The Expanded Programme on Immunization in Thailand

Pornsak Yoocharoen, MD.

Bureau of General Communicable Disease, DDC, MOPH

The implications for

The border provincesAnd

The Displace Person Tempolary Shelter

Administrative system for EPI in Thailand

Permanent Secretary Office

Provincial Health Office

National Vaccine Com.

Hospital, Health Center

Monitoring, SupervisionTechnical support

Budget Planning and Procurement

Vaccine storage and supply (VMI)

Immunization policy

National Health Security Office :

NHSO

Dept of Disease Control

GPO

Ministry of Public Health

Immunization Services

Administrative monitoring & control

monitoring & control

Technical support

Advisory Com. On Immunization Practice

(ACIP)

• BoE• Bogcd• 12 Reg. Off. DPC

Immunization Policy

• Immunization is the basic health need

• All people have the right to be prevented from VPDs

• The service must be provided with equality and free of charge

• The service must be safe and in good quality

Polio Eradication Measles Elimination

Neonatal Tetanus Elimination

Immunization Target and Immunization Target and StrategiesStrategies

• Maintain high vaccine coverage (> 90%) • Keep good quality in vaccine administration & cold chain management• Assessment Immunization Standard and Accreditation• AEFI surveillance & management

Current vaccines in EPICurrent vaccines in EPI

Vaccine

BCG

HB

OPV

DTP-HB

DTP

JE

dT

MMR

20 – 25 M.

US$

Age VaccineAt Birth BCG, HB1HB1

2 Month OPV1, DTP-HB1DTP-HB1

4 Month OPV2, DTP-HB2DTP-HB2

6 Month OPV3, DTP-HB3DTP-HB3

9 Month MeaslesMeasles ---- > MMR1*MMR1*

18 Month OPV4, DTP4, JE1, JE2#

21/2 Year JE3

4 Year OPV5, DTP5

7 Year (School gr.1) MMR2MMR2

12 Year (School gr.6) dT

Pregnant woman dT3 (depend on immunization history)

Current National Immunization Schedule

* Started in 2010* Started in 2010 ;; # = 1 month apart from # = 1 month apart from JE1JE1

Oversea manufacturers

Air port

GPO

Hospital storage

(CUP)

Health care provider (HC)

Vaccine procurement and distribution by VMI system (NHSO)

Local manufacturer (GPO, TRCS) Monthly supply

National Health Security Office

(NHSO)

Vendor Managed Vendor Managed InventoryInventory

(VMI)(VMI)

DPTS

EPI vaccine coverage and disease incidence, 1977-2012

0

20

40

60

80

100

1977 1981 1985 1989 1993 1997 2001 2005 2009

0

20

40

60

80

100

Neonatal Tetanus

Case rate/100,000 (case / 100,000 live births in NNT)

Vaccine coverage

Source: EPI, Bureau of General Communicable Diseases, DDC MOPH

0

1

2

3

4

5

6

1977 1981 1985 1989 1993 1997 2001 2005 2009

0

20

40

60

80

100

EncephalitisStart JE vaccine in

1991 (17 provinces)

Diphtheria

-1

1

3

5

7

9

11

13

15

1977 1981 1985 1989 1993 1997 2001 2005 2009

0

20

40

60

80

100

Pertussis

0

20

40

60

80

100

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

Cases rate

0

20

40

60

80

100Vaccine Coverage

Measles

Vaccine coverage in < 5 years Thailand1999, 2003, 2008

Vaccine 1999 2003 2008

BCG 98 99 99.9 DTP3 97 98 98.7 OPV3 97 98 98.7 HB3 95 96 98.4 Measles 94 96 98.1 JE2 84 87 94.6 JE3 - 62 89.3 DTP4 90 93 96.5 DTP5 - 54 79.4 T2 (or booster) 90 93 93

National Immunization Program, Thailand

Vaccine Coverage (%)

MMR gr.1 91.7 dT gr.6 941.

Vaccine coverage survey in primary school, gr.1 and gr.6 in 2008

National Immunization Program, Thailand

High Risk Group : People in …High Risk Group : People in …

• Remote area Remote area

•Hard to reach Hard to reach Migratory pop. Migratory pop. Urban slum Urban slum Illegal migrant Illegal migrant

workerworker

• Mobile team Mobile team

• Closed Closed mmonitorinonitoringg CCoverageoverage EE pidemiological pidemiological

surveillance surveillance Keep UpKeep Up Catch Up Catch Up Mop UpMop Up

MOPH WHO

DDC

BOE(AEFIs)

EPI, GCD

Regional DDC(monitoring)

FDA (Regulation,

Licencing)

MDSC(lot release, vaccine

lab testing)

PHO, BMA

Hospital, Health Center, Imm. Clinic

IPD, OPD, Well baby clinic

AEFI Surveillance

system

AEFI Surveillance

system

Data flow

Data feedback

Insurgency &

Insecurity Health ReformDistrust

in

Health Services

Migratory Pop.Severe AEFI

&

Rumors

VPD VPD Outbreak Outbreak

Believe & Concerns

GeographicalBarriers & Difficulties

Low Vaccine Coverage

Risk factors and Warning SignsRisk factors and Warning Signs

Challenges

Poor vaccine coverage or unknown in … unrest areas migrant workers (Thai and non-Thai) DPTS

Undetected and un-controlled displace persons and illegal migrant workers move in and out the temporary shelters

Free movement of workers in SEAR from the declaration of AEC

Challenges

Many outbreak of VPDs were related to foreign migrant workers

Measles (Myanmar worker) Rubella (Cambodian worker) Diphtheria (Lao hill tribe, Mong)

Canceling of immunization coverage report from local and provincial level, keeping data at local area but no data at national level.

Challenges Changing of budget allocation from MOPH

to NHSO, limitation of budget but increase flexibility of budget management.

By law, the NHSO will support vaccine only Thai but not include non-Thai population

Dilemma of command line between MOPH and NHSO (direct command and financial support)

Challenges

To harmonize the separated function of immunization services by EPI program and vaccine procurement and delivery system by NHSO

High turn over rate among immunization health personnel

Reduce of health staff and Increase of treatment care from public sector and health care reformation

Opportunities

• Fully support at national level, NHSO have potentially supported with high level of finance.

• Outsource of the delivery system to public-private sector using Vender Manage Inventory system (VMI).

• Potentially support equipment for cold chain system. (Refrigerator, vaccine carrier, thermometer …)

• To convince the NHSO should have fully support the routine immunization vaccines to DPTS and also others foreign children who live in Thailand.

• To co-operate with neighboring countries around Thailand should intensify routine immunization activities to increase and maintain high vaccine coverage, more than 90%, in every country.

Next steps implication

Thank You

An ounce of prevention is always better than

A pound of cureA pound of cure..