Dr. Mohamed El Bakry Chairman of the Pediatrics Department Banha University

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Dr. Mohamed El BakryChairman of the Pediatrics
DepartmentBanha University

• Intercontinental City Stars
• May 19th, 2011

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VaccinationsWhere we R??Where 2 go??
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Vaccination Schedule
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Licensed vaccines in routine use in the USA, 1980
and 2008
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Vaccination Schedule
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Vaccination Schedule
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Vaccination Schedule
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Vaccination Schedule
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Vaccination Schedule
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Vaccination Coverage 2009
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Vaccination Schedule
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Vaccination Schedule
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Vaccination Schedule
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Vaccination Schedule
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Egypt Vaccine Market
optional
obligatory
Hib
BCG
Rotavirus
OPV
Varicella
HBV
Influenza
MMR
PCV
DTP
HAV
Mening
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Vaccination Coverage 2009
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Where do we want to go??
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lobal lliance foraccines mmunization
GA V I
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GAVI

• Is a global alliance between PRIVATE and PUBLIC
  sectors committed to saving CHILDRENS lives
  protecting peoples health by increasing access to
  immunization in peer countries.

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GAVI

• Supporting childrens immunization is
  undoubtedly the best investment weve ever made
  Bill Gates, Co-Chair Bill Melinda Gates
  Foundation

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Alliance board 2008
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GAVIs Goal!

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FACTS

• 9 million children die before their 5th birthday
  every year
• 2.4 million children die from diseases that are
  vaccine preventable (That is one child every 20
  seconds!)
• 24 million children in the world remain
  unvaccinated!!

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Causes of under five child deaths in low income
countries
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GAVI supports 72 countries

• Afghanistan Angola Armenia Azerbaijan
• Bangladesh Benin Bhutan Bolivia
• Burkina Faso Burundi Cambodia Cameroon
• Central African Republic Chad Comoros
• Congo Dem Republic of Côte d'Ivoire Cuba
• Djibouti Eritrea Ethiopia Gambia
• Georgia Ghana Guinea Guinea Bissau
• Guyana Haiti Honduras India
• Indonesia Kenya Kiribati Korea DPR
• Kyrgyz Republic Lao PDR Lesotho Liberia
• Madagascar Malawi Mali Mauritania
• Moldova Mongolia Mozambique Myanmar
• Nepal Nicaragua Niger Nigeria
• Pakistan Papua New Guinea Rwanda São
  Tomé
• Senegal Sierra Leone Solomon Islands Somalia
• Sri Lanka Sudan Tajikistan Tanzania
• Timor Leste Togo Uganda Ukraine
• Uzbekistan Viet Nam Yemen Zambia
• Zimbabwe

½ the worlds population
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GAVI

• Averted 5 million deaths 2000-2010
• Committed 4 billion US for 75 countries between
  2000-2015
• Start up grant US 750 million in 1999 by Bill
  Melinda Gates Foundation
• Additional Hepatitis B vaccination 3 doses for
  267 million children

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GAVI supporting newvaccines
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Vaccine preventable deaths and the global
immunization vision and strategy, 2006 - 2015
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Immunization coverage with DTP3, Hepatitis and
Hib vaccines in GAVI supported countries
2000-2011
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Vaccination and decline of Hib disease in Finland
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GAVIs Strategy
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The GAVI alliance strategy 2011-2015
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• HSS Health System Strengtheningsix key
  components

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• Health service delivery a network of health
  facilities to provide access to primary
  secondary care.

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• Health workers in the right place at the right
  time with training, experience incentives

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• Health information systems to generate quality
  data and to measure what is being done achieved

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• Logistics supply systems so that drugs,
  equipment and fuel are available

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• Health financing to raise sufficient funds for
  health improve financial risk protection

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• Leadership governance to ensure that strategic
  policy frameworks exist and there is proper
  accountability and oversight

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• Egypt is strong in this area because of good
  infrastructure of existing high vaccination
  coverage

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Vaccine Research the future
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Vaccines by Period of Development
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Introduction of first generation of vaccines used
on humans
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Vaccines used by the expanded Programme on
Immunization (EPI)
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Stages of vaccine development

• Vaccine development proceeds through discovery
  process engineering toxicology and animal studies
  to human phase I, II and III trials. The process
  can take more than 10 years, depending on the
  disease

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An ideal Vaccine should be

• Good immune response
• Both cell mediated immunity and antibody
  responses
• Immunity is long lived
• Single dose
• Safety
• Danger of reversion to virulence, or severe
  disease in immunocomprised
• Stability
• Organisms in the vaccine must remain viable in
  order to infect and replicate in the host
• Vaccine preparations are therefore very sensitive
  to adverse storage conditions
• Maintenance of the cold chain is very important
• Expense
• Cheap to prepare

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Calculated Cost effectiveness for any Vaccine

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No of doses of vaccine given
Cost of Vaccination

(doses admin.) No of Episodes of
disease prevented e.g
Otitis Media
-Saving Pneumonia
-Saving
Invasive Diseases
-Saving No life Years Saved
Net Cost of Vaccine
Program Net Cost of Vaccine Program
Cost per Life Year Saved No
life Years Saved
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Pneumococcal Vaccine (1000 children)
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Pneumococcal Vaccine (1000 children)
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Conclusions
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Possible candidates

• Varicella
• Hepatitis A
• Rota
• Pneumococcal

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Funding

• Approach MoH for co-ordination of plans
• Approach GAVI to renew status of Egypt
• Negotiate prices of vaccines with producers
• Approach civil society associations for funding
  start ups and maintenance
• Cost sharing with the public

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• Thank You

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Timeline of vaccines (20th century)
1932
1945
1952
1954
1957
1962
1964
1962
Adenovirus 4 7
measles
Yellow fever
polio
Mumps
Oral polio vaccine
Influenza
Japanese encephalitis
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Timeline of vaccines
1970
1974
1977
1978
1981
1992
1998
Hepatitis B
rotavirus
rubella
pneumonia
Hepatitis A
Chicken pox
meningitis
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New vaccines and combinations

• Hepatitis B (and A) catch up
• Haemophilus influenza b (Hib)- universal
• MMR, Measles, mumps, rubella x 2 universal
• DPT x 4 update policies, catch up, also for
  elderly (H zoster)
• Influenza all ages
• Pneumococcal pneumonia all ages
• Rotavirus
• Human papilloma virus (HPV) and cancer cervix
• Future vaccines streptococcus, cytomegalovirus
  (CMV), helicobacter, HIV, malaria, avian flu
• Cocktails- maximum combination of routine
  vaccines
• New methods of production of vaccines

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WHO/UNICEFs current vaccines
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• Cold chain monitor card upon arrival to a health
  clinic, vaccines are stored in refrigerators and
  temperatures recorded on a chart. The
  temperatures are monitored and recorded twice a
  day to ensure that a safe temperature is
  maintained
• Vaccine vial monitor (VVM) the vaccine vial
  monitor consists of a temperature sensitive label
  placed on each vial that registers cumulative
  heat exposure for that vial. GAVI resolved that
  all vaccines be purchased by the Vaccine Fund
  after 2003 will include VVM (immunization focus,
  July 2003, GAVI newsletter)
• Freeze watch in the freeze watch, a vial with a
  red liquid that bursts and stains a white placard
  if exposed to temp. below zero for gt 1 hour is
  packed with DTP, TT (freezing pt. -6.5 C) (WHO,
  vaccines-cold chain, 2005)

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GIVS Global Immunization vision and strategy
2006-2015
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• Canadian Institutes of Health Research CIHR in
  the 1st 10 years of 21st century research in
  development of new vaccines has accelerated to
  meet antibiotic resistance infections as well as
  combat cancers and diseases that were once
  thought invincible.

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Canadian successes in vaccines research include

• an acellular pertussis vaccine
• a candidate vaccine for Severe Acute Respiratory
  Syndrome (SARS)
• a cattle vaccine against E. coli 0157H7the
  development of vaccine technology to prevent
  meningitis
• candidate vaccines against hemorrhagic fevers
• the preparation for and assessment of the impact
  of human papilloma virus (HPV) immunization in
  Canada
• the development of therapeutic cancer vaccines
• the safe administration of vaccines produced in
  eggs to egg-allergic individuals
• the evaluation of influenza vaccination
  strategies and transmission dynamics within a
  community and,
• the development of new vaccination strategies for
  Human Immunodeficiency Virus (HIV-1)

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• WHO state of the art of new vaccines
• Research and development 2006

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Sexually transmitted diseases

• Chlamydia trachomatis
• Gonorrhea
• Herpes simplex type 2
• HIV/AIDS

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Vector borne viral infant

• Dengue fever
• Japanese encephalitis
• Tick-borne encephalitis
• West Nile virus

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Zoonotic infections

• Anthrax
• Hepatitis E
• Leptospirosis
• Plague
• Rabies

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Viral cancer

• Epstein-Barr virus
• Hepatitis C
• Human papillomavirus

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Diarrhea disease

• Caliciviruses
• Campylobacter
• Cholera
• Enterotoxigenic Escheria coli (ECTC)
• Rotavirus
• Shigellosis
• Typhoid fever

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Respiratory infections

• Influenza
• Parainfluenza viruses
• Respiratory syncytial virus (RSV)
• Severe acute respiratory syndrome (SARS)
• Streptococcus pneumoniae
• tuberculosis

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Bacterial infections

• Helicobacter pylori
• Neisseria meningitidis
• Mycobacterium ulcerans (Buruli ulcer)
• Staphylococcus aueus
• Group A Streptococcus
• Group B Streptococcus

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Parasitic diseases

• Amoebiasis
• Hookworm disease
• Leishmaniasis
• Malaria
• schistosomiasis

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