Midterm Review of the WHOAFRO EPI Strategic Plan, 20012005

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Mid-term Review of the WHO/AFRO EPI Strategic
Plan, 2001-2005

• 11th Task Force on Immunization
• Luanda, Angola.
• 2-5 December 2003

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Background

• Immunization coverage increased steadily during
  late the 1980s and early 1990s but began to
  decline in the mid-1990s
• To address the situation AFRO developed the first
  Regional EPI Strategic Plan. 1996-2000 to address
  the problem
• The 2001-2005 Regional Strategic Plan followed
  the first plan and was adopted by the TFI in
  2000.
• During its annual meeting in 2002, the TFI
  recommended that a mid-term review of
  implementation of the plan be conducted.

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Objective of the Review

• To assess the status of implementation of
  various components of the 2001-2005 regional
  plan
• To evaluate AFRO technical support to countries
• To determine the level of collaboration between
  AFRO and its partners
• To propose milestones for the period 2003-2005

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Review Team composition

• Multi-displinary team of experts with extensive
  experience in EPI
• Prof P.Ndumbe, Dean Faculty of Medicine,
  University of Cameroon
• Prof S. Foster, Emory University
• Dr. S. Hadler, CDC/Atlanta
• Mr. G. Sales, Consultant (formerly SCF/UK, DFID)
• Mr. K. Jobe, Consultant (former EPI Manager, The
  Gambia)
• Dr. L. Arevishatian, Consultant (Former RA/VPD,
  AFRO, former WR)

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Methodology

• Interviews with key informants at Regional ,
  Inter-country and country office levels
• Review of key programme documentation
• Country field visits to 4 countries
• Chad, Mali, Ghana, Ethiopia

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Key findings (strengths)

• 70 of countries have reported increase in DTP3
  coverage with 17 countries achieving gt80
• Training is being provided in a wide range of
  program areas e.g. MLM
• ICCs are active and have began to handle all
  aspects of EPI in most countries
• With support from GAVI, 18 (50) and 8 (22) of
  eligible countries have introduced Hep B and Hib
  vaccines respectively.
• Introduction of new vaccines has been shown to
  stimulate improvement of routine programs

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Progress with new/underused vaccines
introduction 2000 vs. 2003
2000
2003
HepB, Hib
HepB Hib
Before GAVI era
Yellow Fever
YF
HepB, Hib YF
HepB,
Non-AFRO
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Key findings (strengths)

• AFROs technical support to countries from
  Regional Office and ICPs assessed to be adequate.
• Very good collaboration between AFRO and partners
  in the execution of the 2001- 2005 Regional EPI
  Strategic Plan.

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Key findings (strengths)

• Endemic (indigenous) wild poliovirus now limited
  to 2 countries
• AFP surveillance system is being used to detect
  NT and yellow fever cases.
• 81 of countries have achieved certification
  standard AFP surveillance quality
• Significant progress has been made towards the
  goal of 50 reduction in measles mortality by
  2005
• Large proportion of children are been reached
  with measles vaccine through the SIAs
• 52 of high risk countries for yellow fever (YF)
  have incorporated YF vaccine in their routine
  program

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Interrupting WPV transmission
2000
2003
36 countries have been Polio-free for gt 2 yrs
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Measles Control Activities
Follow up 2003
Special circumstances
After 2003
Priority for 2003
Earlier completed
None AFRO countries
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Trend and Estimated Impact of Accelerated Measles
Control in the African Region (1990 - 2003)
Estimated 20 decline in measles deaths
Global target 50 reduction (to 223,000)
measles deaths by 2005
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Key findings (weaknesses/threats)

• Vaccine wastage rates still unacceptably high in
  most countries
• Many countries have yet to achieve DTP3 coverage
  of 50 or better to receive GAVI support for
  vaccine
• Hib vaccine introduction is slow due to
  unavailability of disease burden data at country
  level, high vaccine cost and concerns about
  financial sustainability

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Key findings (weaknesses/threats)

• 95 of wild polio cases in 2003 occurred in
  Nigeria
• The continuing transmission in Nigeria and Niger
  threatens the achievement of polio eradication
• The funding for polio eradication in Africa has
  decreased over the last years
• Routine measles immunization coverage is low in
  many countries which threatens control efforts
• Progress toward MNT elimination goal is slow with
  only 28 (13/46) having achieved elimination
  levels.

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Key recommendations

• Routine Immunization
• All stakeholders and partners should sustain
  political commitment for the execution of the
  plan
• WHO, both HQ and AFRO should allocate sufficient
  funds from regular budget to support routine
  immunization
• Development partners should increase their
  support to national routine immunization systems

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Key recommendations

• Routine Immunization (2)
• Both positive and negative lessons learned in new
  vaccine introduction should be documented and
  disseminated widely
• Milestones for vaccination coverage for 2005
  should be modified to be consistent with UNGASS
  GAVI) milestones
• 80 of countries in the region to have reached
  80 DPT3 nation-wide
• At least 50 of districts in the region should
  reach 80 DPT3 coverage

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Key recommendations

• Polio Eradication
• A polio summit should be held in Nigeria with
  presidents of Nigeria, Niger and the highest
  offices of the UN and AU participating
• Funding must be secured for synchronized NIDs in
  high risk countries
• Successes gained in polio eradication must be
  maintained.

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Key recommendations

• Accelerated Disease Control
• Countries, WHO/AFRO, UNICEF other partners need
  to ensure that human resources for polio, measles
  and strengthening routine immunization work
  synergistically and are maintained.
• Goals and milestones for measles mortality
  reduction should be adjusted to be consistent
  with the joint WHO-UNICEF plan.
• AFRO and TFI should work with UNICEF and other
  partners to secure funding for MNT elimination

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Key recommendations

• Accelerated Disease Control (2)
• WHO should encourage and support the remaining
  countries at risk of yellow fever to integrate
  the vaccine into the routine EPI
• AFRO should support countries to obtain local
  data on Hib burden