Global Vaccine Action Plan: shaping immunization programmes in the current decade

1. Global Vaccine Action Plan: shaping immunization programmes in the current decade

2. Why a Decade of Vaccines? • Significant progress in the past decade • Progress with disease eradication or elimination • Millions of deaths averted • Ability for deliver immunization with high coverage • Already reaching over 80% children globally • Higher than any other intervention across continuum of care • Increasing number of diseases now vaccine preventable • Robust vaccine pipeline • Progress with adding vaccines in national programmes • Despite many challenges, opportunities to do much better

3. Global consultation process has reached approximately 1100 people from more than 140 countries • More than 100 core members in the 8 Working Groups: • Delivery, Global Access, Public & Political Support, R&D, Costing & Funding, Health & Economic Benefits, Accountability Framework Indicators, Communications • More than 180 additional individuals participated in the working group discussions • Overall, around 1100 participants involved in the global consultation process • From more than 140 countries • Approximately 290 organizations: government agencies, health professionals, academia, manufacturers, global agencies, development partners, civil society, private sector, PDPs

4. “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

5. Guiding Principles Country ownership • Countries have primary ownership and responsibility for establishing good governance and for providing effective and quality immunization services for all. Shared responsibility and partnership • Immunization is an individual, a community and a governmental responsibility that transcends borders and sectors Equitable access • Equitable access to immunization is a core component of the right to health Integration • Strong immunization systems, which are part of the broader health systems and closely coordinated with other primary health care delivery programmes Sustainability • Informed decisions and implementation strategies, appropriate levels of financial investments, and improved financial management and oversight Innovation • The full potential of immunization realized only through learning, continuousimprovement, and innovationacross all aspects of immunization.

6. GVAP at WHA 2012 Summary of main points raised by member states and CSOs • 31 country delegates and 7 representatives of CSOs • Overarching support of GVAP strategic direction (vaccine research, integration in national health systems, shared responsibility, equity) • Re-affirmation of WHO’s role (leadership, quality control, NRA, safety, technical support,monitoring, advocacy, research…) • Priorities to include complete set of indicators and accountability framework • Accountability of all stakeholders, avoiding duplication in roles and responsibilities • Further discussions on funding of the GVAP including resources for LMICS • Facilitating regional procurement platforms for better access to prices (High cost of vaccines - a major concern) • Request for more coordinated efforts at regional and country levels and for solidarity for equitable and equal access to vaccines

7. GVAP at WHA Responses by the secretariat Governance • WHO will lead the effort to facilitate regional and national action, including planning, implementation and monitoring. • Existing partnership and coordinating mechanisms will be enhanced for this purpose but no new structure will be established. • DoV secretariat and other governance structures will cease by the end of 2012. • Annual monitoring and reporting on GVAP progress will be WHO Governance processes (RCs, EB, WHA)

8. Goals for the Decade of Vaccines

9. Strategies towards attainment of the DoV Goals Certification of polio eradication Elimination of neonatal tetanus Elimination of measles in at least 5 regions 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 Currently available and underutilized vaccines are scaled-up New or improved vaccines and technologies further enhance the benefits of immunization 1 All countries commit to immunization as a priority 2 Individuals and communities understand and demand immunization 3 Benefits equitably extended to all people 4 Strong immunization systems that are an integral part of a well functioning health system 5 Sustainable access to long-term funding and quality supply 6 Country, regional and global R&D efforts maximize the benefits of immunization

11. From GIVS to GVAP Focus on mortality Focus on mortality, morbidity and economic impact Top-down decision-making Country ownership Supply-side emphasis Supply and demand-side interventions Reaching Every District Reaching Every Community Immunization coverage Comprehensive disease prevention and control / focus on surveillance Access focus on low and middle-income countries Access focus on low-income countries A strategy (GIVS) Predefined accountability framework that includes all stakeholder and not just countries

12. The Monitoring & Accountability Framework: The Game Changer in GVAP?

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

14. GVAP Goals Indicators

15. GVAP Strategic Objectives Indicators

16. Operationalizing the GVAP at Country Level

17. Key actions for the Decade of Vaccines • Generate political commitment • Better governance • Requisite investments • Promote greater community awareness and participation • Address "vaccine hesitancy" • Strengthen systems • Supply chains • Data quality and use • Greater integration with broader health systems • Targeted approaches to reach the "unreached" • Affordable pricing and procurement for middle-income countries • Regular monitoring and corrective actions

18. Translating the GVAP into National Priorities and Actions • Using the cMYPs and annual implementation plans as the basis for implementing GVAP at the country level • cMYP guidelines reviewed and updates to • Accommodate the transition from GIVS to GVAP • Place immunization more firmly within the context of PHC and National health Plans • Better use of programme reviews in situational analysis • Promote greater engagement of sub national managers in the development of the cMYP • Consultations undertaken for the review • Internal brainstorming during EPI/HQ retreat – Oct 2011 • Feedback from WHO Regional Advisers – Dec 2011 • Technical consultation: Meeting July 2012 • Opportunities for countries to pilot the new guidelines

19. Main components of the guideline revision • Change from immunization system components to the health systems building blocks • Immunization system components • Service delivery • Advocacy & communication • Vaccine supply, quality & logistics • Surveillance • Programme management • Health systems building blocks • Immunization Services • Program Management • Human Resource Management • Costing and Financing • Vaccine, Cold Chain & Logistics • Surveillance & Reporting • Demand Generation, Communication & Advocacy

20. Main components of the guideline revision (2) • Emphasis on the use of all available data (from EPI reviews, EVMs, PIEs, health sector reviews etc.) to guide the situation analysis. • Guidance for developing a national monitoring framework aligned to the global/regional monitoring and accountability processes • Revisions to the costing and financing tools • Short term – improve user interface, minimize risks of error, improve data validation, links with other tools and reporting systems • Long term – taking into account BMGF methodological experience and PAHO initiative to develop a new costing tool

21. National Immunization Advisory Groups (NITAGS) • A mechanism to promote country ownership and facilitate independent country level monitoring and accountability • First strategic objective of GVAP: All countries commit to immunization as a priority • "Independent bodies such as regional or national immunization technical advisory groups that can guide country policies and strategies based on local epidemiology and cost effectivenessshould be established or strengthened, thus reducing dependency on external bodies for policy guidance • NITAGs or their regional equivalents should engage with academia, professional societies, and other national agencies and committees to ensure a cohesive and coordinated approach to achieving national health priorities..…"

22. NITAGs 2011 : Existence by Region and Selected Characteristics* NITAGs with a formal legislative or administrative basis • 62% countries reported having a NITAG • 56% a NITAG with formal terms of reference (24% increase from 2008) • 54% a NITAG with formal legislative or administrative basis (14% increase from 2008) • 39% a NITAG with declaration of interests by members (5% increase from 2010) • 59 (32%) NITAGs** met six process indicators (8% increase from 2010) including 11 EMR countries and a total of 38 developing countries *Based on the 2012 JRF *Formal ToRs, legislative or administrative basis, at least 5 areas of expertise, at least one meeting a year, agenda distributed >= 1 week ahead of meetings, mandatory declaration of interests

23. Role of NITAGS in strengthening Immunization programmes Independent technical input with broad expertise: allow for an evidence-based review and decision for an increasingly complex area Adaptation of global policy recommendations with consideration of local epidemiology and social contexts Way to demonstrate country ownership and important element of other DoV - GVAP guiding principles e.g. sustainability, shared responsibility and partnership, equity, integration, sustainability and even innovation Promotes sustainability of programmes and local investments in the programme Facilitates the monitoring of GVAP implementation at country level

24. GVAP Progress Reporting and Review • In line with the guiding principles and request of member states to build on existing systems, progress towards the GVAP goals and strategic objectives and related reporting will build on existing mechanisms as follows: • Country Level: National Immunization Technical Advisory Groups, Immunization Coordinating Committees , … • Regional Level: Regional Immunization Technical Advisory Groups , Regional Committees • Global Level: WHO SAGE, Executive Board and WHA • The GVAP Monitoring and Accountability frameworks will be presented to the 2013 WHA • 2014 WHA to be presented with the first progress report of member states towards achieving the GVAP goals and objectives