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Building Optimal Immunization Systems that Meet the Challenges of the Decade Dr Richard MIHIGO

Building Optimal Immunization Systems that Meet the Challenges of the Decade Dr Richard MIHIGO Programme Area Coordinator Routine Immunization & New Vaccines IVD/AFRO 4 th Annual Regional Conference on Immunization (ARCI) 10-12 December 2012, Dar-es-Salaam, Tanzania.

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Building Optimal Immunization Systems that Meet the Challenges of the Decade Dr Richard MIHIGO

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  1. Building Optimal Immunization Systems that Meet the Challenges of the Decade Dr Richard MIHIGO Programme Area Coordinator Routine Immunization & New Vaccines IVD/AFRO 4th Annual Regional Conference on Immunization (ARCI) 10-12 December 2012, Dar-es-Salaam, Tanzania

  2. Presentation outline • Background • New developments in immunization and future prospects • Core elements of immunization system • Way forward

  3. Background • EPI was established in 1974 through the resolution WHA27.57 to build on the success of the global smallpox eradication programme. • EPI focuses on building sustainable immunization systems to protect children against common vaccine-preventable diseases: • Initially 6 vaccines: diphtheria, tetanus, pertussis, poliomyelitis, TB, and measles. • Other vaccines have been integrated: Yellow fever, hepatitis B, Hib, PCV, Rotavirus vaccines, HPV, MenA, MCV2, etc. • Immunization of pregnant women and WCBA: preventing maternal tetanus and newborn infants from neonatal tetanus. • Introduction of new vaccines currently used as a catalyst to scale up complementary interventions (Pneumonia & diarrhoeal control, Cervical cancer prevention & control, etc.)

  4. Important progress achieved in past decades… DTP1/3 coverage improvements Measles mortality reduction GAVI UCI RED Approach Source : WHO/UNICEF Estimates

  5. Countries with highest number of under-vaccinated 81% of DPT3 under-vaccinated children located in 10 countries Source : WHO/UNICEF Estimates

  6. New vaccines introduction accelerated… Hib and HepB Cape Verde STP Rota Comoros Seychelles Mauritius STP Comoros In country EPI Seychelles 46 countries : All except Equatorial Guinea for Hib vaccine Not yet in country EPI Not AFR Mauritius 19 Countries : Benin, Botswana, Burundi, Cameroon, Congo, Central Afr Rep, DRC, Ethiopia, Gambia, Ghana, Kenya, Madagascar, Malawi, Mali, Rwanda, STP, Sierra Leone, South Africa, Tanzania 7 Countries : Botswana, Ghana, Malawi, Rwanda, South Africa, Tanzania, Zambia

  7. “MenAfriVac” introduction: A vaccine success story • 2010 ~ 20 Million vaccinated • Burkina Faso, Mali, Niger • 2011 ~ 35 Million vaccinated • Mali, Niger + Nigeria, Cameroon, Chad • 2012 ~55 Million to be vaccinated • Nigeria, Cameroon, Chad+ Senegal, Ghana, Benin, Sudan

  8. However…significant unmet needs remain • VPDs remain a major cause of mortality and morbidity: adoption of new vaccines by low- and middle-income countries still slower than in high-income countries. • Coverage gaps persist between countries, as well as within countries: average DTP3 & MCV1 coverage in low-income countries was 16% and 15% below that of high-income countries in 2010 respectively. • Inequities in coverage still exist: between urban and rural areas, richest fifth and poorest fifth, as well as in urban poor & migrant populations / indigenous communities. • Supply and logistics systems: Greater need for innovations. • HR: the number, knowledge and skills of health workers need to be enhanced, better coordinated and better supervised.

  9. New Developments in Immunization and Future Prospects

  10. GVAP launched in May 2012 • 25 May 2012 - Ministers of Health from 194 countries at the 65th WHA endorsed the Global Vaccine Action Plan (GVAP), • GVAP: roadmap to prevent millions of deaths by 2020 through more equitable access to vaccines for people in all communities. • The last week of April was also designated as World Immunization Week.

  11. Vaccine Supply & Quality Logistics Service delivery Advocacy & Surveillance Communication Back to basics: core elements of immunization system Sustainable Financing Operations Capacity building 1. Vaccine Supply & Quality 2. Logistics 3. Service Delivery 4. Surveillance 5. Advocacy & Communication Programme Management

  12. Efficient service delivery systems… • Introduction of a “life-course” approach to immunization: benefits of immunization equitably extended to all people • Renewed strategies to reach the fifth child: • Decrease inequities gaps • Empower the communities to demand services • Refocus the RED strategy to reach every child in every community • Countries in driving seat: effective and quality immunization services for all,

  13. Robust supply chain systems • Cost, storage and transport: • Increasing volume of vaccines delivering more vaccines • Work force: • Increasing workload for handling & delivering more vaccines ( from 10 to 17 doses per child) • Injection safety: • Increasing risk of programmatic errors in handling more vaccines • Waste management: • Increasing pressure on the environment from more injection waste ( 6 to 14 injections)

  14. Reliable information systems needed… • New technologies to facilitate data management: • GIS mapping for better micro planning • Use of cell phones to better communicate for EPI • Community information system to • Strengthen monitoring and surveillance systems: • Enhanced epi/laboratory systems • Use of mathematical modeling • Improve predictability of immunization financing: • Enacting pro-vaccine laws • Improve funding allocation

  15. Effective communication… • Boost public demand for immunization: • Growing availability of information and penetration of mobile telephone, social networks and other electronic media (to build awareness and trust) • Incentives to stimulate demand • Involvement of communities and civil society organizations: • Build advocacy capacity • Engage new voices • People need to be made aware of both the benefits derived from vaccines and their potential risks.

  16. Strengthened human resource capacities… ProgrammeCoordination Capacity building Deputy Programme Coordination Administration & Finances Planification, M&E Data Mangement Research Logistics Service delivery Surveillance Communication Vaccine Supply & Quality Organisation of services Cold chain management / Maintenance Advocacy Imm. Safety / AEFI Forecasting Vaccines procurement Social Mobilization Vaccination strategies & Practices Vaccine management VPDs Case based surveillance Communication for behavior change Vaccine regulation Transport management/ Maintenance Integration

  17. Finally: EPI, an integral part of the broader Health System Strengthening Health system building blocks Immunization sub-system components Health system environment EPI: From a vertical programme to a disease control initiative

  18. Thank you - Merci - Obrigado

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