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TRANSCRIPT
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Measles and Measles Containing Vaccine
Progress in Global Measles
Mortality Reduction
Vaccine Supplier MeetingCopenhagen, 3 - 4 April 2008
Edward Hoekstra, MD, MScSenior Health Specialist
Co-ordinator Global Measles ProgramUNICEF / New York
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Overview
Goal
Strategy
Achievements
3 - 5 year agenda
Future
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Malnourished girl hospitalized with post - measles encephalitis Kratie,Cambodia, 2001 (Photo: Keith Feldon)Estimated 1,700 children died in Cambodia of measles in 2001
Measles kills
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Corneal scarringcausing blindness
Encephalitis
Pneumonia &diarrhea
Measles disables
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Causes of 1.7 million global vaccine-preventable deaths among children, 2000
Source: World Health Report 2001
Measles
HIB
MNT
Pertussis
YF
Diphtheria
Polio
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No second opportunity for measles immunization (47)
98% of all measles deaths
We knew WHERE
Data year 1999
757,000 deaths from measles in 2000
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1. Strong routine immunization of > 80%
2. Provide a 2nd opportunity for measlesimmunization
3. Surveillance
4. Improved measles case management
We knew HOW
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Measles Control Goalsby WHO Region, 2008
2000
2010
2010 2012
Africa and SE Asia havemortality reduction goals
Americas, Europe, E. Mediterranean, W. Pacific have elimination goals
GIVS Goal:90% reduction in deathsby 2010 (vs. 2000)
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From 2001 - - 47 countries BEGAN
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Success To Date
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1st Dose Measles Coverage in 47 MeaslesPriority Countries, 2000 - 2006
50%
55%
60%
65%
70%
75%
80%
2000 2001 2002 2003 2004 2005 2006
Source: WHO / UNICEF coverage estimates, 1999 - 2006 as of August 2007
Percent
56 %
67 %
80 %
72 %Global Coverage 1st dose
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Measles Mortality Reduction47 UNICEF / WHO Priority Countries
2000
No second opportunity 2005 (47)
94 % of all measles deaths
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Measles Mortality Reduction47 UNICEF / WHO Priority Countries
2006
Nationwide second dose of measles introduced (42)
Partial implementation of second dose of measles introduced (3)
No second opportunity 2005 (2)
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Estimated measles deaths, 2000, 2006
Dots are randomly distributedin countries.
Data source: WHO/IVB, November 2007
2000 757 000 deaths
2006 242 000 deaths
= 500 deaths 74%
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Estimated Measles Deaths, 2000-2006
Global Measles Deaths
-
200,000
400,000
600,000
800,000
1,000,000
2000 2001 2002 2003 2004 2005 2006
68%reduction
2005Goal
Source: Morb Mortal Wkly Rep. 2007;56(47):1237-41. A Dabbagh et al.
2010Goal
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Reduction in Estimated Measles Deathsby WHO Region, 2000 to 2006
-100
-90
-80
-70
-60
-50
-40
-30
-20
-10
0
AFR SEAR WPR EMR GLOBAL
%r
educ
tion
68%81%91% 78%
90% 2010 reduction goal
26 %
Source: Morb Mortal Wkly Rep. 2007;56(47):1237-41. A Dabbagh et al.
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Integrated Campaigns
VitaminA
PolioVaccination
DewormingTablets
Bednets
> 87 million > 29 million > 30 million > 31 million
In 2007, 84% of the 37 campaigns were integrated with at leastone other intervention
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MR or MMR introduction
Higher income countries
One large scale introduction campaign
Followed up by 2 dose routine immunization
Not for Sub - Saharan Africa and South Asia
Will see most activities in East Asia
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IFFIm
IFFIm
IFFIm
IFFIm
MR Supplementary Immunization Activities(2007-2008)
Country Dates Target Age Target population Coverage
(reported)Armenia 1-13 Oct 07 6-27 yrs 942,767 96,8%
Turkmenistan 12-25 Nov 07 7-23 yrs + 24-40yrs
2,264,026 96.4%
Uzbekistan 12-25 Nov 07 11-29 yrs 8,143,635 99.8%
Georgia Sep-Oct 08 5-26 yrs 1,100,000
Ukraine 08 15-29 yrs 9,000,000
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Looking ahead
Where we are going
http://customersrock.files.wordpress.com/2007/04/binoculars.jpg -
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Planned Measles SIAs, 2008
MeaslesMeasles - Rubella
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Figure 2: Measles Initiative Annual Donations (2001-2007) and Financial
Resource Requirements, Contributions, & Funding Gap (2008-2010)*
0
50
100
150
200
250
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
$USMillion
Donations Funds from 2007 Funds projected or pledged Funding Gap
2001-2007
Total donations: US$ 635 million
2008: Funding gap US$ 23 million
2009: Funding gap US$ 76 million
2010: Funding gap US$ 102 million
* Excluding anticipated country contributions for catch-up and follow-up SIAs for 2008-2010
Annual Donor Expenditure and FinancialResource Requirements, 20012010*
C
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Figure 3: External contributions since 2001, and Funding Gap for 2008-2010
UNICEF
Japan
UNF*ARC**
CDC
CIDAGAVI IFFIm
2008-2010 funding
gap $202 million
* includes UNF and partners: The Bill & Melinda Gates Foundation, Izumi,Vodafone, The Church of Jesus Christ of Latter-Day Saints
** includes ARC and The Church of Jesus Christ of Latter-Day Saints
Total: $973 million (excluding country contributions)
External Contributions since 2001, andFunding Gap for 2008 - 2010
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Estimated Measles Vaccines Shipped by UNICEF1999 2007 and projections - 2020
020406080
100120
140160180200220240260
1999
2001
2003
2005
2007
2009
2011
2013
2014
2016
2018
2020
Dose
sMillions
India Needs
http://www.unicef.org/infobycountry/27402_30951.html -
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Summary
Most ambitious measles goal
Less than 3 years to go
The strategy works
Africa already reached 2010 goal
South East Asia accounts for 74% remaining deaths
Secure funding for 2009 and beyond
http://www.unicef.org/infobycountry/27402_30951.html -
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Measles InitiativeWorking Together to Save Lives
Thank You
Melinda and Bill GatesFoundation
IFFIm
JapaneseGovernment
Vodafone