WHO PERSPECTIVES: WHICH PRIORITIES FOR SA?

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1 WHO PERSPECTIVES: WHICH PRIORITIES FOR SA? Dr. M. Eshetu and Dr. F. Daniel WHO/IST ESA; 30 April 2014 Vaccination, a gift for life April 2015

2 Presentation outline Immunization success stories & some progress in VPD control in AFR The Decade of vaccines Global Vaccine Action Plan Regional Strategic Plan for Immunization General and specific Considerations for SA 2

3 Immunization success stories & progress in some vaccine preventable diseases in AFRO 3

4 Global Smallpox eradication & certification in , the 19th WHA decided to create the smallpox eradication programme Somalia, 1977: Ali Maalim, last recorded case of naturally-caused smallpox The Expanded Programme on Immunization (EPI) is a direct result of smallpox eradication and it in turn serves as the foundation for primary health care Lead to WHA resolution to eradicate Polio Nous, membres de la commission mondiale de la certification de l éradication de la variole, certifions que l éradication de la variole a été réalisée dans le monde entier. Genève, déc. 1979

5 Summary of progress in some VPDs control, elimination and Eradication in AFR Progress in Polio eradication Global No WPV type 2 since 1999 latest WPV 3 type 3 in Nov 2012 Latest WPV1 case in AFR 9 mths back Measles pre-elimination to elimination by % mortality reduction in 2013 compared to 2000 Addressing rubella using Measles platform MNT elimination Elimination achieved in majority 7 countries likely to miss target of 2015 Men A In Meningitis belt countries use of Men A vaccine allowed for reduction of Men A from75% in 2009 to 2% in 2014 as proportional cause of bacterial Meningitis 5

6 WHO Regional Committee 61 resolution in 2011 & WHO Executive Board Resolution The persistence of Polio is declared as national public health emergency for member states (AFR) "DECLARES polio eradication a programmatic emergency for global public health, requiring full strategy implementation, strong national oversight & accountability, and vaccination recommendations for travelers to & from infected areas 21 January 2012

7 Global Polio Eradication & Endgame Strategic Plan ; 4 main objectives

8 Current status (as at 17th April 2015) There are three polio endemic countries globally (Pakistan, Afghanistan and Nigeria). Latest case in AFRO with onset 24 July 2014 in Nigeria Globally; there have been 22 WPV cases since January from Pakistan and Afghanistan. Polio free certification process being facilitated by the African Regional Certification Commission Containment of WPV containing materials Preparation for at least 1 dose introduction of IPV in 2015 in all the AFR countries & Switch from bopv to topv in 2016

9 African Regional goal to achieve measles elimination by targets & status 2014 >95% MCV1 coverage at national and district level Provision of 2 doses of MCV in Routine immunisation > 95% SIAs coverage in all districts. 84% reduction in measles deaths in AFR (by 2013 compared to 2000 Reported coverage of MCV1 87% Incidence of < 1 case / 10 6 population /year (excluding imported cases). Achieve the surveillance performance targets Source : Monthly RI reports from Member States 19 of 47 countries have MCV2 by end 2014

10 Incidence of confirmed measles in Afr. Source Case based surveillance data 2014 Incidence < 1 per million in 14 countries Only 10 of 14 with sensitive surveillance Incidence < 5 per million in 23 countries 22 of 44 countries met the targets for both of the main surveillance performance indicators in ; Recurrent outbreaks in areas with low population immunity

11 WHO/ESA: RCV introduction & CRS sentinel surveillance establishment Oct 2011 Apr 2015 Year of possible RCV introduction in catch-up Country MR SIAs Rwanda 2013 Tanzania 2014 Kenya 2015 Namibia 2015 Zimbabwe 2015 Zambia 2016 Botswana MR 2016 Comoros MR 2016 Ethiopia? 2018 Lesotho MR 2016 Madagascar 2016 Malawi MR 2016 Mozambique 2016 South Africa? 2016 Swaziland MR June 2016 South Sudan 2017 Eritrea? 2018 Uganda Status of CRS surveillance Mauritius & Seychelles providing RCV prior to 2010

12 Maternal Neonatal Tetanus Elimination in AFR 12 In 35 of the 47 countries MNT elimination is validated by 2014 Priorities through program monitoring Reviewing program data in Nigeria, DRC, Angola, Guinea, and Niger. Validation in Mauritania, Equatorial Guinea, and the Somali region of Ethiopia in 2015.

13 Regional Strategies for Meningitis A Elimination Inducing herd protection Roll out of Men Afrivac in AFR - Through single dose mass vaccination campaigns targeting 1-29 year-olds in the 26 countries of the meningitis belt ( ) Protecting new birth cohorts through - Introduction of MenAfriVac in routine EPI - Organization of periodic mop-up campaigns (SIAs) in areas with low routine coverage (< 60%) Enhancing surveillance & epidemic response- Rapid response to outbreaks Men A cases in meningitis belt countries declined from 75% in 2009 to 2% in

14 We envision a world in which all individuals and communities enjoy lives free from vaccine-preventable diseases". "The mission of the Decade of Vaccines is to extend, by 2020 and beyond, the full benefits of immunization to all people, regardless of where they are born, who they are, or where they live." Decade of Vaccines Vision and Mission

15 Goals for the Decade of Vaccines

16 Global Vaccine Action Plan About 24 Million deaths to be averted using 10 traditional and new vaccines GVAP: In-country EPI MLM Course, Arusha, Tanzania, June 2013

17 General scientific/technical certainty Vaccines pipeline Potential vaccines HIV/AIDS New generation Malaria TB HPV Influenza YF Available & underutilized HepB Typhoid Cholera Hib Pneumococcal Rotavirus Meningococcal A JE Traditional EPI Polio Measles Tetanus Size of circle indicates number of deaths (400,000 deaths, 2002 data) Left side of circle aligned with expected introduction date Year/anticipated year of introduction

18 Strategies towards attainment of the DoV Goals Strategies targets by All countries commit to immunization as a priority Individuals and communities understand and demand immunization Benefits equitably extended to all people Currently available and underutilized vaccines are scaled-up Certification of polio eradication Elimination of neonatal tetanus Elimination of measles in at least 5 regions Strong immunization systems that are an integral part of a well functioning health system Sustainable access to long-term funding and quality supply Country, regional and global R&D efforts maximize the benefits of immunization New or improved vaccines and technologies further enhance the benefits of immunization Elimination of rubella in at least 2 regions Under 5 mortality rate declines significantly Hundreds of millions of cases and millions of future deaths averted

19 The GVAP M&A Framework Monitoring results Indicators for Goals Indicators for SOs Monitoring commitments and Resources National governments Other stakeholders Independent Review Process National Regional Global Alignment with Accountability Framework for Women's and Children's Health 19

20 Regional Strategic Plan for Immunization June 2013: Independent evaluation of the Regional Immunization Strategic Plan Comprehensive consultative process (Countries, partners, etc.) for the development of the next strategic plan aligned with the GVAP May 2014: draft document discussed and approved by TFI November 2014: Member States endorsed the Regional Strategic Plan for Immunization during RC64. 20

21 Strategy formulation Aim & Objectives Aim: to achieve universal immunization coverage within the WHO African Region Objectives: To increase vaccination coverage. To complete the interruption of poliovirus transmission and ensure virus containment. To eliminate measles and advocate for the elimination of rubella and congenital rubella syndrome. To attain and maintain elimination/control of other vaccine-preventable diseases. Guiding principles Country ownership Partnership and mutual accountability Access to universal health coverage Integration Sustainability Innovation and quality improvements 21

22 Strategy implementation: Key approaches for implementation Implementation of the Reach Every District /Child approach and other locally-tailored approaches Extending the benefits of new vaccines to all Sustainable immunization financing Integration of immunization into national health policy and plan Enhancing partnership for immunization Improve monitoring and data quality Improving human and institutional capacities Improving vaccine safety and regulation Promoting implementation research and innovation 22

23 Strategy implementation: Roles and responsibilities Governments: Develop cmyps with annual integrated operational plans. Mobilize and allocate adequate domestic resources to implement immunization plans. Mobilize, involve and empower communities to effectively demand and utilize immunization services. Communities Promote immunization and collaborate closely with local health staff in planned fixed and outreach services. Understand the risks and benefits of vaccination, demand safe and effective immunization programmes and participate in decision-making and service delivery processes. 23

24 Strategy implementation: Roles and responsibilities WHO and Partners Provide technical, financial and material assistance for the development of cmyps and integrated annual operational plans. Support Member States to mobilize the necessary resources to achieve the set objectives and targets 24

25 Monitoring & Evaluation Indicators recommended by the GVAP have been adapted to the regional context and will be used to monitor the implementation of the plan on an annual basis. A mid-term programme evaluation will be conducted in 2017 and a comprehensive end-term evaluation of the strategy in The results will be used to re-align and refine the implementation of the regional plan. The Task Force on Immunization in Africa is expected to conduct annual assessment of the progress towards the achievement of the objectives and targets of the Regional Strategic Plan for Immunization

26 General Considerations for South Africa 26

27 Translation of the Regional Strategic Plan for Immunization into National Priorities and Actions Using the cmyps and annual implementation plans as the basis for implementing the regional strategic plan at the country level Place immunization more firmly within the context of PHC and National health Plans Promote greater engagement of sub national managers in the development of the cmyp 27

28 Operationalization of the Regional Strategic Plan for Immunization Generate political commitment Better governance Requisite investments Strengthening/establishing National Immunization Technical Advisory Groups and Immunization Coordinating Committees/HSCC Promote greater community awareness and participation Address "vaccine hesitancy" 28

29 Operationalization of the Regional Strategic Plan for Strengthen systems Immunization Supply chains Data quality and use Greater integration with broader health systems Targeted approaches to reach the "unreached" Affordable pricing and procurement of vaccines Regular monitoring and corrective actions 29

30 Specific Considerations for South Africa 30

31 Specific Considerations for SA -1 SA is one of the few countries in the region, with a well functioning immunization technical advisory group (National Advisory Group on Immunization). What lessons and expertise can be shared with other African countries? There is a lot of research output in SA. In what ways can synergies be formed between the immunization program and the research institutions so that biomedical and operational research in immunization can be done to strengthen the program? How can inequity in coverage within the country be addressed? How can the cross-border collaboration with neighboring countries in relation to control of VPDs be strengthened 31

32 Specific Considerations for SA -2 High cost of new vaccines: What is the feasibility of local manufacturing capacity of vaccines versus procurement of vaccines to enable sufficient quality supply? where are we? In the interim, how can pooled procurement mechanism for vaccines with non-gavi eligible countries be efficiently facilitated? SA has a vibrant private sector. What role can/does the private sector play (not only in provision of immunization services) but in the use of innovative technologies to produce better quality immunization data? 32

33 Vaccination, a gift for life April 2015 THANK YOU 33

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