Update on vaccination status in the Americas

Dr. Lúcia Helena de OliveiraImmunization Unit/FGL

Población (2014):981.373.000

Media anual de nacimientos:

15.595.200

2014 Población (miles)

5.000 - 1000

1000.01 - 5000

5001.01 - 10000

10000.01 - 100000

100000.01 - 400000

La Región de las Américas

OPS

35 Estados Miembros

4 Miembros Asociados

(Puerto Rico, Aruba, Curazao, San

Martin)

3 Estados Participantes

12 Territorios (6 Reino Unido, 3 Francia, 3 Holanda)

2 Estados Observadores

(Portugal y España)

The Expanded Program on Immunization (EPI) of the Americas was created in 1977 as a Regional Immunization Program

The Revolving Fund for Vaccine Procurement was launched in 1979 as a procurement mechanism for essential vaccines, syringes and other related supplies without interruption

PAHO Directing Council Resolution CD25.R27, 1977

1979 Creation of the Revolving Fund

1980 Creation of international evaluation methodology for the EPI

1983 “Days of Tranquility”

1985 Creation of the EPI Technical Advisory Group

1985 Creation of the Interagency Cooperation Committee

1991 Last indigenous case of polio in Peru

1994 Declaration of the goal to eliminate measles

1994 1st Region certified free of polio

2003 1st Vaccination Week in the Americas

2006 Launch of the Pro-Vac initiative and new vaccines introduction

2010 Directing Council resolution on strengthening the EPI (RIVS)

2012 1st World Immunization Week

2013 Directing Council resolution on the principles of the Revolving Fund

2015 1st Region free of rubella

2015 Directing Council resolution on the Regional Immunization Action Plan

2016 OPV Switch

Milestones in the 39 years of the EPI in the Americas

1977 2016PAHO’s

Directing Council

establishes the EPI

2017

40 years of the EPI in the Americas

We are going for more…elimination of measles and perinatal hepatitis B

LIFE COURSE

15

Disease # Cases before the Vaccine # Cases after the Vaccine

Polio 2,989 (1980) 0 (2014)

Endemic rubella 125,056 (1997) 0 (2014)

Congenital Rubella Syndrome 80 (2000) 0 (2014)

Diphtheria 5,570 (1980) 9 (2014)

Neonatal tetanus 803 (1980) 10 (2014)

Measles 257,790 (1980) 1,996 (2014)

Impact of the Immunization Program in the AmericasMorbidity

Mortality

Disease # Deaths before the Vaccine # Deaths after the Vaccine

Polio 18 (1980) 0 (2014)

Measles 950 (1990) 0 (2014)

Neonatal tetanus 116 (1996) 3 (2014)

Rotavirus 15,000 (2004)* 7,238 (2013)*

* PAHO estimations 2013

Source: Country reports to the PAHO-WHO/UNICEF Joint Reporting Form (JRF)

Global Evolution of the EPI, 2016

Global and Regional DTP3 Coverage, 1980-2014

2023

25

38

45

5052

56

64

69

76

7270 70

73 73 72 72 72 72 73 73 7375

77 7880 80

8284 85 85 85 86 86

50

5457

60

65 64 65

6972 72

74

80 7981

8486 85 86

8991 92 91 92

94 94 94 94 93 93 94 9493 93

90 90

0

10

20

30

40

50

60

70

80

90

10019

80

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

% c

ove

rag

e

Global Africa Americas Eastern Mediterranean Europe Southeast Asia Western Pacific

Source: WHO/UNICEF coverage estimates 2014 revision. July 2015 Immunization Vaccines and Biologicals, (IVB), World Health Organization. 194 WHO Member States.

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

Haiti

Guatemala

Paraguay

Venezuela

Virgin Islands (UK)

Panama

Ecuador

Suriname

Honduras

Bolivia

Mexico

Peru

Colombia

Turks & Caicos

Dominican R.

Costa Rica

Trinidad & Tobago

Jamaica

USA

El Salvador

Brazil

Argentina

Uruguay

Sint Maarten

Chile

Belize

Canada

Bahamas, The

Grenada

Curaçao

St. Vincent

St. Kitts & Nevis

Guyana

Barbados

St. Lucia

Dominica

Bermuda

Nicaragua

Montserrat

Cuba

Cayman Islands

Antigua & Barbuda

Anguilla

21

31

DPT3 Coverage in the Countries of the Americas, 2014

Source: Country reports through the PAHO-WHO/UNICEF Joint Reporting Form (JRF), 2014.

WHO PAHO

Country 2010 2011 2012 2013 2014

Guatemala

94 85 96 85 73

Ecuador100 100 100 87 83

Honduras100 100 88 87 85

Panama94 87 85 80 80

Haiti69 85 81 85 60

Suriname96 86 84 87 85

Mexico 95 97 99 83 87

Virgin Islands (UK)87 92 98 85 80

Peru93 91 95 88 88

Variation of DPT3 Coverage in Selected Countries, 2010 to 2014

Source: Country reports through the PAHO-WHO/UNICEF Joint Reporting Form (JRF), 2014.

0

200 000

400 000

600 000

800 000

1 000 000

1 200 000

2010 2011 2012 2013 2014

GTM

ARG

HTI

BRA

COL

MEX

VEN

No.

Number of Unvaccinated Children (DPT3) by Year and by Country. Selected Countries in the Americas, 2010-

2014

Source: Country reports through the PAHO-WHO/UNICEF Joint Reporting Form (JRF), 2014.

Policy process for new vaccine introduction in Latin America and

the Caribbean

• 1985: in the context of regional efforts to eliminate poliovirus in the Americas, PAHO convenes a regional technical advisory group to formulate evidence-based recommendations specific to the Region

TAG

PAHO

• 1985: PAHO convenes a regional technical advisory group to formulate evidence-based recommendations specific to the Region

• 1999: WHO convenes a global-level committee to advise on immunization and vaccine related policy, which is the main input into the WHO vaccine position papers

TAG

PAHOSAGE

WHO

• 1985: PAHO convenes a regional technical advisory group to formulate evidence-based recommendations specific to the Region

• 1999: WHO convenes a global-level committee to advise on immunization and vaccine related policy, which is the main input into the WHO vaccine position papers

• 2000+: In recognition of the diverse set of national contexts that follow WHO/PAHO recommendations, global push to promote the establishment of national advisory bodies charged with providing independent, expert advise on vaccines and immunization at a country-level

TAG

PAHOSAGE

WHO

NITAG

EPI - MOH

http://www.paho.org/provac

Considerations for new vaccine policymaking

Source: Andrus, JK., Toscano, CM., Lewis, M., Oliveira, L. , et al. 2007, “A model for enhancing evidence-based capacity to make informed policy decisions on the introduction of new vaccines in the Americas: PAHO’s ProVacInitiative”, Public Health Reports, 122(6): 811-816.

Technical

SocialOperational &Programmatic

EVIDENCEPACKAGE

Disease burdenVaccine characteristics• Immunogenicity• Efficacy/effectiveness• Duration of protection• Type-specific protection• DosageSafety and adverse events (harms)Cost-effectiveness

Vaccine supplyLogistics & operational issuesFinancing strategiesPartnerships

AcceptabilityPerception of risk

Political willEquity

Total Cost of Vaccines to Protect a Child Against 13 Vaccine Preventable

Diseases

$14 $13

$13 $13

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2014 2015

Shar

e b

y V

acci

ne

Gro

up

/typ

e

BCG+Penta+IPV+OPV+MMR+Flu Rotavirus PCV

Total Cost

$73.8

Total Cost

$72.8

%60

19% BCG, Penta,

IPV, OPV, MMR, Flu

18% Rotavirus

Pneumococcal conjugate

Dynamics and challenges

New

vaccines

New

technologies

Misinformation

Information

Commercial

interests

Economic

environment

Health

Reform

Political

interests

REGIONAL IMMUNIZATION ACTION PLAN (RIAP)

POLIO ERADICATION & ENDGAME STRATEGIC PLAN 2013-2018

New

players

Organization and Content of RIAP, 2016-2020

Adapt the GVAP to the regional context

Cooperate with countries for the adoption of goals,

strategies and common activities

Facilitate dialogue, promote synergies with partners and

continue to strengthen the EPI in the Region

Vision of the RIAP “The population of the Region of the Americas is protected against vaccine-preventable diseases and the Member States promote universal and equitable access to immunization services, with safe and affordable vaccines throughout the life

cycle”

Equity

Shared responsibility

Solidarity Quality

Sustainability

Universality

1. Sustain the achievements

2. Complete the unfinished

agenda

3. Tackle new challenges

4. Strengthenhealth services

for effectivevaccine

administration

STRATEGIC AREAS OF THE

RIAP

Technical Cooperation to Member States, 2011-2015

Member States

FinancialSupport

TAG

Evaluations

Publications

Trainings/

Meetings

“Godmothers”/ Country

TechnicalTeleconferences

OutbreakInvestigations

Tools

Networks

Studies withCountries

StrategicPlanning

PAHO Representations/

Focal Points

•3 coverage surveys•28 NUVI cost-effectiveness analyses –ProVac•2 EPI costing studies -ProVac•9 Influenza effectiveness•4 OPV•2 environmental polio•1 flu impact•1 multiple injections

Regional Immunization Action Plan(RIAP)

• Syringe quality control (5)•Polio (11)• Measles (24)•Pneumo / meningo(11)•Rota (17)•Revelac-i (15)•ProVac Centers of Excellence (6)

•Surveillance systems:ISIS & Bridges (24)VINUVA Cases (22)•13 VSSM countries•3 cost-effectiveness models (VPH, RV, PCV, Nm)•2 costing models (IM Program and VPD treatment costs)•Toolkit for EPI Managers•Annual Plan of Action

•≈ 3-4 outbreaks per yr

•150 Articles in GIN•93 Articles in Indexed Journals•52 Bulletins per year on AFP/MR•4 IM Newsletters per year •3 Field Guides (IPV, MOV, Esavi, YF)•1 Plan of Action for Regional Measles Elimination) •1 basic indicators brochure per year•1 update on IE evalmethods•1 coffee table book

•12 Data Quality•7 Annual Gavi evals•4 Gavi graduation evaluations•6 International evals•3 EVM•1 PIE•1 Regional Gavi Graduation Analysis •1 VWA impact eval

≈ 36 meetings per year

• 5 regular meetings • 2 extraordinary meetings

•60 M support at the countries •mobilize & manage $74.2M in Gavigrants to countries

•cMYP•Annual Plan•Forecasting vaccines and syringes•28 Gavi policy consultations

Coordination with Partners

Thank you!