Global Vaccines 202X: Access, Equity, Ethics 2-4 May 2011 The Franklin Institute Science Museum
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CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics
2-4 May 2011The Franklin Institute Science Museum. Philadelphia, USA
Global Vaccines 202X: Access, Equity, Ethics2-4 May 2011
The Franklin Institute Science MuseumPhiladelphia, USA
Political Will, Public Confidence, and Immunization Impact: Insights from the WHO European Region Member States
Rebecca Martin
WHO European Regional Office
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WHO European Region 2010: 53 Member States (~890 million)
WHO/Europe role:Policy development & implementationNormative guidanceExpert technical assistance
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Current Landscape in the European Region
Strong history of collaboration for immunization Progress made towards regional goals National routine immunization coverage levels are overall high
across the Region Vaccine-preventable disease incidence is variable and generally
low Increasing momentum of vaccine refusals Marginalized and vulnerable groups require attention, general
complacency in absence of disease (low risk perception), variable public trust
Cannot afford to jeopardize progress made towards goals
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Countries with a standing national immunization technical advisory group on immumnization, 2009
No response (BLR, RUS, UKR, LUX, SMR, MON)No (KAZ, UZB, TKM, AZE, SRB, MNE)No, but ad hoc committee (TJK, ARM, MDA, ROM, CRO, SVN, NOR)Yes (n= 34)
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• Platform for:• Improving information on vaccine • benefits and safety• driving demand for vaccines• advocating for political support and• financial commitment
• 2011: ”Shared solutions to common threats”
European Immunization Week
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Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva
$0
$500
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$5,000
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ARM
AZE
GEO
KGZ
MDA
TJK
UKR
UZB
GAVI eligibility based on Gross National Income (GNI) per capita - Atlas method
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Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva
Country Co-financing Needed (2011-2015)GEORGIA – Graduating Country
GEO NVS / Year 2011 2012 2013 2014 2015 2016
Co-financing
levels
Pentavalent $0.30 $0.37 $0.74 $1.11 $1.48 $1.85
Rotavirus $0.80 $1.60 $2.40 $3.20 $4.00
Pneumococcal $0.70 $1.75 $2.63 $3.50
# of surviving infants 56,369 56,425 56,481 56,538 56,594 56,650
Total co-
financing
Pentavalent $56,313 $69,521 $139,180 $208,981 $278,918 $348,992
Rotavirus $118,493 $189,776 $284,952 $380,312 $475,860
Pneumococcal $164,572 $329,475 $494,702 $660,256
Total $56,313 $188,014 $493,528 $823,408 $1,153,932 $1,485,108
2 dose schedule for rotavirus vaccine and, reserve stock at start and wastage rate included for all vaccines
From 2011 to 2015, estimated GNI growth in US$: 32.0%; US$ inflation: 12.5%
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Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%KGZ
TJK
UZB
ARM
AZE
GEO
MDA
KGZ 4.3% 2.9% 6.4% 8.1% 7.8%
TJK 6.1% 7.4% 6.9% 7.1% 12.8%
UZB 1.7% 2.6% 2.8% 4.8% 5.2%
ARM 1.5% 5.2% 9.1% 13.7% 18.3% 22.9%
AZE 2.2% 2.8% 5.6% 15.1% 27.6% 40.3%
GEO 2.2% 7.3% 19.3% 32.2% 45.1% 58.0%
MDA 1.4% 4.7% 12.3% 20.5% 29.1% 37.6%
2011 2012 2013 2014 2015 2016
Projected co-financing as a percentage of operational budget for routine immunization (2009)
GF/T RI
48.5%
16.2%
71.9%
74.8%
94.6%
81.5%
77.8%
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Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva
Financial sustainability analysis on revised GAVI co-financing
Eligible countries (KGZ, TJK, UZB) Additional co-payment burden may be absorbed by
resource allocation changes within MoH budget Increased advocacy needed
Graduating countries (ARM, AZE, GEO, MDA) Additional co-payment burden may/can not be
absorbed by resource allocation changes within MoH budget
In need of external advocacy support
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Measles-containing vaccine 1st dose coverage by World Bank income category
80.0
82.0
84.0
86.0
88.0
90.0
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100.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
High income
Upper middle income
Low er middle income
Low income
WHO European Region
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Vaccine safety, adverse events following immunization and anti-vaccine movement
Immunization programmes more complex
Role of health care workers, particularly paediatricians, specialists and academicians
AEFIs and trust narcolepsy with pandemic influenza vaccine adverse events with tick-borne encephalitis Suspension of supply of vaccines (Bulgaria)
Anti-vaccine and response Deaths following vaccination in Bosnia and
Herzegovina HPV vaccine introduction in
Netherlands
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Building political will and public confidence
Public confidence and communication– EIW 2011 Round Table with Belgium ,Switzerland,
Germany and France: political, providers, public
Collaborative work WHO, UNICEF, ECDC, EC – European immunization coalition– European communication working group– National regulatory authorities– Behaviour change communication models– Social media activities
CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics
2-4 May 2011The Franklin Institute Science Museum. Philadelphia, USA
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Introduction of new vaccinesWHO European Region 2010
Intorduced (50)Plan introduction (3)
Introduced (23)Not intorduced
HPVIntroduced (20)Not introduced
Hib PCV
HPV
Introduced (4)Not introduced
Rotavirus
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45/48 countries reportedhaving a vaccinationplan (94%)
41/45 of countries implemented A(H1N1)2009 vaccination (91%)
Vaccination implementedyesnoNo data
Influenza A(H1N1) 2009 vaccine implementationWHO European Region
48/53 countries completed the survey (91%)
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Pre-epidemic Epidemic Post-epidemic
41% received vaccine at least 2 weeks before
epidemic peak
22% received vaccine during peak trans-
mission (4 wks)
37% received vaccine 2 weeks or more after
epidemic peak
Availability of pandemic influenza A(H1N1) vaccine relative to epidemic peak (n=41)
-2 2 6-8-12-16 8 12 16 20 22 26-20 30 360 4-4-10-14 10 14 18 24 28-18 34 38-6 32-2 2 6-8-12-16 8 12 16 20 22 26-20 30 360 4-4-10-14 10 14 18 24 28-18 34 38-6 32
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Principal reasons for refusing pandemic vaccine
0
20
40
60
80
100
Doubts onvaccine safety
Doubts onseverity ofpandemic
Lack of HCWconfidence invaccine/need
for vaccination
Doubts onvaccineefficacy
Riskcommunicationnot clear and
confident
Lack ofinformation
about vaccine
Anthroposophyobjection
Diff icult toaccess
vaccinationsites
Religiousobjection
Cost of vaccineto individual
%
N=39
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Summary
Strengthen political commitment at all levels Ensure equitable and affordable access to vaccines,
including vaccine manufacturing, for all countries Align immunization plannning with national health
plans and budgetary cycles to sustain immunization programmes
Advocate for funding – national/international Collaborative work ongoing
CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics
2-4 May 2011The Franklin Institute Science Museum. Philadelphia, USA
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CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics
2-4 May 2011The Franklin Institute Science Museum. Philadelphia, USA
Thank you
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WHO European Region Immunization programmatic goals
Immunization Systems Strengthening• Stewardship/ sustainable financing• Quality-assured vaccines, supply and safety• Access to and utilization of immunization services• Use of new and under-utilized vaccines
Accelerated Disease Control• Diseases with eradication & elimination goals• Priority bacterial and viral diseases
Enhanced Surveillance & Monitoring Communication and advocacy
CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics
2-4 May 2011The Franklin Institute Science Museum. Philadelphia, USA