seasonal influenza vaccine policy and utilization: a ... · seasonal influenza vaccine policy and...

Seasonal influenza vaccine policy and utilization:

A global perspective

Joachim Hombach

Initiative for Vaccine Research

13 July 2011

Influenza vaccine policy and utilization 13 July 2011, Geneva2 |

Factors that impede wider usage include:

• Public health strategy – vaccine policy

• Resource availability – vaccine supply

• Fiscal space – vaccine costs

• Health infrastructure – vaccine delivery and implementation

• Cultural perceptions – public perceptions

GAP Objective 3 "Increase seasonal influenza vaccine usage"

GAP Objective 3

"Increase seasonal influenza vaccine usage"


WHO position paper on seasonal influenza*

� Risk-based approach to vaccination:

– Elderly in long-term care facilities

– Elderly with chronic conditions

– Anybody >6 months with high risk conditions

– Elderly above a nationally defined age limit

– Other groups as nationally defined, in particular HCW, pregnant women, children 6-23 months age.

(*Weekly Epidemiological Record, 19 August 2005)


WHO conducted global survey to understand:

• Seasonal influenza vaccination policies in place

• Programme performance

• Future plans for countries not using seasonal influenza

vaccine

WHO 2010 Survey


Primary data

� WHO 2010 Global Influenza Vaccine Survey: July 2010 – February 2011

Supplementary data

� VENICE survey 2008 ( 27 MS EU+ Norway, Iceland)

� Ropero-Alvarez, BMC Public Health 2009 (research article seasonal influenza Americas)

� IFPMA

� Joint Reporting Form (JRF) survey data 2008-2009

Data sources


Countries/territories responding to the 2010 WHO Seasonal influenza survey

* 25 MSs + 1 territory

** 27 MSs+3 territories

75 Member States + 4 territories79Total

Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Guam, Japan, Kiribati, Laos PDR, Malaysia, Marshall Islands, Micronesia, Mongolia, Nauru, New Caledonia, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, Vietnam

30WPRO**

Democratic Republic of Timor-Leste, Maldives, Nepal, Sri Lanka, Thailand5SEARO

ECDC/VENICE survey (27 countries)not administeredEURO

Afghanistan, Bahrain, Egypt, Iran, Iraq, Jordan, Lebanon, Libya, Morocco, Oman, Palestine, QatarSaudi Arabia, Somalia, Sudan, Syria, United Arab Emirates, Yemen

18EMRO

Argentina, Barbados, Belize, Bolivia, Brazil, British Virgin Islands, Chile, Colombia, Costa Rica, Dominica, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Trinidad and Tobago, Uruguay, Venezuela

26AMRO*

none0AFRO

Country/Territory listCountry/ territory

Countries/territories responded to a 2010 WHO Seasonal influenza survey

Region


Member States participating in WHO 2010 Global Survey for Seasonal Influenza Vaccination by region

0

10

20

30

40

50

60

70

80

90

100

AFRO AMRO EMRO EURO* SEARO WPRO

18/22

5/11

27/27

25/35

%

* Survey not administered

Seasonal Influenza Vaccine

National Policy


Member States with Seasonal Influenza in National Immunization Policy by region

3/46

27/35

33/35

7/22

11/22

40/53

2/11

1/11

8/27

0

10

20

30

40

50

60

70

80

90

100

AFRO AMRO EMRO EURO* SEARO WPRO

2008 JRF survey

2010 WHO and other surveys

2012 Projection from survey data

6/27

9/27

32/35

%

•* based on VENICE survey in 2008 and JRF survey in 2008 - 2009


Countries having Seasonal Influenza vaccination in National Immunization Schedule

Source: WHO seasonal influenza survey 2009, 193 WHO Member States. Data as of February 2011

Countries without seasonal influenza vaccination in national programme

Countries with seasonal influenza vaccination in national vaccination programm

in 2010

Countries plan to have seasonal influenza vaccination in national programme b

2012 Countries offer seasonal influenza vaccination not in national

programme but in private sector

Countries which data are currently not available and pending on the new

regional survey in 2011


% of countries by region recommending seasonal influenza

vaccination for specific target groups, 2010

78%92%85%54%64%WPRO

100%100%100%0%100%SEARO

85%100%100%41%22%EURO

89%100%67%22%11%EMRO

87%67%90%50%79%AMRO

n/an/an/an/an/aAFRO

Essential

Personnel

including

HCWs

At risk groupsElderly

>65 AdultsChildren

% of countries by region recommending seasonal influenza vaccination for specific target groups, 2010

Region


Age groups recommended for vaccination at global level (n=88)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

6-11 months 12-23 months 2-5 years 6-18 years 18-49 years 50-64 years >65 years

Global

Countries


At risk groups recommended for annual seasonal influenza vaccination at global level,

(n=75)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Pregnancy

Hepat ic diseases

HIV/ AIDS

Haemat o./ met abolic disorders

Immune Disorders

Renal

Cardiovascular

Chronic pulmonary

%Countries


Essential personnel groups recommended for

annual seasonal influenza vaccination (n= 75)

0% 10% 20% 30% 40% 50% 60% 70% 80%

Finance and banking sector

Energy sector

General travelers

Military

Field w orkers investigate outbreaks in animal

Field w orkers investigate outbreaks in human

Lab w orkers

Health care w orkers

% Countries


% Countries including seasonal influenza in the national programme and able to meet WHA 56.19

(75% coverage in elderly by 2010)

5/8

0/1

1/27

2/9

13/36

0/3

0 10 20 30 40 50 60 70 80 90 100

AFRO

SEARO

EURO

EMRO

AMRO

WPRO

%

Seasonal Influenza Vaccine

Supply


Type of seasonal influenza vaccine used

by region

8/15

7/8

13/24

5/8

1/1

1/8

10/24

2/15

1/24

0

10

20

30

40

50

60

70

80

90

100

AFRO* AMRO EMRO EURO* SEARO WPRO

Both northern and southern hemisphereSouthern hemisphereNorthern hemisphere

%

* Data not available


Seasonal Influenza public sector purchase

and costs by region

5.82.0 - 11.0 $86,601,44875,941,50340Total

9.46.9 - 11.0$11,056,42011,857,8608WPRO

6.05.9 - 7.3$2,400,0002,200,0001SEARO

n/an/an/an/anot administeredEURO*

4.22.0- 5.5 $1,359,0001,438,0008EMRO

3.42.0 - 7.0 $71,786,02860,445,64323AMRO

n/an/an/an/a0AFRO

AverageRange2009-20102008-2009

Costs/dose (USD)Doses purchased Number of

countries responded

Region


Procurement of Seasonal Influenza Vaccine

by region

1/14

17/24

2/9

8/14

1/16/9

3/24

4/24

1/14

4/14

1/9

0

10

20

30

40

50

60

70

80

90

100

AFRO* AMRO EMRO EURO* SEARO WPRO

Unicef Bulk purchase mechanismDirect purchase Direct purchase and donationsDonations Other

%

* Data not available


Distribution of

Seasonal Influenza Vaccine 2004-2009

by WHO Region (IFPMA)


Sector administering seasonal influenza vaccine

45 (90%)37 (74%)5 (29%)8 (16%)50Total

12 (71%)10 (59%)5 (29%)2 (12%)17WPRO

1 (100%)1 (100%)0 (0%)0 (0%)1SEARO

n/an/an/an/anot administeredEURO*

8 (100%)6 (75%)0 (0%)2 (25%)8EMRO

24 (100%)20 (83%)0 (0%)4 (17%)24AMRO

n/an/an/an/a0AFRO

Free of charge by public sector

Countries offered vaccine

through both public and

private sectors

Countries offered vaccine through

private sector

Countries offered vaccine through

public sector

Sector where vaccine is administered

No. countries responded

Region

Outlook: Update on

WHO's Seasonal Influenza Vaccines

Recommendations

Revisiting WHO's Position paper on seasonal influenza

vaccination*: SAGE WG

Revisiting WHO's Position paper on seasonal influenza

vaccination*: SAGE WG

Target populations:

children < 2 years,

elderly,

pregnant women,

high risk groups

health care workers

Key questions:

burden of disease

vaccine performance

cost effectiveness

operational issues affecting

vaccine delivery

Coverage targets

(*WER, 19/08/2005)

Acknowledgements:

Claudia Vivas Torrealba

Kanokporn Coninx

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