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Vaccin grippal: mondialisation des enjeux de Sant Publique

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... (H1N1) 2009. Pandemic influenza vaccine and WHO Global Action Plan (GAP) Production and availability of pandemic (H1N1) 2009 vaccine ... 265 deaths: CFR of 60 ... – PowerPoint PPT presentation

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Title: Vaccin grippal: mondialisation des enjeux de Sant Publique


1
Vaccin grippal mondialisation des enjeux de
Santé Publique
17 Septembre 2009 XVe Actualités du Pharo,
Marseille
  • Nicolas Collin
  • Global Influenza Program, WHO

2
Outline
  • Overview on the pandemic (H1N1) 2009
  • Pandemic influenza vaccine and WHO Global Action
    Plan (GAP)
  • Production and availability of pandemic (H1N1)
    2009 vaccine
  • Future challenges of influenza vaccines

3
  • Overview on the pandemic (H1N1) 2009
  • Pandemic influenza vaccine and WHO Global Action
    Plan (GAP)
  • Production and availability of pandemic (H1N1)
    2009 vaccine
  • Future challenges of influenza vaccines

4
(No Transcript)
5
Pandemic (H1N1) 2009 - epidemiology
  • Efficient, rapid person-person transmission
  • Current situation in Northern hemisphere
  • Continued circulation outside of usual influenza
    season
  • Preparation for second wave of pandemic and
    seasonal epidemic
  • Current situation in Southern hemisphere
  • Co-circulation of pandemic and seasonal influenza
    strains
  • Tropical vs. temperate countries

6
Pandemic (H1N1) 2009 clinical features
  • Most cases in children and young adults 5-45 yrs
    of age
  • Spectrum of disease range from non-febrile, mild
    upper respiratory tract illness to severe or
    fatal pneumonia
  • Hospitalization and case/fatality in young adults
    higher than seasonal influenza
  • At risk groups Pregnant women, people with
    underlying health conditions, young children,
    people with immunosuppression
  • WER, 24 JULY 2009, No. 30, 2009, 84, 301308,
    http//www.who.int/wer

7
  • Overview on the pandemic (H1N1) 2009
  • Pandemic influenza vaccine and Global Action Plan
    (GAP)
  • Production and availability of pandemic (H1N1)
    2009 vaccine
  • Future challenges of influenza vaccines

8
The pandemic influenza vaccine challenge
  • Lag time between declaration of the pandemic and
    availability of vaccines (5-6 months)
  • Regional disparity between vaccine production
    regions and the global need for vaccines
  • Gap between vaccine potential demand and
    anticipated supply

9
The Global Action Plan (GAP) to increase supply
of pandemic vaccines
  • 2005 World Health Assembly (WHA) resolution 58.5
    requested WHO to seek solutions to address the
    global shortage of influenza vaccines
  • May 2006 WHO formulated the Global Action Plan
    to increase supply of influenza vaccines through
    3 approaches
  • 1. Increase in seasonal vaccine use
  • 2. Increase in production capacity
  • 3. Research and development to produce more
    immunogenic vaccines

10
  • Overview on the pandemic (H1N1) 2009
  • Pandemic influenza vaccine challenge and Global
    Action Plan (GAP)
  • Production and availability of pandemic (H1N1)
    2009 vaccine
  • Future challenges of seasonal, zoonotic and
    pandemic influenza vaccines

11
Global seasonal trivalent vaccine production
capacity 0.9 B doses / year
WHO survey (Collin N. et al, Vaccine 2009.
27(38)5184-6 )
12
Global pandemic (H1N1) 2009 vaccine production
capacity 4.9 B doses / year
Estimated H1N1 Vaccine Capacity At 11 yields,
most dose-sparing formulation, full capacity
Assumptions / Methodology
  • Survey sent to 36 potential influenza vaccine
    manufacturers
  • 100 response rate
  • All 21 current influenza vaccine producers
    responded
  • 26 manufacturers that intend to produce pandemic
    vaccines
  • Includes LAIV and one recombinant vaccine
    capacity
  • Survey assumes
  • 11 H1N1 to seasonal yields
  • Most dose sparing formulation for each
    manufacturer
  • Use of full production capacity

H1N1 doses
Timeframe
WHO survey (Collin N. et al, Vaccine 2009.
27(38)5184-6 )
13
Countries are drawing against this capacity in
different ways
of H1N1 Capacity
Segments
Access Strategy
Population
High- income (e.g., U.S., Canada, Europe, Japan,
Australia)
  • Mostly open system Countries negotiate contracts
    for vaccine with major, industrialized country
    manufacturers
  • Facilities serve home countries and export to
    other markets

893 M
90
  • Mostly closed system Will procure vaccine mainly
    from within country
  • Limited or no plans by manufacturers to export

3,114 M
10
Low / Middle Income with local supply (e.g.,
China, Russia)
Low / Middle Income without local supply
  • No current access to H1N1 vaccine

2,662 M
N/A
WHO survey (Collin N. et al, Vaccine 2009.
27(38)5184-6 ) and UNPD population dataset
14
Pandemic (H1N1) 2009 vaccine ongoing WHO
activities
  • Global coordination of pandemic influenza vaccine
    development
  • Negotiations with vaccine manufacturers for
    access of vaccine to low and middle income
    countries (preferential price or donation)
  • Deployment guidelines
  • Forecasting tool and user guide developed to
    assist programme managers
  • Workshops of deployment/logistics in countries
  • Assessment of AD syringe and safety box supplies
    for delivery of vaccine

15
SAGE recommendation for the use of pandemic
(H1N1) 2009 vaccine
  • Protection of the health-care system
  • Health professionals (1-2 of population)
  • Reduction of morbidity and mortality
  • Pregnant women
  • Individuals aged of gt6 months with one of several
    chronic medical conditions
  • Healthy young adults (aged gt15 years and lt49
    years)
  • Healthy children
  • Healthy adults aged gt49 years and lt65 years
  • Healthy adults aged gt65 years
  • WER, 24 JULY 2009, No. 30, 2009, 84, 301308,
    http//www.who.int/wer

16
Results of the GAP - September 09
  • Encouraging results in terms of investment of
    companies (large / established and smaller / new)
    in influenza vaccine production
  • Several companies willing to provide access to
    low and middle income countries
  • Promising dose-sparing potential of oil-in-water
    adjuvants
  • Technology transfer on going for broader access
    of live-attenuated influenza vaccine (LAIV)
    technology, scale-up of existing plants,
    generation of new plants in developing countries…

17
  • Overview on the pandemic (H1N1) 2009
  • Pandemic influenza vaccine and Global Action Plan
    (GAP)
  • Production and availability of pandemic (H1N1)
    2009 vaccine
  • Future challenges for influenza vaccines

18
Challenges for pandemic and seasonal influenza
vaccines
  • Regulatory and licensing hurdles for pandemic
    vaccine
  • Gaps in countries pandemic preparedness plans
  • Underestimation of seasonal influenza burden of
    disease in several countries
  • Competing Public Health priorities
  • Financial resources limited
  • Challenge of an universal seasonal vaccine

19
Don't forget H5N1!
and the other zoonotic strains…
  • Since November 2003, 438 human cases have been
    officially reported to WHO currently pandemic
    phase III
  • 265 deaths CFR of 60
  • Egypt, Indonesia, Mongolia are currently
    reporting circulation of the virus in poultry
  • Concerns of reassortment of H5N1 with current
    pandemic strain
  • WHO recommendations on the use of H5N1 vaccine in
    interpandemic period
  • WER, 24 JULY 2009, No. 30, 2009, 84, 301308,
    http//www.who.int/wer

20
Acknowledgments
Sylvie Briand and the Global Influenza Program
Marie-Paule Kieny and the Initiative for Vaccine
Research
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