubella using Measles
Meningitis
platform
5|
WHO Regional Committee 61 resolution in
2011 & WHO Executive Board Resolution
The persistence of Polio is declared as
national public health emergency for
member states (AFR)
"DECLARES polio eradication a
programmatic emergency for global public
health, requiring full strategy
implementation, strong national oversight
& accountability, and vaccination
recommendations for travelers to & from
infected areas “ 21 January 2012
Global Polio Eradication & Endgame Strategic Plan 2013-2018; 4 main objectives
Current status (as at 17th April 2015) • There are three polio endemic countries globally (Pakistan, Afghanistan and Nigeria). Latest case in AFRO with onset 24 July 2014 in Nigeria • Globally; there have been 22 WPV cases since January 2015. from Pakistan and Afghanistan. • Polio free certification process being facilitated by the African Regional Certification Commission – Containment of WPV containing materials • Preparation for at least 1 dose introduction of IPV in 2015 in all the AFR countries & Switch from bOPV to tOPV in 2016
African Regional goal to achieve measles
elimination by 2020- targets & status 2014
• >95% MCV1 coverage at • 84% reduction in measles deaths
national and district level
in AFR (by 2013 compared to
– Provision of 2 doses of MCV in
2000
Routine immunisation
• Reported coverage of MCV1 87%
• > 95% SIAs coverage in all
districts.
• Incidence of < 1 case / 106
population /year (excluding
imported cases).
• Achieve the surveillance Source : Monthly RI reports from Member States
performance targets • 19 of 47 countries have
MCV2 by end 2014
Incidence of confirmed measles in Afr. Source
Case based surveillance data 2014
• Incidence < 1 per
million in 14
countries
• Only 10 of 14 with
sensitive
surveillance
• Incidence < 5 per
million in 23
countries
22 of 44 countries met the targets for both of the main surveillance performance indicators in
2014. ; Recurrent outbreaks in areas with low population immunityWHO/ESA: RCV introduction & CRS sentinel
surveillance establishment Oct 2011 – Apr 2015
Year of possible RCV
introduction in catch-up
Country MR SIAs
Rwanda 2013
Tanzania 2014
Kenya 2015
Namibia 2015 Status of CRS
Zimbabwe 2015 surveillance
Zambia 2016
Botswana MR 2016 Mauritius &
Seychelles providing
Comoros MR 2016 RCV prior to 2010
Ethiopia ? 2018
Lesotho MR 2016
Madagascar 2016
Malawi MR 2016
Mozambique 2016
South Africa ? 2016
Swaziland MR June 2016
South Sudan 2017
Eritrea ? 2018
11 |
Uganda 2018Maternal Neonatal Tetanus Elimination in AFR
In 35 of the 47 countries MNT
elimination is validated by 2014
Priorities through program
monitoring
– Reviewing program data in
Nigeria, DRC, Angola, Guinea,
and Niger.
– Validation in Mauritania,
Equatorial Guinea, and the
Somali region of Ethiopia in
2015.
12 |Regional Strategies for Meningitis A Elimination
Inducing herd protection Roll out of Men Afrivac
2010-2016 in AFR
- Through single dose mass vaccination campaigns
targeting 1-29 year-olds in the 26 countries of the
meningitis belt (2010-2016)
Protecting new birth cohorts through
- Introduction of MenAfriVac in routine EPI Men A cases in
- Organization of periodic mop-up campaigns (SIAs)
meningitis belt
in areas with low routine coverage (< 60%) countries declined
from 75% in 2009
Enhancing surveillance & epidemic to 2% in 2014
response- Rapid response to outbreaks
13 |“We envision a world in which all individuals and communities enjoy lives free from vaccine-preventable diseases". "The mission of the Decade of Vaccines is to extend, by 2020 and beyond, the full benefits of immunization to all people, regardless of where they are born, who they are, or where they live." Decade of Vaccines Vision and Mission
Goals for the Decade of Vaccines
Global Vaccine
Action Plan
2011-2020
About 24 Million deaths
to be averted using 10
traditional and new
vaccines
GVAP: In-country EPI MLM Course, Arusha, Tanzania, 10-21 June 2013 |Vaccines pipeline
Potential
vaccines
HIV/AIDS
Malaria
General scientific/technical
New TB
generation
HPV
certainty
Pneumococcal
Typhoid
Available &
underutilized Rotavirus
Cholera
Influenza Meningococcal A
HepB JE
YF Hib
Traditional
EPI Polio Measles
Tetanus
1960 1970 1980 1990 2000 2010 Year/anticipated year of introduction
Size of circle indicates number of deaths (400,000 deaths, 2002 data) Left side of circle aligned with expected introduction dateStrategies towards attainment of the DoV Goals
Strategies targets by 2020
1
All countries commit to immunization as a priority
Certification of polio
eradication
2
Individuals and communities understand and Currently
demand immunization Elimination of neonatal
available and
tetanus
underutilized
3 vaccines are
Elimination of measles in at
Benefits equitably extended to all people scaled-up
least 5 regions
New or improved
Elimination of rubella in at
4 Strong immunization systems that are an integral vaccines and
least 2 regions
part of a well functioning health system technologies
further enhance
Under 5 mortality rate
the benefits of
declines significantly
5 immunization
Sustainable access to long-term funding and
quality supply Hundreds of millions of
cases and millions of future
6 deaths averted
Country, regional and global R&D efforts
maximize the benefits of immunizationThe GVAP M&A Framework
Monitoring results National
• Indicators for Goals
• Indicators for SOs
Independent
Monitoring Review Regional
commitments and Process
Resources
• National governments
• Other stakeholders Global
Alignment with Accountability Framework for Women's
and Children's Health
19 |Regional Strategic Plan for Immunization 2014-2020
• June 2013: Independent evaluation of the
Regional Immunization Strategic Plan 2009-2013
• Comprehensive consultative process
(Countries, partners, etc.) for the development of
the next strategic plan aligned with the GVAP
• May 2014: draft document discussed and
approved by TFI
• November 2014: Member States endorsed the
Regional Strategic Plan for Immunization 2014 -
2020 during RC64.
20 |Strategy formulation
Aim & Objectives Guiding principles
Aim: to achieve universal immunization Country ownership
coverage within the WHO African
Partnership and mutual
Region
accountability
Objectives: Access to universal health
– To increase vaccination coverage. coverage
– To complete the interruption of poliovirus
transmission and ensure virus Integration
containment.
– To eliminate measles and advocate for the Sustainability
elimination of rubella and congenital rubella
syndrome. Innovation and quality
– To attain and maintain elimination/control improvements
of other vaccine-preventable diseases.
21 |Strategy implementation: Key approaches for implementation Implementation of the Reach Every District /Child approach and other locally-tailored approaches Extending the benefits of new vaccines to all Sustainable immunization financing Integration of immunization into national health policy and plan Enhancing partnership for immunization Improve monitoring and data quality Improving human and institutional capacities Improving vaccine safety and regulation Promoting implementation research and innovation 22 |
Strategy implementation: Roles and responsibilities
Governments:
– Develop cMYPs with annual integrated operational plans.
– Mobilize and allocate adequate domestic resources to implement
immunization plans.
– Mobilize, involve and empower communities to effectively demand and
utilize immunization services.
Communities
– Promote immunization and collaborate closely with local health staff in
planned fixed and outreach services.
– Understand the risks and benefits of vaccination, demand safe and
effective immunization programmes and participate in decision-making and
service delivery processes.
23 |Strategy implementation: Roles and responsibilities
WHO and Partners
Provide technical, financial and material
assistance for the development of cMYPs and
integrated annual operational plans.
Support Member States to mobilize the necessary
resources to achieve the set objectives and
targets
24 |Monitoring & Evaluation Indicators recommended by the GVAP have been adapted to the regional context and will be used to monitor the implementation of the plan on an annual basis. A mid-term programme evaluation will be conducted in 2017 and a comprehensive end-term evaluation of the strategy in 2020. The results will be used to re-align and refine the implementation of the regional plan. The Task Force on Immunization in Africa is expected to conduct annual assessment of the progress towards the achievement of the objectives and targets of the Regional Strategic Plan for Immunization 2014–2020 25 |
General Considerations for
South Africa
26 |Translation of the Regional Strategic Plan for Immunization into
National Priorities and Actions
Using the cMYPs and annual implementation
plans as the basis for implementing the
regional strategic plan at the country level
Place immunization more firmly within the
context of PHC and National health Plans
Promote greater engagement of sub national
managers in the development of the cMYP
27 |Operationalization of the Regional Strategic Plan for
Immunization
Generate political commitment
Better governance
Requisite investments
Strengthening/establishing National Immunization
Technical Advisory Groups and Immunization
Coordinating Committees/HSCC
Promote greater community awareness and participation
Address "vaccine hesitancy"
28 |Operationalization of the Regional Strategic Plan for
Immunization
Strengthen systems
Supply chains
Data quality and use
Greater integration with broader health systems
Targeted approaches to reach the "unreached"
Affordable pricing and procurement of vaccines
Regular monitoring and corrective actions
29 |Specific Considerations for
South Africa
30 |Specific Considerations for SA -1
SA is one of the few countries in the region, with a well functioning
immunization technical advisory group (National Advisory Group on
Immunization).
– What lessons and expertise can be shared with other African countries?
There is a lot of research output in SA.
– In what ways can synergies be formed between the immunization
program and the research institutions so that biomedical and operational
research in immunization can be done to strengthen the program?
– How can inequity in coverage within the country be addressed?
How can the cross-border collaboration with neighboring countries in relation
to control of VPDs be strengthened
31 |Specific Considerations for SA -2
High cost of new vaccines:
– What is the feasibility of local manufacturing capacity of vaccines
versus procurement of vaccines to enable sufficient quality
supply? where are we?
– In the interim, how can pooled procurement mechanism for
vaccines with non-Gavi eligible countries be efficiently facilitated?
SA has a vibrant private sector.
– What role can/does the private sector play (not only in provision of
immunization services) but in the use of innovative technologies to
produce better quality immunization data?
32 |“Vaccination, a gift for life”
24-30 April 2015
THANK YOU
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