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Edward J. Hoekstra, MD, MSc Senior Health Advisor UNICEF HQ, New York

Global Overview of Measles Partners for Measles Advocacy 7th Annual Meeting Washington D.C., 27 – 28 February 2007. Edward J. Hoekstra, MD, MSc Senior Health Advisor UNICEF HQ, New York Peter Strebel , MBChB, MPH WHO HQ, Geneva Jeff Mcfarland, MD

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Edward J. Hoekstra, MD, MSc Senior Health Advisor UNICEF HQ, New York

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  1. Global Overview of Measles Partners for Measles Advocacy 7th Annual Meeting Washington D.C., 27 – 28 February 2007 Edward J. Hoekstra, MD, MSc Senior Health Advisor UNICEF HQ, New York Peter Strebel, MBChB, MPH WHO HQ, Geneva Jeff Mcfarland, MD UNICEF HQ, New York

  2. 2005 Mortality Reduction Goal Achieved !!

  3. Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 1999 94 % of all measles deaths No second opportunity 2005 ( 47 )

  4. Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 2005 Nation - wide second opportunity 2005 ( 34 ) Partial implementation of second opportunity 2005 ( 11 ) No second opportunity 2005 ( 2 )

  5. 1st Dose Measles Coverage in 47 Measles Priority Countries 1999 - 2005 77 % Percent 71 % Global Coverage 1st dose 65 % 54 % Source: WHO / UNICEF coverage estimates, 1980 - 2005 as of August 2006

  6. 60% reduction Estimated Global Measles Deaths1999 - 2005 2005 Goal High-low lines indicate uncertainty bounds Source: Lancet 2007, L Wolfson, P Strebel, M Gacic-Dobo, E Hoekstra, J McFarland, B Hersh

  7. Percent reduction in estimated measles deaths by WHO region between 1999 and 2005 81 % 62 % 60 % 75 %

  8. 2005 Mortality Reduction Goal Achieved !! • > 360 million vaccinated in SIAs • 2.3 million additional deaths prevented • Phone - in press conference • > 220 media reports

  9. How was this possible ? • Caring … Parents • Commitment … Countries and Governments • Cash …. Partnership • Measles control benefited from other investments • Strengthening routine immunization systems ( GAVI ) • Polio eradication infrastructure and field staff Photo: Aung

  10. Progress in 2006

  11. Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 2005 Nation - wide second opportunity 2005 ( 34 ) Partial implementation of second opportunity 2005 ( 11 ) No second opportunity 2005 ( 2 )

  12. Measles Mortality Reduction 47 UNICEF / WHO Priority Countries 2006 Nation - wide second opportunity 2006 ( 42 ) Partial implementation of second opportunity 2006 ( 3 ) No second opportunity 2006 ( 2 )

  13. Measles Vaccines Shipped by UNICEF1999 - 2006 Doses Millions

  14. A - D Syringes Shipped by UNICEF1998 - 2006Safe Injection Practices Number A-D Syringes in millions 0.5 ml Auto Disable Syringes

  15. Expenditures Measles Mortality ReductionUNICEF HQ and WHO HQ , 1999 - 2007 $ Millions

  16. m & m integration

  17. Measles & Malaria Foto: Mark Grabowsky

  18. Rapid ITN scale - up LLINs delivered during integrated campaigns, 2002-2007 2006 Pre-2006 2007 In 2006, most LLINs are being delivered during integrated measles campaigns. Source: Global Fund

  19. Measles Control Goalsby WHO Region Americas, Europe, E. Mediterranean, W. Pacific have elimination goals GIVS Goal: 90% reduction in deaths by 2010 (vs. 2000) 2010 2010 2012 2000 Africa and SE Asia have mortality reduction goals

  20. Strategies

  21. Reported Measles Incidence by WHO region, 1980 - 2005 Elimination Source: Joint Reporting Form, WHO/IVB database, August 2006

  22. Americas: Measles Eliminated since 2002 • Importations cause limited outbreaks • No persistent genotype Genotype D4 D5 D6 D8 D9 B3 H1 Unknown / other D6 transmission ends D9 transmission ends 2001 2002 2003 2004 2005 2006 Sources: PAHO, Country reports, Global Measles Laboratory

  23. What will it take to achieve the goal ? 90% Source: WHO/IVR projections, February 2007

  24. What will it take to achieve the goal ? 90% Source: WHO/IVR projections, February 2007

  25. What will it take to achieve the goal ? 90% Source: WHO/IVR projections, February 2007

  26. What will it take to achieve the goal ? 90% Source: WHO/IVR projections, February 2007

  27. Planned measles campaignsJanuary – December 2007 Other interventions: Vitamin A – 19 De-worming – 10 Bed nets – 9 OPV - 4 Measles activities only MR MMR WHO/IVB SIA database, as of 31 January 2007

  28. Challenges • Completecatch-up • Sustainthe gains • Stronger routine • Quality follow – up • Low incidence  declining support • Government financing of follow - up SIAs • Integratewith other child health programmes … going down hill is also going forward ..

  29. Funding Source: Orenstein WA. Pediatr Infect Dis J 2006; 25: 1093-1101

  30. Measles Good spots, bad spots “ … But the fight against disease is like any battle. It is unwise to let your guard drop when you are on top … " …The Economist, 20 Jan 2007

  31. Funding for Measles Mortality Reduction2007 - 2010 ( in million USD ) Estimated Total Funds needed = 479 million USD ( Measles Investment Case II ) Excludes country contributions

  32. Summary • Most ambitious measles goals ever • Less than 4 years to go • Comprehensive strategy required • Inverse relationship: funding down, measles up • Some 2.3 m lives are saved; But don't fail now

  33. Myanmar January 2007 … Next step … We are going to ASIA …

  34. So … Where in the world is Peter Strebel ?? Thanks

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