new vaccines in developing countries: evidence, practice, policy, and challenges global vaccines...
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New Vaccines in Developing Countries: Evidence, Practice, Policy, and Challenges
Global Vaccines 202X: Access, Equity, EthicsPhiladelphia, USA
2 May 2011
Jon Kim Andrus, MDDeputy Director
Number of childhood vaccines routinelyused industrialized countries and in
Latin America and the Caribbean, 1975-2010
5
7
9
11
13
15
17
19
1975 1980 1985 1990 1991-1995
1996-2000
2001-2005
2006-2010
Industrialized countries
Latin America and the Caribbean
Current GAPHPVVaricelaHepatitis AMeningococcal
Seasonal flu - 2006Rotavirus - 2006Pneumococcal- 2006
Measles, DPTPoliomyelitis, BCG
Haemophilus Influenzae b
RubellaMumps
Hepatitis B**
Accelerating PolicyAccelerating Policy
PrioritiesHPV vaccine and cervical cancer
PrioritiesHPV vaccine and cervical cancer
Source: IARC 2004 estimates
0
20
40
60
80
100
120
0-14 15-44 45-54 55-64 65+
AGE GROUP [years]
AG
E SP
ECIF
IC M
OR
TALI
TY R
ATE
S
N. America
Cen. America
Caribbean
So. America
Cervical Cancer Disease
Burden • Taking advantage of new technologies while enhancing approaches to screening to reduce mortality of this disease of poverty
• Reducing the developing country uptake time lag >2 decades
• Taking advantage of new technologies while enhancing approaches to screening to reduce mortality of this disease of poverty
• Reducing the developing country uptake time lag >2 decades
77,000 new cases per year
33,000 deaths per year
77,000 new cases per year
33,000 deaths per year
Urged Member States to:
Expand legal and fiscal space and identify new revenue sources to sustainably finance the introduction of new vaccines against rotavirus, pneumococcus, influenza, and human papillomavirus;
Support the mortality reduction targets, consistent with GIVS and the MDGs, for HPV, RV, influenza, and pneumo associated disease;
Utilize the PAHO Revolving Fund for Vaccine procurement to purchase new and underutilized vaccines
47th Directing Council, September 2006
ProVac Policy Framework
Technical criteriaProgrammatic criteria
Financial criteria
www. paho.org/immunization
Andrus et al. Public Health Reports 2007;122(6):811-19
Tools for Economic Analysis
CostsHealth Gains
Vaccine Intro
Costs Tool
Burden of Disease
Tools
Economic Analysis
Cost Effectiveness
Studies Rotavirus
Cost Effectiveness
StudiesPneumococcus
Cost Effectiveness
StudiesHPV
Cost Effectiveness
StudiesInfluenza
Number of Countries with Seasonal Influenza
Vaccination Programs in the Americas, 1975-2008
0
5
10
15
20
25
30
35
40
45
Nu
mb
er o
f co
un
trie
s
1975 1980 1985 1990 1995 2000 2005 2007 2008 2009
42 Countries
Accelerating DeploymentAccelerating Deployment
Pro-Vac Workshop, September 2006
Congenital Rubella SyndromeCongenital Rubella Syndrome
Strategies
Strategies always rely on:
• Immunizing susceptible population
• Conducting effective surveillance
• Sustaining the gains
*Vaccination of men and women
Vaccination of women only
82
98 98 99 99 97 99 99 98 99 969999
0
20
40
60
80
100
CAR COR HON ELS PAR COL NIC BOL PER DOR ARG* CHI BRA
Source: Country reportsAndrus JK, et al. Vaccine 2008
Co
vera
ge
(%
)Rubella Vaccination Coverage in Selected
Countries of the Americas,1997-2006
Rubella elimination and primary health care
PAHO. Changing lives: The EHDI experience in Costa Rica. EPI Newsletter August 2007;29(4):1.
Castillo-Solorzano C, Andrus JK. Rubella elimination and improving health care for women. Emerging Infectious Diseases 2004;10(11):17-21.
14
0
50,000
100,000
150,000
200,000
250,000
300,000
Nu
mb
er
Rubella
Measles
Rubella Elimination
Source: Country reports
Accelerated rubella control
Measles Elimination
Rubella and Measles Elimination,The Americas, 1980–2009
Future ChallengesFuture Challenges
Pro-Vac Workshop, September 2006
16Pan AmericanHealthOrganization
Uptake of Pentavalent Vaccine in the Americas
0
5
10
15
20
25
30
35
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Nu
mb
er o
f C
ou
ntr
ies
$0
$1
$2
$3
$4
$5
$6
$7
$8
Pri
ce (
$)
Countries Purchasing Price per dose
4 Countries,3.9 million Doses
31 Countries,10.5 million Doses
$7.20
$3.94
Urban cluster of yellow fever Urban cluster of yellow fever cases in Paraguay, 2008cases in Paraguay, 2008
A urban cluster of A urban cluster of human YF cases, human YF cases, Asunción Metropolitan Asunción Metropolitan area*. area*.
10 deaths10 deaths
Median of age: 24 Median of age: 24 years (11-39)years (11-39)
Female: 55%Female: 55%
Infestation Index by Infestation Index by Ae. AegyptiAe. Aegypti: 23%: 23%
*Laurelty, Central Department*Laurelty, Central Department
In summary, there is no magic bullet to ensuring equitable and sustainable introduction of new vaccines into
developing countries. Ultimately, the solution requires a strategic vision
grounded in long-term goals, not short-term fixes.
Pan AmericanHealthOrganization
www. paho.org/immunization