GAVI/Vaccine Fund Support to Improve Injection Safety

GAVI/Vaccine Fund Supportto Improve Injection Safety On behalf of the Injection Safety sub-group

GAVI Board GAVI is an Alliance Bilateral agencies Canada The Netherlands Norway Health Ministries Bhutan Mali Industry- OECD country Aventis Pasteur, France WHO UNICEF Industry- Developing Country CIGB, Cuba The World Bank Technical health institute CDC, USA The Bill & Melinda Gates Foundation Research institute NIH, USA Foundation Rockefeller Fdtn. NGO Gates Children’s Vaccine Program at PATH, USA

GAVI Structure

Initial steps taken: • Injection Safety (IS) plan required as part of application • Member of WHO SC on Immunization Safety participates on independent review team • Established IS established as a top priority of the Advocacy Task Force • Conceptually “Bundling” each dose of vaccine supplied by Vaccine Fund with an AD syringe and means for disposal

Unmet need: • Support countries in their transition to use of AD syringes for all vaccines • National and local ownership of problem and means for addressing it • Support for governments and partners to develop implement long-term multifaceted plans to increase awareness and stimulate necessary behavior change • Guidance and options for disposal of health care wastes (HCW) resulting from immunization efforts

GAVI commitments • Based on the principle of “first do no harm” commit to focusing special attention on Injection Safety • Commit to “The Joint WHO/UNICEF/UNFPA/IFRC Joint Statement on the Use of AD syringes in Immunization Services” • Request WHO finalize a statement on medical waste disposal • Commit to using the Aide Memoires on Injection Safety and Healthcare Waste Management to guide investments and actions

Vaccine Fund support for transition to ADs • Support for three years, all countries that receive awards from the Vaccine Fund • Countries currently without means for obtaining ADs and means for disposal for all traditional routine EPI vaccines will be provided these supplies.

Vaccine Fund support • Countries with means to obtain safety supplies will be provided the equivalent amount of grant funds for use on injection safety and waste disposal related activities. • Proposal has to indicate: • source and amount of funding for the AD syringes and safety boxes, • areas to be financed by the Vaccine Fund

Vaccine Fund Support • Support can be applied for either as part of a proposal for immunization services or new vaccine support. • Countries that have previously been approved for immunisation services or new vaccine support must resubmit injections safety portion of application.

Vaccine Fund support • Syringes/funds awarded based on review of IS plan component of country application. • Plans must include • process for establishing national policies • documentation of national commitment • plans of actions

Plans of action • Assure compliance with the WHO/UNICEF/UNFPA statement of 1999 both now and after the resources provided by the Vaccine Fund are no longer available; • provide training and support the necessary behavior change among health care providers; • provide, appropriate information, education and communication to clients on the risks resulting from unsafe injections and poor sharps waste management;

Plans of action • plan for monitoring programme progress (including specific indicators that will be used, and annual targets for these indicators); • steps that will be taken to improve safety of the disposal of medical waste (especially sharps) resulting from immunization activities. • formulation of policy, • assessment of the waste management system, and, • selection of appropriate waste disposal systems for all levels of health care facilities.

Additional Actions • Support implementation of Vaccine Fund assistance (i.e., number of safety boxes, source of safety boxes) • Monitor improvement in the safety in a manner that encourages safety to serve as a “counterbalance” to coverage as GAVI priorities (TFCC) • Commit to support long-term communication effort (Advocacy Task Force, WHO, UNICEF)

Additional Actions • Based on the principle of “polluter pays” support countries in immediate action to use best options available for safely disposing of HCW. • Support R & D of environmentally sound and reasonably priced methods for HCW disposal

Summary • Focus special attention on IS and commit to follow existing policies and guidelines • Through the Vaccine Fund provide temporary assistance to countries in their transition to full use of AD syringes • Support long-term efforts which are crucial to sustainability • Commit to support efforts to improve the safety of HCW disposal

Problem/Opportunity • Available data suggest that injection overuse and unsafe injection practices result in: • 22.5 million Hep B virus infections • 2.7 million Hep C virus infections • 98,000 HIV infections • Injections provided by immunization programs • represent roughly 5% of global injections • widely considered the safest • Immunization programs can be the leaders in improving the safety/quality of health service delivery

GAVI/Vaccine Fund Support to Improve Injection Safety