New Vaccines in Developing Countries: Evidence, Practice, Policy, and Challenges
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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
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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**
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Accelerating PolicyAccelerating Policy
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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
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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
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ProVac Policy Framework
Technical criteriaProgrammatic criteria
Financial criteria
www. paho.org/immunization
Andrus et al. Public Health Reports 2007;122(6):811-19
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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
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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
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Accelerating DeploymentAccelerating Deployment
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Pro-Vac Workshop, September 2006
Congenital Rubella SyndromeCongenital Rubella Syndrome
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Strategies
Strategies always rely on:
• Immunizing susceptible population
• Conducting effective surveillance
• Sustaining the gains
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*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
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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.
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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
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Future ChallengesFuture Challenges
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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
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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
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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