An overview of the Decade of Vaccine: Vision and Process to develop a Global Action Plan Geneva

1. An overview of the Decade of Vaccine: Vision and Process to develop a Global Action Plan Geneva 15 March, 2011

2. Background DAVOS 29 January 2010 Bill and Melinda Gates Pledge $10 Billion in Call for Decade of Vaccines • Research,develop and deliver vaccines for the world’s poorest countries • Increase vaccination and save more than 8 million children by 2020 • Call for other to help fill critical financing gaps in both research funding and childhood immunization programs • Commit significantly with $10 Billion, while realizing the investment is not sufficient • Confirm that the new funding is in addition to the $4.5 billion already committed by BMGF to vaccine research, development and delivery to date across its entire disease portfolio since its inception • Request increased investments in vaccines by governments and the private sector

3. Highest Level Support to the DOV January 2010 DAVOS Margaret Chan, the director-general of the World Health Organization, called the announcement "unprecedented" in a written statement, but added that it's "absolutely crucial that both governments and the private sector step up efforts" as well. May 2010 WHA DG's Opening Remarks ..."Earlier this year, the Bill and Melinda Gates Foundation launched the Decade of Vaccines by pledging $10 billion over the next ten years to help deliver existing vaccines and develop new ones. This commitment is most welcome. Vaccines are one of the best life-saving buys on offer, preventing an estimated 2 to 3 million deaths each year. WHO and UNICEF, in close collaboration with the Gates Foundation, countries, and partners, are initiating a process to define the ambitions and scope of this Decade of Vaccines."....

4. What is DoV? • DoV: A vision on how to use the next ten years to achieve further immunization goals and key milestones in the discovery, development and delivery of lifesaving vaccines, with a focus on • children and the poor. • A way to re-position Immunization more deeply in national agendas and within the context of primary health care. • DoV Delivery: A way to strengthen immunization systems as a platform to prevent mortality and morbidity, building on, and extending the fundaments of GIVS

5. The Decade of Vaccines, 2011-2020: a comprehensive venture to advance immunization • The Decade of Vaccines (DoV) envisions a world where children, families, and communities enjoy lives free of the fear of vaccine preventable diseases. • The goal of the DoV is to extend the full benefits of immunization to all people, regardless of where they live. • This goal reflects the perspective that access to safe and effective vaccines is a human right that is not currently enjoyed by all people, particularly in low and middle income countries. • Will require full engagement of the diverse stakeholders needed to facilitate vaccine discovery, development and delivery

6. DoV Work Streams • Establishing and sustaining broad public and political support for the use of vaccines and the financing of immunization services. • Strengthening the equitable delivery of immunization services to achieve universal coverage of safe and effective vaccines by 2020 in order to prevent, control, eliminate or eradicate vaccine-preventable diseases. • Cultivating a robust scientific enterprise to produce innovation in the discovery and development of new and improved vaccines and associated technologies for high priority disease targets. • Creating the right market incentives to ensure an adequate and reliable supply of affordable vaccines.

8. Proposal for Delivery Goal The goal of the Delivery stream of the Decade of Vaccine is, throughout the life-course, to achieve equity in the delivery of effective and safe immunization along with other essential primary health care interventions in order to prevent, control, eliminate or eradicate vaccine-preventable diseases. To strengthen country capacities to deliver immunization services to all people, following five guiding principles: • National ownership, responsibility and accountability in extending safe and effective immunization to their target populations; • Greater equity and equality in access to immunization both within and across countries, with a particular focus on populations in greatest need; • Ready and rapid access to new vaccines, technologies and products to meet national, regional and global disease burden reduction; • Alignment of immunization with other primary health care interventions; and • Preparedness and response to special needs created by unusual events, including humanitarian emergency action and the emergence of epidemics.

9. Proposed Delivery Themes and Priorities 2011-2020 Coverage – Equity – Eradication Create and sustain demand Reduce disparities in access Develop a life-course approach Alternate and integrated delivery strategies Response to outbreaks and humanitarian crisis Achieve disease control, elimination and eradication goals Protection – Synergies Country-led, evidence-based decisions Innovative, comprehensive health packages Stakeholder collaboration Strengthening Immunization Systems Performance and Monitoring Structures & processes for policy development Systems and tools for generating data, monitoring performance and use of data for action Human resources Supply chains Country ownership, accountability & self-reliance Engagement of civil society and communities Sustainable and reliable financing Costing Achieving Equity in the use of vaccines Uphold Immunization as a human right Seek Synergies: Immunization as a key component of primary health care Develop immunization systems able to meet the challenge Bolster national self reliance and partnerships

10. Costing of DoV/Delivery • Estimate of the resource requirements to achieve the goals of “DoV/Delivery" in low and lower-middle income countries for the period 2010-2020 and derive the unfunded mandate over the next decade • Deliverables by Dec 2012: • Headline figure on needs, financing and gaps in LLMIC • Analysis of estimates and report on findings • Documented methodology • Established process to review and validate methodology and results • Estimates presented a various global and regional forums as needed

11. Costing DoV/Delivery: Recipe (building blocks) & Ingredients (data sources & methods) ADC, ELIMINATION & ERADICATION 1 Global forecasts 1 VACCINES, INJ. SUPPLIES & COLD CHAIN 2 Global forecast tool 2 Driven by COVERAGE Projection methods 4 SERVICE DELIVERY (HR, TRANSPORT…) 3 cMYP unit costing & typologies 3 COST COMPONENTS: 1. Campaigns: Vaccines; injection supplies and operational costs for Polio, Measles and MNT 2. Routine: Vaccines (traditional, underused and new vaccines (Hib, Rota, Pneumo, Mening A and HPV)); injections supplies and cold chain equipment/maintenance 3. Routine: Human resources; vehicles/transport, training, IEC/social mobilization, programme management and disease surveillance DATA SOURCES: 1. Global forecasts produced by the Polio, Measles and MNT initiatives 2. Global 2010-2020 forecast produced by WHO for the GAVI AVI but supplemented with the 30+ non-GAVI LLMICs 3. cMYP costing and financing tools from 60+ countries and extrapolated to other countries and over time using a unit costing and typology methodology (see related methods document) 4. WHO-UNICEF coverage projection algorithm (see related methods document)

12. DoV and Accelerated Disease Control • Objective I. Achieve Equity in the Use of Vaccines • Approach 1.5.: Achieve global and regional goals for accelerated disease control, elimination and eradication • Strive to achieve the existing disease control goals • Increase national responsibility for and accountability to the agreed global and regional goals. • Forge effective partnerships involving governments, development agencies, as well as civil society, including private entities and foundations, for financing, advocacy and technical expertise. • Establish a reliable supply of safe and effective vaccines to meet demand and create procurement mechanism that provide predictable and stable supply volume at optimal cost. • Optimize the use of accelerated disease control, elimination and eradication resources and capacity, in order to simultaneously strengthen routine immunization and surveillance system in the hardest to reach areas. • Sharpen tools and models to guide the accelerated control, elimination, and eradication programmes.

13. DoV-Delivery – Timeline • 12 Nov 2010: Partners meetings DoV/Delivery • Nov 2010 -Jan 2011: DoV/Delivery Sub-Groups develop ideas and strategies in each area of work • 31 Jan-2Feb 2011: DoV/Delivery meeting to consolidate the work of each of the Subgroups. • 17 Feb 2011: DoV/Delivery meeting on draft consolidated document • May 2011: WHA discussion on DoV • Mar-Dec 2011: Consultations with partners and countries on DoV/Delivery • June 2011: Discussions at Pacific Health Summit • Dec 2011: Final Draft of the DoV/Delivery document • March 2012: 'zenith' week to finalize DoV Global Action Plan • May 2012: WHA discussion on DoV Global Action Plan

14. Issues for discussion • Comments and feedback on the guiding principles • Comments and feedback on the five high level objectives of DoV Delivery • Alignment of the measles strategic plan to the guiding principles and objectives of DoV Delivery.