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Investing in the Measles Initiative What Dividends Has It Paid?

State of Measles Initiative Financing Partners for Measles Advocacy Meeting Washington, D.C. September 22, 2008 Andrea Gay. Investing in the Measles Initiative What Dividends Has It Paid?. Current investment of $635 million (2001-2007) has paid high dividends in mortality and morbidity reduction

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Investing in the Measles Initiative What Dividends Has It Paid?

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  1. State of Measles InitiativeFinancingPartners for Measles Advocacy MeetingWashington, D.C.September 22, 2008Andrea Gay

  2. Investing in the Measles InitiativeWhat Dividends Has It Paid? • Current investment of $635 million (2001-2007) has paid high dividends in mortality and morbidity reduction • Extremely cost effective with high impact: • equity, • meet (exceed) UN targets on time, • vaccinate over 600 million children (by end 2008), • prevent 2.3 million deaths (end 2006) at cost of $184/death averted • Contribute to achievement of MDG # 4 • Expand and strengthen polio surveillance system – useful for new vaccine introduction

  3. Dividends continued • Enable scale-up coverage with preventive health interventions: vitamin A, deworming, ITNs and other vaccines (OPV, Rubella) • Countries financial commitments are increasing for sustainability: experience with follow-up campaigns • 31 countries contributed to operational costs up to 50% with upward trend Good future for measles mortality reduction & elimination if sufficient finances available

  4. Investing in Measles Initiative Entry Point to Strengthening Health Systems Components of campaigns that strengthen health systems: • Micro-planning • Training – injection safety • Cold chain improvement • Logistics • Increase community demand for immunizations with social mobilization • Waste management improvement • Disease surveillance and data management

  5. Immunization Strengthening Support WHO AFRO • 2007: 6 countries received $348,575 (range $6,000 – 184,704) • 2008: 9 countries received $1,050,000 (range $80,000 – 250,000)

  6. Measles Initiative Annual Donations 2001-2008 and Estimated Financial Resource Requirements, Contributions, Funding Gap 2009* 2009: Funding gap US$ 35 million Excluding India * Excluding country contributions for catch-up and follow-up SIAs

  7. Resource Requirements 2009 • Total required for at least 26 follow-up campaigns (plus possible India catch-up), surveillance, minimal routine strengthening: approximately $55 million (plus India) • Total pledged by existing donors: approximately $20 million (CDC, ARC, UNF, Merck, LDS, Vodafone Fdn) • Gap: approximately$35 million

  8. Options to Address Funding Gap for 2009 • Decrease number of countries conducting SIAs • Shorten age range of target populations • Cease specific support for routine immunization • Increase countries’ share of budget beyond 50% ops costs (ex: Nigeria) • Rather than proactively conduct SIAs to prevent outbreaks, simply respond to outbreaks when they occur (without donor support)

  9. Annual Donor Expenditure and Financial Resource Requirements (FRR) 2001–2010* 103

  10. Financial Strategy (Banker) • Support follow-up SIAs and improve routine coverage • Avoid collapse of gains, resurgence of measles • Use smaller age range when possible & appropriate • Increase sustainability with increased country financial responsibility (shift costs) • Increase separate financing for surveillance (as global public good?) • Increase number/type of donors • Improve cost sharing with added interventions

  11. Financial Challenges • Consistent immunization donors are limited: bilaterals [notably CDC], GAVI, ARC, UNF, Vodafone Fdn., LDS, Gates Fdn., Rotary International, BD, and most recently, Merck • How broaden this base? • Countries can use SWAP, country multi-year plan (CMYP) funds for measles, but compete with newer vaccines being introduced • How involve measles staff in CMYP process to access funds?

  12. Should global measles elimination be considered?? • WHO Executive Board consideration for elimination 1/09 • 4 of 6 WHO regions have elimination targets: PAHO – 2002, EURO & EMRO – 2010, WPRO – 2012 • 1 WHO region has “pre-elimination” target: AFRO – 2012 • 1 WHO region has no target: SEARO • Measles goals have been met on time • Political will currently exists in countries • For sustainability and elimination goals need more predictable multi-year financing • Potential donor support (appetite for large scale activities not evident)

  13. Questions to Ponder • Why donors reluctant to continue support when innovative strategy proven to work? • When is proven strategy no longer “innovative”? • What is time frame for innovation? • What is the value of innovation/catalytic? • Pilot / lessons learned / lessons lost

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