CDC Global Immunizatio

n

Strategic Framework 20112015

Photo Credits:

Cover image courtesy of Stephi Bergerson www.stephi.com

Other photos provided by the Pan American Health Organization (PAHO) and GID employees

http:www.stephi.com

Table of Contents

Abbreviations and Acronyms ........................................................ 4

Vision Statement, Mission Statement, Purpose ............................ 7

Background and Introduction ........................................................ 9

Strategic Principles.......................................................................11

Progress, Aims, and Challenges...................................................11

U.S. Government and Global Health Context ...............................15.

Framework Format ........................................................................17

Goal 1: Control, eliminate, or eradicate targeted VPD disability and death globally ............................................19

Goal 2: Strengthen capacity and enhance performance of health systems to sustainably deliver routine immunization services .....................................................23

Goal 3: Strengthen VPD health information and surveillance systems to enhance decision-making capacity for immunization programs ..............................................27

Goal 4: Increase the appropriate development, introduction, and use of new and underused vaccines to prevent diseases of global and regional public health importance.............................................................31

Goal 5.: Promote synergies between immunization and other public health interventions to strengthen health systems and contribute to decreased maternal and child mortality and morbidity .....................35.

Goal 6: Build and strengthen partnerships that maximize coordination and synergy in meeting immunization goals ..........................................................39

http:morbidity.....................35

Abbreviations and Acronyms Vaccines BCG: Bacillus Calmette-Gurin vaccine

DTP: diphtheria, tetanus, pertussis vaccine

DTP3: 3rd DTP dose

HepB: hepatitis B vaccine

Hib: Haemophilus influenzae type b vaccine

LAIV: live attenuated influenza vaccine

MCV: measles-containing vaccine

MCV1: 1st MCV dose

MenA: meningococcal group A conjugate vaccine

OPV: oral polio vaccine

OPV3: 3rd OPV dose

PCV: pneumococcal conjugate vaccine

TT: tetanus toxoid vaccine

Diseases and pathogens CRS: congenital rubella syndrome

HBV: hepatitis B virus

HIV: human immunodeficiency virus

HPV: human papillomavirus

JE: Japanese encephalitis

MNT: maternal and neonatal tetanus

NNT: neonatal tetanus

WPV: wild polio virus

WPV1: WPV serotype 1

WPV3: WPV serotype 3

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Organizations CDC: Centers for Disease Control and Prevention

GAVI: GAVI Alliance

HHS: U.S. Department of Health and Human Services

MOH: Ministry of Health

UNICEF: United Nations Childrens Fund

USG: U.S. Government

WHO: World Health Organization

WHO IVB: WHO Department of Immunization, Vaccines, and Biologicals

AFRO: WHO Regional Office for Africa

EMRO: WHO Regional Office for the Eastern Mediterranean

EURO: WHO Regional Office for Europe

PAHO: Pan American Health Organization

SEARO: WHO Regional Office for South-East Asia

WPRO: WHO Regional Office for the Western Pacific

Other AEFI: adverse events following immunization

DOV: Decade of Vaccines

GIVS: Global Immunization Vision and Strategy

GHI: Global Health Initiative

GPEI: Global Polio Eradication Initiative

NITAG: National Immunization Technical Advisory Group

NVP: National Vaccine Plan

RED: Reaching Every District approach

VPD: Vaccine-preventable disease

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Vision Statement A world without vaccine-preventable disease, disability, and death

Mission Statement To protect the health of Americans and global citizens by preventing disease, disability, and death through immunization

Purpose The purpose of this strategic framework is to articulate CDCs goals, objectives, and strategies for effectively meeting global immunization challenges during 20112015. This document is intended to build on and complement CDCs previous 5-year plan: CDC GLOBAL IMMUNIZATION STRATEGIC FRAMEWORK, 200620101 and is linked to the 2010 National Vaccine Plan of the U.S. Department of Health and Human Services2.

1 http://www.cdc.gov/vaccines/programs/global/downloads/gisf-2006-2010.pdf 2 http://www.hhs.gov/nvpo/vacc_plan/2010%20Plan/nationalvaccineplan.pdf

http://www.hhs.gov/nvpo/vacc_plan/2010%20Plan/nationalvaccineplan.pdfhttp://www.cdc.gov/vaccines/programs/global/downloads/gisf-2006-2010.pdf

Background and Introduction The burden of vaccine-preventable diseases (VPDs) in the United States has been greatly reduced due to childhood immunization. However, even as VPDs such as polio, measles, and rubella have been eliminated in this country, the United States remains vulnerable to disease importations as long as they persist elsewhere. In an era of mass travel and global epidemics, the health of U.S. citizens is closely related to disease occurrence in other countries. Thus, support for immunization programs worldwide contributes toward providing an umbrella of protection for the United States, as well as fulfilling the U.S. governments broader commitment to global health.

Childhood immunization is one of the most cost-effective public health interventions. Basic immunizations are estimated to prevent more than 2.5 million annual child deaths globally, primarily due to prevention of measles, pertussis, and tetanus. Vaccines also prevent severe morbidity from other devastating diseases such as polio for millions more children. Vaccination of children also is expected to avert adult deaths by preventing hepatitis B virus (HBV)-related cirrhosis and liver cancer and human papillomavirus (HPV)-related cervical cancer. However, immunization can potentially do much more. The World Health Organization has estimated that about 1.5 million children under age 5 years continue to die annually from VPDs (approximately 20% of overall childhood mortality). In particular, pneumococcal conjugate vaccine (PCV), Haemophilus influenzae type B (Hib) vaccine, and rotavirus vaccine prevent pneumonia and diarrhea, the two leading causes of death among children under age 5 years in the developing world; the expanded use of these vaccines will be critical for achieving UN Millennium Goal 4to reduce 1990 child mortality levels by two-thirds by 2015.

An estimated 130 million infants are born around the world each year. Protecting each new birth cohort from VPDs requires a well-functioning and accessible immunization service delivery system as a cornerstone of national public health systems. Routine immunization service delivery at fixed posts or through periodic outreach activities (e.g., child health days, immunization weeks) provides at least three contacts per year to more than 100 million infants and their caretakers. In addition, supplemental

immunization campaigns play key roles in making progress toward meeting targeted disease control goals such as polio eradication and measles mortality reduction. However, these achievements are temporal because large outbreaks are probable, and cases and deaths are likely to increase, without further improvements in immunization service delivery.

As a well-accepted and demanded community health program, the immunization service delivery platform is key in ensuring equitable distribution of other essential health services and decreasing morbidity and mortality from other diseases. Through either routine immunization services or supplemental immunization campaigns, immunization service delivery is the backbone upon which multiple additional services are added, including delivery of de-worming medicine, vitamin A, long-lasting insecticide-treated bed nets, safe water systems, and other health commodities. Also, the infant immunization contact provides opportunities to screen mothers for HIV/AIDS and provide health education on a variety of topics. The integrated service delivery process must be coordinated and rational so that health care workers are not overburdened. However, if done effectively, integrated service delivery offers the potential to efficiently expand outreach for multiple health care services to previously unreached populations.

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Strategic Principles This immunization framework is based on key elements of CDCs overall global health strategy: Assist ministries of health in planning and managing health

programs effectively. Eradicate and eliminate disease where possible and feasible. Strengthen the ability of governments and multilateral

organizations to achieve major global health goals. Create a flexible and responsive portfolio of global health

programs at CDC to reflect the changing burden and

distribution of disease globally. Acquire new knowledge to improve achievement of global

health goals. Improve the effectiveness and efficiency of health systems

globally. Promote equal access and equitable delivery to all people of

needed vaccines and other health interventi