CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics

2-4 May 2011The Franklin Institute Science Museum. Philadelphia, USA

Global Vaccines 202X: Access, Equity, Ethics2-4 May 2011

The Franklin Institute Science MuseumPhiladelphia, USA

Political Will, Public Confidence, and Immunization Impact: Insights from the WHO European Region Member States

Rebecca Martin

WHO European Regional Office

WHO European Region 2010: 53 Member States (~890 million)

WHO/Europe role:Policy development & implementationNormative guidanceExpert technical assistance

Current Landscape in the European Region

Strong history of collaboration for immunization Progress made towards regional goals National routine immunization coverage levels are overall high

across the Region Vaccine-preventable disease incidence is variable and generally

low Increasing momentum of vaccine refusals Marginalized and vulnerable groups require attention, general

complacency in absence of disease (low risk perception), variable public trust

Cannot afford to jeopardize progress made towards goals

Countries with a standing national immunization technical advisory group on immumnization, 2009

No response (BLR, RUS, UKR, LUX, SMR, MON)No (KAZ, UZB, TKM, AZE, SRB, MNE)No, but ad hoc committee (TJK, ARM, MDA, ROM, CRO, SVN, NOR)Yes (n= 34)

• Platform for:• Improving information on vaccine • benefits and safety• driving demand for vaccines• advocating for political support and• financial commitment

• 2011: ”Shared solutions to common threats”

European Immunization Week

Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

$5,000

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

ARM

AZE

GEO

KGZ

MDA

TJK

UKR

UZB

GAVI eligibility based on Gross National Income (GNI) per capita - Atlas method

Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva

Country Co-financing Needed (2011-2015)GEORGIA – Graduating Country

GEO NVS / Year 2011 2012 2013 2014 2015   2016

Co-financing

levels

Pentavalent $0.30 $0.37 $0.74 $1.11 $1.48 $1.85

Rotavirus   $0.80 $1.60 $2.40 $3.20 $4.00

Pneumococcal      $0.70 $1.75 $2.63 $3.50

# of surviving infants 56,369 56,425 56,481 56,538 56,594 56,650

Total co-

financing 

Pentavalent $56,313 $69,521 $139,180 $208,981 $278,918 $348,992

Rotavirus   $118,493 $189,776 $284,952 $380,312 $475,860

Pneumococcal      $164,572 $329,475 $494,702 $660,256

Total $56,313 $188,014 $493,528 $823,408 $1,153,932 $1,485,108

2 dose schedule for rotavirus vaccine and, reserve stock at start and wastage rate included for all vaccines

From 2011 to 2015, estimated GNI growth in US$: 32.0%; US$ inflation: 12.5%

Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%KGZ

TJK

UZB

ARM

AZE

GEO

MDA

KGZ 4.3% 2.9% 6.4% 8.1% 7.8%

TJK 6.1% 7.4% 6.9% 7.1% 12.8%

UZB 1.7% 2.6% 2.8% 4.8% 5.2%

ARM 1.5% 5.2% 9.1% 13.7% 18.3% 22.9%

AZE 2.2% 2.8% 5.6% 15.1% 27.6% 40.3%

GEO 2.2% 7.3% 19.3% 32.2% 45.1% 58.0%

MDA 1.4% 4.7% 12.3% 20.5% 29.1% 37.6%

2011 2012 2013 2014 2015 2016

Projected co-financing as a percentage of operational budget for routine immunization (2009)

GF/T RI

48.5%

16.2%

71.9%

74.8%

94.6%

81.5%

77.8%

Immunization Financing Task Team Meeting, 20-21 January 2011, Geneva

Financial sustainability analysis on revised GAVI co-financing

Eligible countries (KGZ, TJK, UZB) Additional co-payment burden may be absorbed by

resource allocation changes within MoH budget Increased advocacy needed

Graduating countries (ARM, AZE, GEO, MDA) Additional co-payment burden may/can not be

absorbed by resource allocation changes within MoH budget

In need of external advocacy support

Measles-containing vaccine 1st dose coverage by World Bank income category

80.0

82.0

84.0

86.0

88.0

90.0

92.0

94.0

96.0

98.0

100.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

High income

Upper middle income

Low er middle income

Low income

WHO European Region

Vaccine safety, adverse events following immunization and anti-vaccine movement

Immunization programmes more complex

Role of health care workers, particularly paediatricians, specialists and academicians

AEFIs and trust narcolepsy with pandemic influenza vaccine adverse events with tick-borne encephalitis Suspension of supply of vaccines (Bulgaria)

Anti-vaccine and response Deaths following vaccination in Bosnia and

Herzegovina HPV vaccine introduction in

Netherlands

Building political will and public confidence

Public confidence and communication– EIW 2011 Round Table with Belgium ,Switzerland,

Germany and France: political, providers, public

Collaborative work WHO, UNICEF, ECDC, EC – European immunization coalition– European communication working group– National regulatory authorities– Behaviour change communication models– Social media activities

CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics

2-4 May 2011The Franklin Institute Science Museum. Philadelphia, USA

Introduction of new vaccinesWHO European Region 2010

Intorduced (50)Plan introduction (3)

Introduced (23)Not intorduced

HPVIntroduced (20)Not introduced

Hib PCV

HPV

Introduced (4)Not introduced

Rotavirus

45/48 countries reportedhaving a vaccinationplan (94%)

41/45 of countries implemented A(H1N1)2009 vaccination (91%)

Vaccination implementedyesnoNo data

Influenza A(H1N1) 2009 vaccine implementationWHO European Region

48/53 countries completed the survey (91%)

Pre-epidemic Epidemic Post-epidemic

41% received vaccine at least 2 weeks before

epidemic peak

22% received vaccine during peak trans-

mission (4 wks)

37% received vaccine 2 weeks or more after

epidemic peak

Availability of pandemic influenza A(H1N1) vaccine relative to epidemic peak (n=41)

-2 2 6-8-12-16 8 12 16 20 22 26-20 30 360 4-4-10-14 10 14 18 24 28-18 34 38-6 32-2 2 6-8-12-16 8 12 16 20 22 26-20 30 360 4-4-10-14 10 14 18 24 28-18 34 38-6 32

Principal reasons for refusing pandemic vaccine

0

20

40

60

80

100

Doubts onvaccine safety

Doubts onseverity ofpandemic

Lack of HCWconfidence invaccine/need

for vaccination

Doubts onvaccineefficacy

Riskcommunicationnot clear and

confident

Lack ofinformation

about vaccine

Anthroposophyobjection

Diff icult toaccess

vaccinationsites

Religiousobjection

Cost of vaccineto individual

%

N=39

Summary

Strengthen political commitment at all levels Ensure equitable and affordable access to vaccines,

including vaccine manufacturing, for all countries Align immunization plannning with national health

plans and budgetary cycles to sustain immunization programmes

Advocate for funding – national/international Collaborative work ongoing

CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics

2-4 May 2011The Franklin Institute Science Museum. Philadelphia, USA

CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics

2-4 May 2011The Franklin Institute Science Museum. Philadelphia, USA

Thank you

WHO European Region Immunization programmatic goals

Immunization Systems Strengthening• Stewardship/ sustainable financing• Quality-assured vaccines, supply and safety• Access to and utilization of immunization services• Use of new and under-utilized vaccines

Accelerated Disease Control• Diseases with eradication & elimination goals• Priority bacterial and viral diseases

Enhanced Surveillance & Monitoring Communication and advocacy

CVEP Symposium: Global Vaccines 202X: Access, Equity, Ethics

2-4 May 2011The Franklin Institute Science Museum. Philadelphia, USA