202X trends and perspectives

- Immunization Strategy -

Philadelphia, 2 May 2011

JM Okwo-Bele, WHO

WHO EPI Schedule- 1984

Age Vaccines

Birth BCG

6 weeks DPT, OPV

10 weeks DPT, OPV

14 weeks DPT, OPV

9 months Measles

Recommended Routine Immunization (Summary of WHO Vaccines Position Papers)

• Childhood Immunization– Global : BCG, DTP, Polio, Measles + Hepatitis B, Hib

Pneumo, Rotavirus, Rubella, Influenza– Regional : Yellow Fever, Japanese Encephalitis

• Adolescent– Global : Td booster, HPV, Hep B– Regional: Japanese Encephalitis

• Adult– Global : Td booster

• Individuals in some high-risk populations – Typhoid, Meningococcal, Cholera, Rabies, Hep A,

Influenza, Tick Born Encephalitis

www.who.int/immunization/policy/immunization_tables/en/index.html

2011-2013 SAGE Meetings: Topics on the HorizonCross-cutting and strategic issues

Decade of Vaccine/Delivery Framework

Highest priorities

1. Use of vaccine in humanitarian emergencies

2. Reinforcing surveillance networks

3.Accessibility to affordable vaccines and WHO's role

4. Communication methods for vaccine-hesitant populations

5. Validation of coverage figures

6. Use of vaccines in immunocompromised populations

7. Optimizing immunization schedules

8. Impact of introduction of new vaccines on strengthening of immunization and health systems

9. Maternal immunization to enhance the protection of mothers and infants

10. Involvement of the private sector

11.Strengthening of NITAGs

Accessibility to affordable vaccines : WHO's role in supporting Emerging Manufacturers

• Methods used by WHO to support EMs– Engagement in a PDP

– Direct support to EMs

– Support through a technology hub to transfer technology

• SAGE position: Support to EMs is one element to increase affordability but WHO should focus its efforts on core activities: – regulatory / prequalification

– developing TPPs

– capacity building (supply, demand, financing, delivery)

Affordable vaccines :Major gaps & issues to address for healthy and

balanced market

• Availability– Need to innovate, but guard traditional vaccines supply

• Quality– NRA dependence could threaten vaccine security & raise

prices in case of failure – Manufacturer gaps in quality systems

• Affordability– EMs lower cost structure, but other important elements in

prices: demand forecasts, scale decisions, market guarantees – Access not guaranteed by low prices alone. Importance of

country decision making (NITAGS), disease burden, procurement expertise

– Need for economic analysis prior to tech transfer

Use of vaccine in humanitarian emergencies

• Purpose: – Develop a framework for public health decision-

making for vaccination in humanitarian emergencies

• The specific question that needs to be addressed:– What key scientific, ethical, economic, public health

and operational criteria should be part of a decision-making framework to guide the use of vaccines in emergencies?

Example: Cholera vaccine use

• Recent cholera outbreaks where use of vaccine was discussed – Pakistan flood in July 2010 (>20 million people affected)

– Haiti in late 2010

• Cholera vaccination felt as an inappropriate response…– Large number of displaced people, constantly moving,

difficult to define target

– Many important priorities such as food, clean water, acute care etc..

– Implication on the time and human resources needed to mount a reasonable campaign

– Limited supplies of vaccine and not immediately available

Surveillance network and validation of coverage figures

Measles in Senegal, 2009

Vaccination status of measles casesSenegal, 2009

0 dose, 88%

1 dose, 12%

Age distribution of measles casesSenegal, 2009

0%10%20%30%40%50%

< 1 yr 1 - 5 yrs >5 yrs UnknownAge group

Perc

enta

ge

N= 1228 suspected cases(750 confirmed) – MoH/Senegal

0

10

20

30

40

50

60

70

80

90

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Measles coverage estimates 1999-2008

Epidemiology of pneumo diseases before and after PCV introduction

• Increases in non-vaccine type invasive pneumococcal disease observed after introduction of PCV

• Magnitude of changes vary between different settings

• Changes are also observed in settings without vaccine use

• Number of differences between different populations:

– Surveillance methods; Pre-vaccine incidence rates;

– Vaccine dosages and schedules …

– Antimicrobial resistance patterns and antibiotic use

Global IBD surveillance network: challenges and ways forward

• Today's data is very heterogeneous & difficult to interpret.– Not all adhering to surveillance protocols – Quality of specimen handling & laboratory processes – True epidemiological differences

• Introduce new tests such as PCR and antigen detection

• Need to be able to bridge to special studies

• Longer terms investments

Data source: WHO/UNICEF coverage estimates, July 2010Slide by J. Vandelaer, UNICEF

Validating immunization coverage figures:challenges and opportunities.

• Clear recommendations for recording and reporting

• Review of coverage figures for consistency overtime – Check both numerators and denominators– Compare coverage results with other data sources

(surveillance data, vaccine supplies)

• Periodic household/community surveys to validate administrative monitoring systems

• Explore use of new technologies to improve the recording and reporting of data

2011-2013 SAGE Meetings: Topics on the HorizonCross-cutting and strategic issues

Decade of Vaccine/Delivery Framework

Highest priorities

1. Use of vaccine in humanitarian emergencies

2. Reinforcing surveillance networks

3.Accessibility to affordable vaccines and WHO's role

4. Communication methods for vaccine-hesitant populations

5. Validation of coverage figures

6. Use of vaccines in immunocompromised populations

7. Optimizing immunization schedules

8. Impact of introduction of new vaccines on strengthening of immunization and health systems

9. Maternal immunization to enhance the protection of mothers and infants

10. Involvement of the private sector

11.Strengthening of NITAGs

Smallpox statue

À Genève, devant l’Organisation mondiale de la santé, la vaccination est érigée À Genève, devant l’Organisation mondiale de la santé, la vaccination est érigée en statue. Un symbole pour tous les peuples du monde (Le Pays, 28 Apr)en statue. Un symbole pour tous les peuples du monde (Le Pays, 28 Apr)

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