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The Challenge of Getting Vaccines Delivered and Used
Robert Steinglass
Technical DirectorIMMUNIZATIONbasics
JSI Research & Training Institute
Discovery, Development and Delivery: The Promise and Challenge of Vaccine Innovations
Global Health Council 33rd Annual Conference 2 June 2006
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Should I re-inventShould I re-invent the wheel?the wheel?
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Estimated Deaths: Ebola Virus in Democratic Republic of Congo, 1995
= 350 People
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Estimated Deaths: Ebola Virus vs. Measles in D.R. Congo, 1995
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= 350 People
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The “Twin Engines”
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The Twin Engines
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Sustainable Immunization Systems
Communications
Management
Supplies& Logistics
PoliciesPractices
Financing
Training
Monitoring
& Surveillance
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Global Immunization 1980-2004, DTP3 coverageglobal coverage at 78% in 2004
2023
26
3844
4952
5663
6875
71 70 7073 74 73 73 72 71
75 76 76 77 78
0
10
20
30
40
50
60
70
80
90
100
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
% c
ove
rag
e
Global African American
Eastern Mediterranean European South East Asian
Western Pacific
Source: WHO/UNICEF estimates, 2005
192 WHO Member States. Data as of September 2005
Date of slide: 12 September 2005
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Countries with national DTP3 coverage in infants ³ 80% for each of last three years (2000-2002)
Source: WHO & UNICEF estimates of National Immunization coverage
DTP380%
DTP3<80%
Not WHO member
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DPT3 coverage, under 1, by State 2005, Nigeria
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0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Pla
teau
Nasara
wa
Ben
ue
Ko
gi
Kw
ara
Nig
er
FC
T, A
bu
ja
Bau
ch
i
Bo
rno
Yo
be
Ad
am
aw
a
Tara
ba
Go
mb
e
Jig
aw
a
Zam
fara
So
ko
to
Kan
o
Keb
bi
Kats
ina
Kad
un
a
En
ug
u
Ab
ia
Imo
Eb
on
yi
An
am
bra
Bayels
a
Akw
a Ib
om
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a
Cro
ss R
iver
Riv
ers
Ed
o
Oyo
Ekit
i
Lag
os
On
do
Osu
n
Og
un
% D
PT
3 C
ov
era
ge
2006 target
National Average: 37.5%
NC NE NW SE SS SW
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Gap in actual coverage
113
33
63
94
93
94
101
60.6
21.7
61
80
38.3
90.1
23
Andhra Pr
Bihar
Delhi
Kerala
Madhya Pr
Tamil Nadu
Uttar Pradesh
0 20 40 60 80 100 120 140Reported Evaluated
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Prices of Newer Vaccines Increase Vaccine Costs Exponentially for Under-ones
02468
1012
Routine Basic Routine Basic +HepB
Routine Basic +DTP-HepB
Routine Basic +DTP-HepB+Hib
$
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Immunization in Urban Areas
Lesson Learned:
Improving health services in high-risk, urban areas requires strategies that address epidemiologic, institutional, and political concerns.
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Immunization coverage is not enough !
Was potent vaccine administered safely and efficiently in a timely manner before exposure to disease?
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Hop on board! There is always room for one more.
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Gas powered and gas dependent
WHO
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An Arab Proverb
“Don’t count your children until they have had measles”
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Slowly he would cruise Slowly he would cruise the neighborhood, the neighborhood, waiting for that waiting for that occasional careless occasional careless child who confused child who confused him with another him with another vendor.vendor.
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Quality of Immunization Services
Improving Injection Safety:
•12 billion injections 12 billion injections annually in developing annually in developing countriescountries
•Over 50% unsafe Over 50% unsafe HIV, Hepatitis B, HIV, Hepatitis B, Hepatitis CHepatitis C
•Immunization Immunization injections: 10% of total injections: 10% of total but EPI leading push but EPI leading push for safe injectionfor safe injection
Source:WHOSource:WHO
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Examples of Auto-Disable Syringes
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Technologies for Sharps Waste Management are Needed
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Injection Safety
Lesson Learned:
Concerted advocacy is needed to raise awareness and promote ownership and action for an unpopular problem.
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“We know in our hearts that we are in the world for keeps, yet we are still tackling 20-year problems with 5-year plans staffed by 2-year personnel working with 1-year appropriations. It’s simply not good enough.”
“We know in our hearts that we are in the world for keeps, yet we are still tackling 20-year problems with 5-year plans staffed by 2-year personnel working with 1-year appropriations. It’s simply not good enough.”
- Harlan Cleveland (President, World Academy of Art and Science)
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EVERY CHILD SHOULD BE A VIP: Vaccinated, Immunized and Protected
THANK YOUTHANK YOU