IMMUNIZATIONHIGHLIGHTS 2010WHO REGIONAL OFFICE FOR EUROPE

KeywordsIMMUNIZATION, VACCINES2010 HIGHLIGHTSWHO REGIONAL OFFICE FOR EUROPEISBN XXX XX XXX XXX X

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IMMUNIZATION HIGHLIGHTS 2010

World Health Organization Regional Office for Europe

Every child has the right to live free from vaccine-preventable diseases. Safe vaccines exist and it is well established that vaccination is one of the most effective health interventions available, saving millions of people from illness, disability and death each year. The cost of disease is much higher than the cost to prevent disease.

Recognizing this, Member States in the European Region are strengthening their national immunization programmes and the health systems that underpin them. Supported by the World Health Organization Regional Office for Europe (WHO/Europe) and other partners, their commitment to immunization and hard work has reduced suffering and delivered great social and economic benefits. As a result, the Region is now on the cusp of eradicating or eliminating serious diseases.

However, after years without an outbreak of poliomyelitis (polio) in the Region, there were 478 confirmed polio cases in 2010. There is no cure for polio. Likewise, although previous decades saw declining numbers of cases of measles and rubella in the Region, severe outbreaks in 2010 signalled the beginning of a crisis that continues to this day. Each year, nearly 1 million children born in the Region are not fully immunized against measles or rubella.

Unfortunately, public complacency was only one of the serious challenges readily identified in 2010. In response to the H1N1 pandemic, countries had to rapidly deliver a new vaccine to millions across the Region, straining their immunization programmes and revealing the critical need for stronger vaccine delivery systems. Strengthening these systems requires greater investment, however, and the global economic crisis is challenging the capacity of governments and donors to finance desperately needed improvements. Five countries in the European region (Armenia, Azerbaijan, Georgia, the Republic of Moldova and the Ukraine) will graduate from GAVI Alliance support in 2011.

WHO/Europe’s goal is to reach and maintain high levels of immunization coverage, particularly in vulnerable groups, safely. To achieve this, WHO/Europe works with Member States, international organizations and bilateral agencies to help countries strengthen their immunization programmes and practices through capacity building efforts, the introduction of new and underutilized vaccines, laboratory enhancements and broader, more timely and effective surveillance and information sharing.

These efforts continued to bear fruit in 2010. With support from WHO/Europe and partners, Member States quickly and effectively stopped the outbreak of polio and deployed millions of doses of pandemic H1N1 vaccine to those at greatest risk. In parallel, WHO/Europe worked together with Member States to prepare for and prevent future outbreaks. New tools, such as a laboratory data management system, were rolled out to Member States as part of an on-going effort to promote and support evidence-based decision-making. Vital meetings of key immunization experts and leaders, such as the annual meeting of national immunization programme managers in the region, led to new regional policy and the exchange of information and best practices between Member States. This guidance, and increasing foundation of evidence, facilitated the introduction of new vaccines in several countries in 2010. Efforts to train national and field-level immunization programme staff, such as through the Immunization in Practice programme, continued to enhance immunization delivery, planning and financing.

The events of 2010 exposed the many challenges that immunization programmes still face and, sadly, reminded us that lethal diseases can quickly re-emerge with dire consequences for families. While great improvements were seen in the planning and execution of immunization programmes, it is vital that Member States and WHO/EURO continue this life-saving work.

Dr Rebecca MartinTeam Leader, Programme Manager, a.i.Vaccine Preventable Diseases and Immunization ProgrammeWHO Regional Office for Europe

2010 IMMUNIZATION HIGHLIGHTS IN THE EUROPEAN REGION

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“The only way to eradicate polio is immunization.”

Dr Nusratullo Faizul Loevich SalimovMinister of Health, Tajikistan

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In 2010, European countries were conducting large-scale vaccination campaigns against pandemic H1N1 influenza when outbreaks of polio, and then measles, were reported in the Region. Already strained health systems, including immunization programmes and regulatory authorities, were able to sustain their H1N1 vaccination efforts while shifting focus to these new outbreaks thanks to support from WHO/Europe and other partners, including the European Centre for Disease Prevention and Control (ECDC) and the United Nations Children’s Fund (UNICEF).

LEADING THE EUROPEAN RESPONSE TO POLIO OUTBREAKS

In April 2010, the European Region witnessed an outbreak of polio in Tajikistan, the first outbreak in the Region since it was declared polio-free in 2002. WHO/Europe quickly assessed the risk of further spread of the virus and urged its Member States to strengthen surveillance and accelerate case finding. Shortly afterwards, several other countries reported cases of polio and/or increased cases of acute flaccid paralysis (AFP).

Once alerted, governments acted quickly to limit further spread of the virus. Kazakhstan, Kyrgyzstan, the Russian Federation, Tajikistan, Turkmenistan and Uzbekistan carried out national and subnational immunization days in order to maintain high population immunity until transmission of polio was interrupted. WHO/Europe technical experts facilitated these efforts by advising Member States on vaccine strategies, helping them plan and execute supplementary immunization campaigns and gathering and sharing surveillance information. Experts also worked closely with partners in other regions, such as in the Western Pacific, to investigate the source of the imported poliovirus and to help prevent further transmission.

In 2010, there were 478 confirmed cases of wild poliovirus in Europe. Hundreds of children in the central asian republics and the Russian Federation were infected and – tragically – 30 individuals lost their lives to a disease that could have been prevented. The last case of polio was reported on 25 September 2010 by the Russian Federation. The outbreak in Tajikistan occurred because large numbers of people susceptible to polio infection had been allowed to accumulate in geographic areas, meaning that vaccination coverage was low. The impact of the outbreak was magnified in Tajikistan because some of the local health systems did not quickly recognize the initial warning signs, allowing time for more children to be infected and the virus to spread across borders. Kazakhstan and Turkmenistan experienced few cases from the importation of wild poliovirus, while in the Russian Federation there was local transmission in the Northern Caucasus, again due to clustering of non-vaccinated populations.

Recognizing these challenges, in September 2010, the WHO Regional Committee for Europe held a special side session on polio and adopted Resolution EUR/RC60/R12. The resolution called for Member States to sustain the polio-free status of the European Region by assuring human and financial resources; sustaining high quality AFP and supplementary surveillance; responding to importation of wild poliovirus or detected circulating vaccine-derived poliovirus; and meeting laboatory requirements to contain wild polioviruses.

RESPONDING TO OUTBREAKS AND URGENT NEEDSPOLIO RETURNS TO TAJIKISTAN

On 13 April 2010, the Government of Tajikistan notified WHO/Europe of a sharp increase in reported cases of acute flaccid paralysis (AFP), the most common sign of acute polio. Within a week, the regional reference laboratory in Moscow confirmed wild poliovirus type 1 in specimens from Tajikistan.

Tajikistan sought guidance and support from WHO/Europe, which sent experts to investigate the outbreak and to strengthen national surveillance and case detection.

Tajikistan reported 460 laboratory-confirmed cases of polio. Most of those affected were children under 5 years of age, however 11.5% (53/460) were 15 years of age or older. WHO/Europe worked with authorities to ensure quality clinical management of patients and to plan their response. Outbreak communications support was provided throughout the crisis. The virus spread to 3 other countries: the Russian Federation (14 cases), Turkmenistan (3 cases) and Kazakhstan (1 case).To halt the outbreak, Tajikistan used the Short Interval Additional Dose (SIAD) approach to swiftly boost population immunity, as part of its outbreak response. With donor support, including an emergency grant from Rotary International, Tajikistan conducted six supplemental rounds of vaccination and one subnational exercise. About 1.1 million children were vaccinated during these campaigns, maximizing their protection against polio and helping end the outbreak.

The Tajikistan response was made possible by vaccines donated by UNICEF with support from the US Centers for Disease Control and Prevention (US CDC), and critical financial and technical support from WHO/Europe, US CDC, Rotary International, Bill and Melinda Gates Foundation, USAID, the Governments of India and Japan and other key partners.

POLIO RETURNS TO TAJIKISTAN

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SETTING A NEW TARGET DATE FOR MEASLES AND RUBELLA ELIMINATION IN EUROPE

Measles remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. An estimated 164 000 people died from measles in 2008 – mostly young children.

Like polio, the previous decade saw a drastic decline in cases of measles and rubella in the European Region. Encouraged by this, 2010 was established as the target date for elimination of measles and rubella and prevention of congenital rubella syndrome (CRS) in 2002.

At the end of 2009 and into 2010, however, there were severe outbreaks of measles in Bulgaria and other European countries (such as Germany, Ireland, Switzerland and the United Kingdom). In 2010, 30 828 cases of measles were reported by Member States. Although the European outbreak subsequently appeared to subside, a large outbreak of measles in France at the end of 2010 signalled that the crisis would continue. The pattern of these outbreaks highlights the fundamental challenges that must be overcome before measles can be eliminated. In each case, the outbreak began among a small, concentrated population of un-immunized people, such as those overlooked by health services or in older individuals, and then spread to the increasing numbers of unimmunized individuals in the general population, including those too young to be vaccinated.

Each year, nearly 1 million children born in the Region are not fully immunized against measles or rubella, increasing the likelihood of severe outbreaks. Political and public complacency about the value of immunization has led to low rates of vaccination coverage in western Europe, where 76% of measles cases in the Region were reported in 2008–2009. Such low coverage with the rubella vaccine also has consequences. Although the symptoms of rubella are usually mild among children, infection during pregnancy can be serious; the child may be born with CRS, which causes a range of incurable illnesses.

In September 2010, countries in the Region set a new target date for eliminating measles and rubella – 2015 – in a resolution adopted by the WHO Regional Committee for Europe. Although gaps and challenges remain, the new goal represents an accelerated commitment to elimination – but one that requires a process for verifying and documenting elimination. Therefore, national immunization experts from the Region met in December 2010 to review a framework for verification that had been developed in consultation with WHO/Europe technical experts. Participants agreed on this framework, which outlines the steps that will be taken to document and verify the elimination of measles and rubella and the prevention of CRS in the Region.

ABOUT WHO/EUROPE VACCINE-PREVENTABLE DISEASES AND IMMUNIZATION (VPI)

The 2005 World Health Assembly Resolution WHA58.15 urged all Member States to adopt the Global Immunization Vision and Strategy (GIVS) – a framework for strengthening national immunization programmes through higher vaccination coverage and equitable access to vaccines and by extending the benefits of vaccination to age groups beyond infancy. Complementary to GIVS, in 2010 the Bill and Melinda Gates Foundation announced a commitment of US$ 10 billion over the next 10 years (the Decade of Vaccines) to help research, develop and deliver vaccines for the world’s poorest countries. In line with Millennium Development Goals 4 and 6, GIVS, and the Decade of Vaccines, the goal of WHO/Europe is to reach and maintain high levels of immunization of children, adolescents and adults, particularly those in vulnerable groups. To achieve this, WHO/Europe’s Vaccine-preventable Diseases and Immunization Programme (VPI) provides policy guidance and technical assistance to countries to maximize equitable access of all people to vaccines of assured quality, including new immunization products and technologies. In doing so, VPI aims to strengthen Member State programmes for the control of vaccine-preventable disease through partnerships with ministries of health, national health institutes, international organizations and bilateral agencies.

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INCREASING ACCESS TO PANDEMIC H1N1 VACCINE

In 2009, WHO declared the first influenza pandemic in 40 years. To help countries protect their populations from developing severe disease from pandemic infection, WHO and partners provided technical assistance and an emergency supply of H1N1 vaccine to countries that could not otherwise access it. Six countries in the Region received approximately two million doses of donated H1N1 vaccine, bundled with syringes and safety boxes and accompanied by technical support. In total, 41 countries in the Region deployed H1N1 vaccine during the pandemic. These extensive H1N1 immunization campaigns were facilitated by technical assistance from WHO/Europe throughout deployment. WHO experts worked closely with countries to monitor and assess evidence of adverse events and to adjust their deployment and communication strategies accordingly. With partners in the region, such as ECDC and UNICEF, WHO/Europe also supported logistics planning and vaccine transportation/storage through workshops and hands-on support in the field.

LOOKING FORWARD

Given the experience in 2010, it appears likely that outbreaks of vaccine-preventable diseases will continue in 2011. European countries were able to withstand and control outbreaks in 2010 with support from Member States in the Region, WHO/Europe and other UN agencies, bilateral agencies, donors, technical institutions and others.

The need for this support was a reflection of the status of health systems and vaccination coverage in some countries in the Region. Significant progress has been made to strengthen and fully capacitate national immunization systems, but these efforts must be intensified.

In 2011 and beyond, countries will have to consider and implement accelerated efforts to increase vaccine coverage, such as by addressing barriers to immunization and tailoring effective interventions, and by changing public perceptions about the risks and benefits of vaccines. In its 2010 Resolution, the WHO Regional Committee for Europe reflected on this need when it urged Member States to reinforce their political commitment and make available the resources required to accelerate actions to eliminate measles and rubella and maintain polio-free status, including responding rapidly to importation of wild poliovirus.

ABOUT WHO/EUROPE VACCINE-PREVENTABLE DISEASES AND IMMUNIZATION (VPI) DELIVERING H1N1 VACCINE IN AZERBAIJAN

Azerbaijan was the first European country to receive donated H1N1 vaccine from WHO.

WHO/Europe worked closely with Azerbaijan to prepare its vaccination campaign. Target groups were prioritized based on experience gained from previous immunization campaigns in Azerbaijan, WHO/Europe recommendations and surveillance data. About 880 000 persons were targeted for vaccination, including health workers, pregnant women and people with chronic lung disease.

Azerbaijan received 516 000 doses of donated H1N1 vaccine. The first shipment arrived in early January 2010. Journalists and film crews were present at the airport to witness the arrival of vaccines. The quality of the vaccine was checked by staff from the Innovation and Supply Centre of the Ministry of Health, after which the vaccine was re-packed and dispatched to health care centres.

Immunization began on 15 January in Baku, the capital of Azerbaijan.

Thousands of people in Azerbaijan were vaccinated against H1N1 and disease was prevented, thanks to effective planning and collaboration between the Ministry of Health and international partners, such as WHO/Europe, the International Federation of Red Cross and Red Crescent Societies, UNICEF and the United States Agency for International Development (USAID).

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“We need a concerted effort at both the local and federal levels with strong political commitment to strengthen immunization. It is encouraging that measles elimination is still

a high priority in countries in the region.”

Dr Sabine Reiter, Deputy Head Preventive Immunization Division

Robert Koch Institute, Germany

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While rapidly responding to the needs of Member States during outbreaks of vaccine-preventable diseases, WHO/Europe strengthens the capacity of immunization programmes to prevent such outbreaks from happening. Through its work with Ministries, WHO/Europe helps Member States: 1) improve immunization programme plans and financing; 2) build human resource capacity, at all levels; 3) introduce new approaches and tools, including vaccines; 4) improve surveillance, laboratory performance and networking; 5) assure vaccine quality, safety and supply; and 6) mobilize demand and resources for immunization services.

1. IMPROVING IMMUNIZATION PROGRAMME PLANNING AND FINANCING

WHO/Europe works with Member States to harmonize and improve their immunization planning activities. In 2010, WHO/Europe helped seven countries that were eligible for support from the GAVI Alliance (Armenia, Azerbaijan, Georgia, Kyrgysztan, the Republic of Moldova, Tajikistan and Uzbekistan) to develop costed, comprehensive multi-year immunization plans. These plans, a pre-requisite for financial and technical support from the GAVI Alliance and an invaluable tool for planning other vaccination campaigns (such as measles and rubella), define each country’s immunization objectives, strategies, key activities, financial requirements and resource gaps. Planning was facilitated by a WHO/Europe workshop in January 2010, as well as by hands-on technical assistance from WHO/Europe and partners. WHO/Europe also helped Albania and the Former Yugoslav Republic of Macedonia (two countries that were ineligible for GAVI Alliance support) to complete their multi-year plans. As a result, all nine countries now have comprehensive five-year immunization plans that will facilitate more cost-effective interventions and closer coordination between governments and partners. In addition to its direct assistance to countries, WHO/Europe informs Member State immunization plans by proposing evidence-based public health interventions. In September 2010, WHO/Europe released recommendations on influenza vaccination for the 2010/2011 winter season, including advice about specific risk groups to be targeted for vaccination, the influenza viruses to be included in vaccination and vaccine safety.

2. BUILDING HUMAN RESOURCE CAPACITY, AT ALL LEVELS

WHO/Europe addresses critical gaps in immunization service delivery through practical training for district-level staff (WHO Mid-level Management training) and field-level level staff (the Immunization in Practice programme). This work advanced in 2010 with the establishment of a WHO Collaborating Centre for training and advocacy: the International Children’s Centre in Istanbul, Turkey. Through this successful collaboration, national coordinators from more than 20 Member States across the Region benefitted in 2010 from courses on how to train mid-level managers about immunization.

STRENGTHENING NATIONAL IMMUNIZATION SYSTEMS ARMENIAN IMMUNIZATION IN PRACTICE

In 2010, WHO/Europe helped Armenia improve the quality of its immunization services through WHO Immunization in Practice (IIP) training for nurses. 2510 nurses working in nine provinces were trained.

By implementing IIP, countries elevate the skills of health care workers while enabling them to educate others in the community about immunization – thus increasing demand for vaccinations. Following this training, Armenia used domestic funds to implement extensive outreach immunization services and supportive supervision activities. As a result, routine immunization coverage improved significantly both at national and sub-national levels.

At the end of 2010, coverage (for third dose of DTP vaccine) exceeded 91% in all 11 provinces, indicating significantly improved coverage compared to 2007, when 5 out of 11 provinces had coverage lower than 80%. Improved performance of previously low-performing districts contributed to the increase of immunization coverage at the national level.

NEW WHO COLLABORATING CENTER ON IMMUNIZATION

In May 2010, the International Children’s Center (ICC) in Ankara, Turkey was designated as a WHO Collaborating Centre for immunization training and advocacy after several years of successful work with WHO/Europe. WHO and ICC continue to collaboratively develop and conduct training of national immunization coordinators.

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3. INTRODUCING NEW APPROACHES AND TOOLS, INCLUDING VACCINES

In recent years, the European Region has seen a dramatic increase in the number of countries introducing and routinely immunizing populations with new vaccines, through new approaches. Doing so can prevent untimely death and disability, reduce child mortality and decrease the burden of diseases. However, immunization programmes require careful planning and communication to realize these benefits. Expert counselling and hands-on technical assistance from WHO/Europe helps countries develop and execute evidence-based strategies, while continuously monitoring, learning from and refining these efforts.

3A. PROMOTING EVIDENCE-BASED DECISION-MAKING Evidence-based decision-making is the cornerstone of effective public health interventions. WHO/Europe cultivates this approach to new vaccines and technologies by helping countries establish and strengthen formal, technical groups to advise on all technical and scientific topics related to vaccines and immunization. Furthermore, WHO/Europe supports the work of these National Immunization Technical Advisory Groups (NITAGs) by providing them information about methods of vaccine planning, financing and delivery and updating them on new, relevant evidence (such as about the affordability and cost-effectiveness of different vaccination strategies). In June 2010, WHO/Europe provided training for NITAG members from three countries. Representatives from established NITAGs (France and the United Kingdom) participated in the training to share their experience and perspectives. WHO/Europe also helps Member States gather and assess evidence that can be used to improve future efforts to introduce other vaccines. In 2010, WHO/Europe assisted Armenia to identify lessons learned from Haemophilus influenzae type B (Hib) vaccine introduction.

3B. MICROPLANNING SERVICE DELIVERY The Reaching Every District (RED) strategy was developed and introduced in 2002 by WHO and partners to help improve immunization systems. RED encourages districts and health facilities to develop mircoplans that identify local problems and find solutions. Such efforts are necessary for designing effective approaches that can serve as the underpinnings for strong immunization programmes. WHO/Europe continues to routinely educate countries in the Region about microplanning (e.g. during the 2010 Programme Managers meeting) 2010, six of these countries also received financial and technical support from WHO/Europe for their RED strategies.

3C. DEVELOPING AND EXECUTING NEW VACCINE STRATEGIESDuring high-level meetings, regional workshops and NITAG meetings in six countries in 2010, WHO/Europe provided information about the characteristics, safety and potential impact of new vaccines (such as pneumococcal and rotavirus vaccines), as well as best practices and lessons learned from countries that had previously introduced them. WHO/Europe informed technical discussions and decision-making about changes in vaccines at the national level, such as technical assistance to Kazakhstan to aid the country in switching from PCV7 to PCV10 (or PCV13) vaccine. This guidance proved invaluable to countries, as demonstrated by the number of new vaccines introduced in 2010. Three countries in the Region introduced Hib vaccine into their routine immunization programmes in 2010, increasing the number of such countries to 50 in Europe. Three countries also introduced the human papilloma virus (HPV) vaccine into routine immunization. In addition, WHO helped immunization programmes in seven GAVI-eligible countries develop plans to introduce pneumococcal and/or rotavirus vaccines.

2010 PROGRAMME MANAGERS MEETING

From 16 to 18 November 2010, WHO/Europe held a regional meeting of national immunization programme managers in Istanbul, Turkey. Attended by programme managers and experts from 40 Member States and 15 partner agencies and bodies, including WHO/Europe, the meeting was an opportunity for regional immunization leaders to share and learn from experiences in the successful delivery of immunization services in the Region.

NEW VACCINE INTRODUCTION IN EUROPE, 2010

Countries now routinely immunizing (end 2010)

Hib 50

HPV 20

Pneumococcal 25

Rotavirus 3

Meningococcal 16

Countries that introduced vaccines in 2010

Hib 3

HPV 3

Pneumococcal 7

Meningococcal 2

Countries planning to introduce vaccine in 2011

Hib 2

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4. IMPROVING SURVEILLANCE, LABORATORY PERFORMANCE AND NETWORKING

Vaccine-preventable diseases cannot be controlled, eliminated or eradicated without well-functioning surveillance systems. Surveillance systems provide the evidence needed for informed immunization policies, strategies and responses. WHO/Europe took a three-pronged strategy to support surveillance in the Region in 2010: it helped Member States to develop more effective routine surveillance systems, including laboratory systems; it supported Member State monitoring and tracking of disease outbreaks; and it helped cultivate regional laboratory works for both existing and new vaccines.

4A. ENHANCING ROUTINE SURVEILLANCE In 2010, WHO continued to help countries build surveillance systems (including laboratory systems) that can accurately confirm and quickly report cases of vaccine-preventable disease and adverse events following immunization. The WHO Regional Laboratory Network (Labnet) provided hands-on technical support and training, helped introduce new laboratory and data management standards, systems and policies and delivered vital information (such as clinical and diagnostic guidelines and training tools). By accrediting 120 national and sub-national laboratories in 2010, Labnet helped ensure and improve the ability of these laboratories to work safely and follow essential principles of laboratory quality. At the regional level, WHO/Europe continued to collect, consolidate, cleanse and analyze surveillance data from countries in 2010, adding

value to the information before sharing it with other countries, regional laboratory networks and partners.

4B. TRACKING MEASLES, POLIO AND OTHER OUTBREAKSThroughout 2010, national surveillance systems were challenged by disease outbreaks. WHO/Europe actively responded to these challenges by providing rapid technical support to countries affected by outbreaks and by sharing up-to-the-minute outbreak information that helped countries tailor their responses. Through its annual meeting for influenza surveillance in September 2010 (Brasov, Romania) and its November meeting of National Immunization Programme Managers (Istanbul, Turkey), WHO/Europe played an important leadership role in helping coordinate outbreak surveillance in the Region.

NEW LABORATORY DATA MANAGEMENT SYSTEM

In 2010, WHO/Europe developed a new online laboratory data management system (LDMS). LDMS is a user-friendly tool for online reporting of laboratory results and epidemiological data. First piloted in Russian Federation polio labs, LDMS was used by epidemiologists during the 2010 polio outbreak to track samples and test results online. This reduced specimen loss and accelerated results and notification of cases. Virologists appreciated the ability to enter virus sequencing information in the system and link this information with epidemiologic data. In addition, the new LDMS offers overall immunization profiles of the 53 Member States in the Region and access to valuable resources, such as biosafety guidelines and laboratory manuals.

ASSISTING EUROPEAN LABORATORIES In addition to its many other forms of support to European laboratories, WHO experts provided on-site support in 2010.

COUNTRY SUPPORT PROVIDED

Greece Accredited national and sub-national laboratories

Poland Accredited national laboratory

Russian Federation

Piloting laboratory data management systems; Support for polio, measles and rubella

Tajikistan Technical support during polio outbreak

Turkey Accredited national and sub-national laboratories

Ukraine Technical support during polio outbreak

In 2010, WHO/Europe published its first Statistical Summary of Vaccine Preventable Diseases and Immunization in the WHO European Region. This comprehensive report of epidemiological and programmatic data from the European Region, based on data reported by Member States themselves, is a valuable reference for countries and partners that require data on vaccine-preventable diseases and immunization coverage rates for planning and evaluation for decision-making.

NEW ANNUAL IMMUNIZATION DATA REPORT

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4C. BUILDING REGIONAL SURVEILLANCE CAPACITYWHO/Europe support for regional measles and polio laboratory networks continues to provide a platform for national laboratories to share experiences and data, exchange information on recent developments in laboratory diagnostic methods and discuss solutions to the challenge they face. In addition, in 2010, WHO/Europe helped cultivate regional networks to monitor the introduction of vaccines for invasive bacteria disease (IBD) and rotaviruses.

The WHO/Europe Sentinel Surveillance Network for Rotavirus works through sites in six countries and a regional reference laboratory in Minsk, Belarus. In 2010, WHO/Europe convened the first meeting of the network, attended by epidemiologic, clinical and laboratory staff from each of the countries. Participants discussed the data collected to date, current challenges and future plans. Subsequently in 2010, the network produced the first data about genotype distribution among the countries.

The European Invasive Bacterial Diseases Surveillance Network tracks cases of IBD from sites in three countries (including cases caused by haemophilus, neisseria and pneumococcus) in collaboration with a Regional Reference Laboratory in Moscow, Russian Federation. In 2010, two of these sites (Azerbaijan and Georgia) began enrolling cases and reporting data. WHO/Europe and partners strengthened this network through hands-on assistance and training and by implementing software for management and reporting of information from sites in the network. WHO/Europe continues to work with the network to prepare for surveillance in a fourth country in 2011.

5. ASSURING VACCINE QUALITY, SAFETY AND SUPPLY

Support for vaccine quality assurance and safety continues to be indispensable for immunization programmes in the European Region. In 2010, WHO/Europe provided guidance and assistance to help build the capacity of national regulatory authorities (NRAs) and to develop and implement improved injection safety and waste management policies countries.

5A. STRENGTHENING NATIONAL REGULATORY AUTHORITIESEnsuring a safe and effective supply of vaccines requires NRAs to continually learn and adapt. WHO/Europe supports this through its advocacy, guidance and assistance to help NRAs effectively regulate and monitor vaccine use. Efforts in previous years (including financial and technical support) to strengthen the network of NRAs in the Region resulted in close collaboration in 2010. For example, NRAs in the Region transparently shared critical, sensitive information during the H1N1 pandemic, including updates on the regulatory status of vaccines and news of suspected adverse events through public websites. WHO/Europe provided valuable leadership and advice for NRAs during these emergency responses.

5B. IMPROVING INJECTION SAFETY AND WASTE MANAGEMENTWHO/Europe promotes a holistic approach to injection safety and waste management. By providing technical support and access to best practices, data and expert advice, WHO strengthens country capacity and helps Member States to use immunization as a driver for system-wide improvements.

In 2010, WHO/Europe led independent assessments of injection safety and waste management in several countries, and provided three countries with the tools and training necessary to conduct their own assessments in the future. These expert reviews stimulated national dialogue and provided valuable insight and recommendations for future policies and practices. For example, during its 2010 assessment, The Former Yugoslav Republic of Macedonia determined that implementing a monitoring system for health care waste was a priority. As a result, the country will implement such a system in 2011 – one of the first of its kind in the European Region.

“The pandemic showed us clearly how crucial and difficult

communication can be.”Zsuzsanna Jakab

WHO Regional Director for Europe

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“It is important to be prepared for multiple scenarios, to envisage the worst but also to be ready to rapidly adapt to a much better situation.”

Zsuzsanna jakab, WHO Regional Director for Europe

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WHO also supports the complex process of developing national policies and plans through direct technical assistance to countries. In 2010, WHO technical support to Azerbaijan helped the country develop a national policy and plan for waste care management. With technical guidance from WHO, seven countries conducted cold chain assessments, such as a 2010 assessment of effective vaccine store management in Tajikistan.

6. MOBILIZING DEMAND AND RESOURCES FOR IMMUNIZATION SERVICES

Communication and advocacy underpins accelerated disease control, surveillance and monitoring activities. Effective communication and advocacy helps increase and sustain demand for immunization services and mobilize the resources needed to support them.

6A. DEVELOPING A NEW COMMUNICATION APPROACHThe 2010 WHO Global Immunization Meeting expressed the urgent need to reach the unimmunized and under-immunized.. A global evaluation revealed that children are often not vaccinated because of perceptions about vaccine safety. This need for a new communication approach was highlighted during a 2010 meeting of the WHO Strategic Advisory Group of Experts (SAGE) on immunization, which emphasized that the European Region must address behaviour change and increase demand for immunization in order to achieve measles eradication.

To address behavioural barriers to vaccination, WHO/Europe is working with partners and countries to better understand the epidemiology of susceptible populations and implement strategies to create demand for vaccines, change risk perception and ensure equity to immunization services through communication activities. In 2010, WHO/Europe founded a Vaccine Communications Working Group in Europe with the express aim to support this work in countries. 6B. SPREADING THE WORD ABOUT IMMUNIZATIONSince European Immunization Week (EIW) began in 2005, the initiative has spread across the Region. Nearly 50 Member States joined in 2010, reflecting a widespread commitment to immunization. The theme of EIW 2010 was the elimination of measles and rubella, providing a timely opportunity for stakeholders to refocus on achieving that goal by 2015 – the new target date. EIW 2010 leveraged Internet and social media technologies to expand its reach and impact. A virtual launch, hosted by WHO/Europe in conjunction with the World Bank and made possible by the World Bank’s Global Development Learning Network, kicked off a week of activities throughout the Region. WHO provided an EIW campaign website in 2010 through which visitors could access campaign materials and real-time updates about EIW activities from around the world. Visit the EIW campaign site at http://eiw.euro.who.int.

ALLOCATION OF WHO/EUROPE IMMUNIZATION FUNDING (2010)

Support for regional activities: 37%

Support for specific countries: 37%

Immunization system: 24%

Polio: 26%

Measles and rubella: 11%

H1N1: 2%

VACCINE COMMUNICATIONS WORKING GROUP

In late 2010, WHO/Europe established the European Region’s first Vaccine Communications Working Group (VCWG). Communications, advocacy and social mobilization experts from immunization programmes in Member States, the media, NGOs, universities and WHO/Europe participated in the inaugural meeting of the VCWG.

The partners in the Working Group will collectively work to develop strategies and provide assistance that addresses the advocacy and communication needs of European immunization programmes, while helping ensure the overall quality of WHO’s communications activities in the Region.

The VCWG will meet in 2011 to continue refining and reporting on its plan of work, which includes a social and behavioural communications toolkit for immunization programmes and a VPI communications strategy. For more information about the VCWG or how to contribute to its work, please contact vaccine@euro.who.int.

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6C. RESPONDING TO ROUTINE AND URGENT INFORMATION NEEDS To help countries effectively plan and quickly respond during crises, WHO/Europe introduced its Epidemiological Brief in 2010. WHO/Europe published eleven briefs during the year, providing up-to-date summaries of epidemiologic data and response measures taken by immunization programmes during the 2010 polio outbreak and the importation of wild poliovirus into the Region.

In addition, WHO/Europe continued to publish its EURO Immunization Monitor, a newsletter providing regular information on immunization-related activities in the Region while monitoring the surveillance and coverage rates for polio, measles and rubella. The 2010 newsletter included valuable information from regional and global immunization meetings, as well as an overview of the H1N1 pandemic, a summary of new WHO recommendations on hepatitis B vaccines and detailed, country-by-country immunization data.

6D. MOBILIZING RESOURCES TO SUPPORT MEMBER STATESThe WHO/Europe VPI Programme mobilizes and dispatches resources, such as financial aid and technical assistance, to help Member States ensure their populations are protected from disability and death from vaccine-preventable diseases, with services delivered through strong and sustainable immunization systems. Many donor contributions were critical to the work of the VPI Programme in 2010. Member States, UN agencies, technical agencies, bilateral and independent donors and individuals generously contributed to support national immunization programmes. More than a third of donations were made to support specific country activities during the outbreaks of measles and polio.

Other donations helped towards building better responses for the future by facilitating regional collaboration and innovation (e.g. development of the LDMS laboratory system) and through system strengthening activities within countries (e.g. Mid-level Management training or planning to introduce pneumococcal vaccines).

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PUBLICATIONS AND REFERENCESUnless otherwise stated, all publications can be found at: http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/publications

• Report of the 23rd Meeting of the European Regional Certification Commission for Poliomyelitis Eradication. WHO/Europe. 2010.

• Renewed commitment to measles and rubella elimination and prevention of congenital rubella syndrome in the WHO European Region by 2015: Report from the Sixtieth session of the Regional Committee for Europe. WHO/Europe. 2010.

• Report of the 2010 Regional Meeting of National Immunization Programme Managers. WHO/Europe. 2010.

• Eliminating measles and rubella and preventing congenital rubella infection: WHO European Region strategic plan 2005-2010.

• Surveillance Guidelines for Measles, Rubella and Congenital Rubella Syndrome in the WHO European Region, WHO/Europe, 2009.

• European Immunization Week Guidelines: Public Relations and Working with the Media. WHO/Europe. 2010.

• European Immunization Monitor. A quarterly newsletter of the World Health Organization Regional Office for Europe.

• European Immunization Week 2010 Narrative Report. WHO/Europe. 2011.

• Weekly Epidemiological Record. 2010 Index. WHO. http://www.who.int/wer/2010

• Morbidity and Mortality Weekly Report (MMWR). 2010 Index. US CDC. http://www.cdc.gov/mmwr/index2010.html

• WHO/Europe Vaccines and Immunization. WHO. http://www.euro.who.int/vaccines

• Vaccine safety web sites meeting credibility and content good information practices criteria. WHO. http://www.who.int/immunization_safety/safety_quality/approved_vaccine_safety_websites

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WHO is the authority responsible for public health within the United Nations system. The WHO Regional Office for Europe (WHO/Europe) is one of WHO’s six regional offices around the world.

It serves the WHO European Region, which comprises 53 countries, covering a vast geographical region from the Atlantic to the Pacific oceans. WHO/Europe collaborates with a range of public health stakeholders in the Region and globally, to ensure that coordinated

action is taken to develop and implement efficient health policies and to strengthen health systems.

WHO/Europe is made up of public health, scientific and technical experts, who are based in the main office in Copenhagen, Denmark, in 5 outposted centres and in country offices in 29 Member States.

ContactWHO Regional O�ce for Europe

Scher�gsvej 8DK-2100 Copenhagen Ø

DenmarkTelephone: +45 39 17 17 17

Fax: +45 39 17 18 18E-mail: postmaster@euro.who.int