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Expanded Programme on Immunization

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Title: Expanded Programme on Immunization


1
Expanded Programme on Immunization
  • by Ginny Grenier-Minasian
  • Talene Balekian

2
Expanded Programme on Immunization
  • Expanded Programme on Immunization (EPI)
  • Created in 1974 after much success with the
    smallpox eradication program by the World Health
    Organization (WHO)
  • Considered expanded
  • it branched out to include polio and measles
  • before most programs included BCG, smallpox and
    DPT
  • EPI now recommends yellow fever, Hep B and MMR
    vaccines
  • included worldwide coverage
  • Selection of diseases to be eradicated based on
  • the high burden of the disease
  • the availability and affordability of the vaccines

www.who.int
3
EPI
  • Expanding Immunization (EPI) Mission
  • Development of policies and strategies for
    maximizing the use of vaccines of public health
    importance and their delivery.
  • Supporting regions and countries in acquiring the
    necessary skills, competence and infrastructure
    to implement these policies and strategies and
    achieve disease control/elimination and
    eradication objectives.
  • Main products/targets
  • International/interagency consensus on strategies
    for the use of vaccines and immunization-related
    tools.
  • Assisting countries to achieve and maintain a
    minimum standard in the delivery of national
    immunization services.
  • Assisting regions and countries in the selection
    and implementation of appropriate strategies and
    priority activities for vaccine-preventable
    disease control/elimination and eradication
    initiative.

www.who.int
4
Immunology, Vaccines and Diseases
5
Mechanism of the Bodys Defense Against Disease
  • The bodys defense against disease
  • General immunity
  • external defenses, complement system, and
    phagocytes that destroy foreign substances in the
    blood stream
  • Specific immunity
  • bodys recognition of a particular foreign
    substance by antibodies that destroy infections
    within cells
  • after an initial attack, the body remembers and
    stores antibodies for that disease and is able to
    illicit a quicker response to a second attack
  • more effective
  • basic concept of vaccines and immunization

dcc2.bumc.bu.edu/ih887
6
How Vaccines Work
  • Vaccine pathways
  • Disease resistant vaccines (measles, polio)
  • prevents infection in vaccinated individuals
  • Incomplete resistant vaccines (pertussis, BCG)
  • lessens the severity of the symptoms
  • Toxin protecting vaccines (tetanus, diphtheria)
  • destroys the bacterial waste (toxins)
  • does not protect against transmission of the
    organism

dcc2.bumc.bu.edu/ih887
7
How Vaccines Work
  • Types of Vaccines
  • Bacterial Vaccines
  • live attenuated (BCG)
  • killed (pertussis)
  • Viral Vaccines
  • live attenuated (measles, yellow fever, OPV)
  • Toxoids (tetanus, diphtheria)
  • Recombinant Vaccines (HB, acellular pertussis)
  • Polysaccharide Vaccines (Hib, meningoccal,
    pneumococcal)
  • Polysaccharide Conjugated Vaccines (Hib,
    pneumococcal)

www.who.int/gpv-dvacc/service/policy.htm
8
How Vaccines Work
  • Multiple Doses and Boosters
  • In some cases, antibody levels gradually diminish
    over time (HB, yellow fever)
  • Boosters are needed for some diseases to elevate
    antibody levels to effective immunity (DPT)
  • Multiple doses of vaccine are needed for some
    diseases to ensure the resulting antibody levels
    are sufficient and long-lasting ( DPT, HB, OPV)

dcc2.bumc.bu.edu/ih887
9
Definitions of EPI Six Target Diseases
  • Pertussis (whooping cough)
  • bacteria causing thick, sticky mucus in windpipe
  • can cause severe pneumonia and seizure
  • Diphtheria
  • toxin causing thick, gray coating at back of
    throat making it difficult to swallow/breathe
  • can invade heart, kidneys, and nerves
  • Tetanus
  • toxin causes severe and painful muscle spasms
  • can cause severe damage to the heart

Offit PA, Bell LM. What every parent should know
about vaccines. New York, 1998
10
Definitions of EPI Six Target Diseases
  • Poliomyelitis
  • virus causes sore throat, cough, fever, stomach
    pain, vomiting, or stiff neck and headache
  • 1 in 1000 infected with natural polio are
    paralyzed
  • Measles
  • virus first causes cough, runny nose, fever and
    pink eye
  • then a rash appears on face and spreads over body
  • Tuberculosis
  • can infect every organ of body, most prominently
    the lungs
  • bacteria causes persistent, unrelenting cough
  • can cause sweating at night, loss of weight,
    decrease in physical activity

Offit PA, Bell LM. What every parent should know
about vaccines. New York, 1998
11
Vaccines used in EPI
  • Target diseases and their vaccines
  • Tuberculosis - Bacille Calmette Guerin (BCG)
  • Diphtheria - Diphtheria Toxoid (formaldehyde-inact
    ivated preparation of diphtheria toxin, absorbed
    onto aluminum salts)
  • Tetanus - Tetanus Toxoid (TT)
  • Pertussis - Whole cell vaccines and acellular
    vaccines
  • Poliomyelitis - Oral (OPV) and injectable
    vaccines (IPV)
  • Measles - Live attenuated viral vaccine
  • Yellow Fever - Freeze-dried live attenuated 17D
    viral strain
  • Hepatitis B - Plasma-derived and recombinant
    HBsAg vaccines

www.who.int/gpv-dvacc/service/policy.htm
12
WHO/EPI immunization schedule for infants
in countries where yellow fever poses a risk
scheme A recommended in countries where perinatal
transmission of HBV is frequent
www.who.int/gpv-dvacc/service/immschedule.htm
13
Disease Eradication
  • Eradication of disease occurs when
  • sufficient uniform levels of immunization achieve
    herd immunity throughout the population
  • indirect action of vaccines producing resistance
  • as immunization rates increase then exposure to
    the disease decreases
  • non-vaccinated individuals dont get the disease
    because theyre simply not exposed
  • does not guarantee that there will not be an
    outbreak
  • there is universal commitment from all governments

dcc2.bumc.bu.edu/ih887
14
Disease Eradication
  • Eradication difficulties
  • different diseases have different levels of
    transmission and therefor require different rates
    of immunization to produce herd immunity
  • Easiest for diseases that need a lower level of
    immunization
  • More difficult for diseases that have non-human
    vectors or are difficult to diagnose

dcc2.bumc.bu.edu/ih887
15
Levels of Vaccine Coverage Needed to Block
Transmission
  • DISEASE NEEDED COVERAGE
  • Measles 92-95
  • Pertussis 92-95
  • Rubella 85-87
  • Diphtheria 80-85
  • Polio 80-85
  • Smallpox 50-75
  • Hepatitis B 80-100

dcc2.bumc.bu.edu/ih887
16
The Cold Chain
17
The Cold Chain
  • What is the cold chain?
  • A chain of storage, handling, transport, and
    distribution facilities and equipment at the
    central, regional, and local levels to maintain
    the necessary temperature to protect the
    vaccines antigenic strength (maintain useful
    antibody levels) from the moment it leaves the
    manufacturer to the moment it is given to the
    individual
  • The system has to be tailored to meet every
    system
  • intermittent or no electricity, transportation
    issues, government networks collapsed from war,
    etc

dcc2.bumc.bu.edu/ih887
18
Vaccine Stability
  • At storage temperature (0-8 degrees Celsius)
  • Tetanus/Diphtheria 3-7 years
  • Pertussis 18-24 months
  • Freeze-dried BCG 1 year
  • Freeze-dried Measles 2 years
  • OPV 6-12 months
  • IPV 1-4 years

dcc2.bumc.bu.edu/ih887
19
Vaccine Stability
  • At hot temperatures (gt37 degrees Celsius)
  • Tetanus/Diphtheria 2 weeks or less
  • Pertussis 10 loss potency/day
  • Freeze-dried BCG unstable up to 50 loss
  • Freeze-dried Measles 50 loss after 2-3 day
  • OPV very unstable 50 loss after 1 day

dcc2.bumc.bu.edu/ih887
20
Recommended Temperature ranges (degrees Celsius)
very sensitive to temperature changes and will
crystallize at -1.0 degrees Celsius
Who/VB/99.15
21
New Technology in the Cold Chain
  • Temperature monitors for vaccines and the cold
    chain
  • cold-chain monitor
  • monitors max. temp. during transport/storage
  • has labels for date of arrival/shipment
  • US 2.74 for min order 500
  • vaccine vial monitor
  • round disk of irreversible heat sensitive
    material placed on a vaccine vial to register
    cumulative heat exposure for that vial only

Who/VB/99.15
22
New Technology in the Cold Chain
  • Temperature monitors for vaccines and the cold
    chain (cont.)
  • Freeze watch
  • A vile with red liquid bursts and stains a white
    placard if exposed to temp below zero for gt 1
    hour
  • Packed with DTP, TT, DT (freezing pt -6.5 C) and
    HB (freezing pt -0.5C)
  • US 2.81 min order 400
  • Stop!Watch
  • Monitors refrigerator temp. over time
  • US 5.72 min order 400

Who/VB/99.15
23
New Technology in the Cold Chain
  • Temperature monitors for vaccines and the cold
    chain (cont.)
  • DT and TT shipping indicator
  • DT and TT are very heat resistant and are shipped
    without insulation from manufacturers, are
    damaged at temp above 48C, and device is used
    to monitor temp during shipping
  • One indicator/3000 doses of DT and TT
  • US 0.60 min order 600

Who/VB/99.15
24
Current Issues in Immunization Poliomyelitis,
Measles and Hepatitis B
25
Poliomyelitis
  • Word origin is Greek
  • Polio Gray
  • Myelin Marrow, indicating the spinal cord
  • What is it ?
  • A Virus that effects the Spinal Cord often
    resulting in paralysis.
  • Polio was first described by a British Physician
    Michael Underwood in 1789. However, prior
    evidence of crippling diseases are found in
    ancient documents.
  • The first reported outbreaks occurred in the
    Western and Northern Hemispheres in the 19th
    Century.

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January,
1999.
26
Poliomyelitis-Pathogenesis
  • Pathogen by mouth
  • Replicated
  • Pharynx, G.I Tract, and Local Lymphatics
  • Spread in the blood stream to Lymphatic and
    Central Nervous System
  • Virus spreads along the nerve fibers
  • Destroys motor neurons
  • Results in Paralysis

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January,
1999.
27
Poliomyelitis-Outcomes
  • The four clinical presentations of polio
  • Paralytic 1
  • Non-paralytic aseptic meningitis 1-2
  • stiff neck and limbs, minor illness (flu like)
  • complete recovery
  • Minor Non-CNS illness 4-8
  • URI, GI Disturbance, Influenza like
  • complete recovery
  • Asymptomatic 95
  • may transmit to others via oral-fecal root (virus
    shed in stool)

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January,
1999.
28
Poliomyelitis-Epidemiology
  • Reservoir
  • Human
  • Transmission
  • Oral-fecal
  • Communicability
  • 7-10 days prior to onset
  • Virus remains present in stool 3-6 weeks
  • Vaccinations
  • IPV (1955) Inactivated Polio virus ( usually
    given to adults)
  • OPV (1961) Oral Polio virus
  • Adverse Reactions
  • IPV - local reaction is uncommon, allergic
    reaction may vary
  • OPV - Paralytic Poliomyelitis

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January,
1999.
29
Poliomyelitis-Eradication
  • 1985 - Pan American Health Organization set a
    goal to eliminate polio from the Western
    Hemisphere by 1990
  • 1991 - One case of Paralytic Poliomyelitis
    reported in Peru
  • 1994 - Western Hemisphere certified Polio free
  • 1998 - World Health Assembly (WHO) set a goal for
    global eradication of Polio by 2000

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January,
1999.
30
Poliomyelitis-Current Situation
  • 1997 - over 50 of all reported Polio cases were
    from the Indian subcontinent
  • Substantial progress in many WHO regions being
    reported
  • East Asia, Middle East, Southern Eastern Africa
    and Europe
  • Polio remains endemic in part of the Eastern
    Mediterranean and Africa

Http//www.who.int/programmes/gpv/gpv_home.htm
31
Poliomyelitis-Current Situation
www.cdc.gov/nip/publications/manual/poliome.htm
32
(No Transcript)
33
Poliomyelitis-Strategies and Interventions
  • Increasing immunization coverage
  • Enhancing surveillance for suspected cases
  • Supplemental immunization strategies
  • NID (National Immunization Days)
  • House to house vaccination
  • Containment activities

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January,
1999.
34
Poliomyelitis-Eradication Initiative
  • A Coalition of International Organizations help
    to support this initiative, including WHO,
    UNICEF, Rotary International and other bilateral
    and multilateral organizations. Recently the
    Rotary International contributed more than 240
    million to support the eradication initiative.
    www.cdc.gov/nip/publications/manual/poliome.htm

35
Poliomyelitis-Recent Initiatives
  • Nepal
  • 100-250 children per year are disabled due to
    polio
  • 1996 NID initiative, since that time 3.3million
    children under 5 years old have been immunized
    each year
  • Democratic Republic of Congo
  • reported to have one of the highest polio
    transmission rates in the world
  • On August 13-15, 1999
  • a cease fire was declared in this war torn
    country in order to hold a NID, organized by
    UNICEF
  • 8.2 million of the countrys 10 million children
    received Polio Vaccination despite outbreaks of
    fighting

WHO/Organisation Mondiale de la Sante,
1999 WHO/43 Press Release, 20 August 1999
36
Poliomyelitis-Final Assessment
  • According to WHO Annual Report, 1998
  • the number of reported polio cases has fallen by
    over 90 world wide
  • the polio virus has been eliminated on three
    continents
  • only 50 countries continue to report cases of
    polio, primarily in Sub-Saharan Africa and the
    Indian Continent

37
Poliomyelitis-Final Assessment
  • Civil unrest and war remain the major impediments
    to eradication in these areas
  • The recent success of UNICEF and the DRC to
    declare cease fire days in order to hold NIDs
    will help to make WHOs goal for eradication by
    2000 a real possibility
  • if not by 2000, it will be in the very near future

38
Measles
  • An acute highly contagious viral disease
  • First described in the 7th Century
  • Near universal childhood infection
    (pre-immunization era)
  • Often fatal in developing countries
  • Measles is responsible for more than 1 million
    deaths world wide each year
  • 50 of the deaths occur in Sub-Saharan Africa
  • Measles accounts for 10 of all deaths in
    children under 5 years of age

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January,
1999 Hinman A. Eradication of vaccine-preventable
diseases. Annu. Rev. Public Health. 1999.
20211-29
39
Measles-Pathogenesis
  • Respiratory transmission
  • Replicated in nasopharynx and regional lymph
    nodes
  • Primary viremia 2-3 day after exposure
  • Secondary viremia 5-7 days after exposure with
    spread to the tissues

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January,
1999.
40
Measles-Clinical Outcome
  • Self immunizing
  • Severe complications/consequences
  • pneumonia is the primary cause of death
  • encephalitis, deafness, blindness
  • subacute sclerosing panencephaphalitis
  • rare, manifests approximately 7 years post virus

Offit PA, Bell LM. What every parent should know
about vaccines. McMillian, Inc. New York, 1998.
41
Measles-Epidemiology
  • Reservoir
  • Human
  • Transmission
  • Respiratory, person to person
  • airborne droplet
  • Communicability
  • 10-12 days from exposure
  • live virus has been documented in closed areas up
    to 2 hours after being occupied by an infected
    person

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January,
1999.
42
Measles-Eradication
  • Eradication goals
  • The Americas by the year 2000
  • Europe by the year 2007
  • Eastern Mediterranean by the year 2010
  • Globally, measles is most likely the target
    disease for eradication, after polio

wonder.cdc.gov/wonder/prevguide/m0047959/entire.ht
m
43
Measles-Current Status
  • 1990 - 80 global immunization coverage under EPI
  • 1994 - WHO reported gt 1 million children died
    from measles
  • 1995 - Less than 1/3 of all countries (EPI)
    reached 90 reduction in number of cases
  • ½ of countries (EPI) reduced of deaths by 95
  • 1998 - Less than 1000 cases reported in U.S.
  • most cases related to importation

www.cdc.gov.epo/mmwr/preview/mmwr.html
44
(No Transcript)
45
Measles-Global Statistics
  • 1980 1995
  • 100 million cases 44 million cases
  • 5.8 million deaths 1.1 million deaths
  • 5 of children vaccinated 42 of children
    vaccinated
  • (lt2 years old) (lt2 years old)
  • In 1995
  • morbidity decreased 78
  • mortality decreased 88
  • In 1996
  • annual cases decreased by 90 in WHO regions of
    S.E. Asia (2 countries) and Africa (5 countries)
  • There is a wide disparity in developing areas
    between individual regions and countries

wonder.cdc.gov/wonder/prevguide/m0047959/entire.ht
m
46
Measles-Global Statistics
www.who.int/gpv-surv/graphs.htm
47
Measles-Current Status
  • On going outbreaks remain problematic in
    developing countries
  • low vaccination coverage
  • children vaccinated lt 1 year of age
  • vaccine is less effective, increasing
    susceptibility in preschool and school age
    children despite vaccination

www.cdc.gov/epo/mmwr/preview/mmwr.html/00051700.ht
m
48
Measles-Strategies and Interventions
  • PAHO (Pan American Health Organization) 3 step
    vaccination campaign in the Americas (excluding
    the U.S.)
  • Catch-up
  • targets all children 9 mo.-14 yrs. (despite
    previous history of immunization or disease)
  • Keep-up
  • increase initial vaccination coverage from 9 mo.
    to 12 mo. (provides better immunity and helps to
    decrease of preschool children who remain
    susceptible to disease)
  • Follow-up
  • targets all children 1 - 4 yrs. (despite previous
    history of immunization or disease)
  • To be carried out every 3 - 5 years

wonder.cdc.gov/wonder/prevguide/
49
Measles-Strategies and Interventions
  • 1997 Joint effort WHO/UNICEF (dependent on the
    capability of the country to properly implement
    the interventions)
  • improved routine immunizations
  • increase surveillance
  • target supplementary immunization

wonder.cdc.gov/wonder/prevguide/m0047959/entire.ht
m
50
Measles-Strategies and Interventions
  • WHO Recommendation
  • Vaccination campaign include two dose
    immunization schedule
  • Immunization of all children ages 9 mo.- 5 yrs.
    despite previous immunization status
  • Re-immunization of all children lt 16 years
    despite previous immunization status (in high
    risk populations)

wonder.cdc.gov/wonder/prevguide/m0047959/entire.ht
m
51
Measles-Obstacles to Eradication
  • Vaccine efficacy
  • 10 of vaccinated population remain unprotected
  • Vaccine is extremely sensitive to temperature
    changes which can jeopardize potency
  • Perceptual
  • Acknowledge that measles is a serious threat and
    major cause of illness, disability and death in
    children
  • Political
  • Support is necessary to carry out successful
    global eradication efforts
  • Financial
  • Initial vaccination cost verses cost of
    hospitalization, disability and preventable deaths

www.medscape.com/govmt/cdc/mmwr
52
Measles-Final Assessment
  • WHO has established global measles eradication
    goals for the next decade, however eradication of
    measles appears to be difficult
  • control over eradication is more probable
  • high communicability
  • difficulty in establishing effective surveillance
    and reporting
  • low levels of vaccination in some areas
  • recommended changes in immunization schedule
  • re-immunization efforts of those who may no
    longer be protected

53
Hepatitis B
  • Hepatitis B Virus (HBV) (serum hepatitis)
  • Viral infection involving inflammation of the
    liver, resulting in jaundice
  • Epidemic jaundice described by Hippocrates in the
    5th century B.C.
  • First reported cases believed to be associated
    with Small Pox vaccination in 1883

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January
1999
54
HBV
  • 1943 - Recipients of blood transfusions
    identified with HBV
  • 1965 - Hepatitis B Surface Antigen(HBsAg)
    identified
  • 1970 - Serologic markers for HBV infection were
    identified and now used in vaccines for the
    prevention of HBV infection

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January
1999
55
HBV-Clinical Outcomes
  • Fulminant Hepatitis occurs in 1-2 of HBV
    carriers
  • mortality rate of 63-93
  • Hospitalization R/T Chronic Illness
  • 25 of carriers
  • Cirrhosis (liver damage)
  • Hepatocellular Carcinoma
  • Death

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January
1999
56
HBV-Epidemiology
  • Reservoir
  • Human, Endemic
  • Transmission
  • Blood bourne
  • Sub-clinical cases transmission
  • Sexual Contact
  • Direct percutaneous inoculation
  • Contamination of mucosal surfaces

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January
1999
57
HBV-Epidemiology
  • Transmission (cont..)
  • sub-clinical transmission
  • Perinatal transmission HBsAg positive
  • 20 transmission of which 90 will be carriers
    and 25 will eventually die from related
    complications
  • Communicability
  • 1-2 months before and after onset of symptoms
  • Chronic carriers

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January
1999
58
HBV-High Risk Populations
  • clients in institutions for developmentally
    disabled
  • patients of hemodialysis units
  • intravenous drug users
  • homosexual males
  • household contact of HBV carriers
  • recipients of certain blood products
  • Alaskan Natives, Pacific Islanders and
    immigrants/refugees from areas of high HBV
    endemicity

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January
1999
59
HBV-Intermediate Risk Populations
  • male prisoner
  • health care workers with frequent blood contact
  • staff of institutions for developmentally
    disabled

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January
1999
60
HBV-Prevention Strategies
  • 1981 - immunization of high risk groups only
  • 1991 - prenatal testing of pregnant women
  • identification of newborns at risk for HBsAg
  • identification of household members who should be
    vaccinated
  • routine immunization of infants
  • immunization of adults at high risk for infection

Epidemiology and Prevention of Vaccine-Preventable
Diseases, Center for Disease Control, January
1999
61
HBV-Obstacles to Targeting High Risk Groups
  • No known risk factors in 25-35 of adults with
    acute HBV
  • limited access to person in high risk groups,
    because difficult to identify them as being in a
    high risk group
  • less likely to receive preventative care
  • limited success in providing vaccines to persons
    in some high risk groups
  • rapidly infected after initiation of high risk
    behaviors
  • low initial vaccine acceptance
  • low completion rates (3 doses)

State of the worlds vaccines and immunization,
WHO and UNICEF, 1996
62
HBV-Facts
  • More than 2 billion people alive today have been
    infected with HBV
  • 350 million remain chronically infected carriers
  • Every year 4 million acute clinical cases are
    diagnosed
  • One million deaths occur annually
  • Child-child, mother-child transmission accounts
    for the majority of infections and carriers
  • Large number of infections occur during
    adolescence and adulthood when acute clinical
    disease is more likely

State of the worlds vaccines and immunization,
WHO and UNICEF, 1996
63
HBV-Global Initiative
  • 1991 - EPI recommended HB vaccine be included in
    national immunization programs in countries with
    HBV carrier rates of 8 or higher by 1995, and in
    every country by 1997
  • 1994 - WHO disease reduction target at 80
    reduction in number of new incidences of HBV
    carriers in children by 2001
  • Expecting to reduce the number of HBV carriers
    annually to less than 1

State of the worlds vaccines and immunization,
WHO and UNICEF, 1996
64
HBV-Current Status
  • In 1998, 75 countries had introduced HB vaccine
    into their national immunization programs
  • WHO Western Pacific Region
  • one of the worst affected areas
  • EPI has helped to secure donor support for the
    purchase of HB vaccine
  • HB vaccine has now been included in all national
    immunization programs within this region
  • WHO region of China
  • has the worlds largest number of HBV carriers,
    and is currently trying to incorporate HB vaccine
    into their EPI Program to improve coverage and
    alleviate the cost to private citizens

State of the worlds vaccines and immunization,
WHO and UNICEF, 1996
65
HBV-Global Immunization
www.who.int/gpv-surv/graphics
66
Vaccine Prices and Global Immunization
67
Vaccine Prices
  • Vaccine prices are tiered with prices tailored
    to different markets which allows WHO to procure
    vaccine at a low price for use in poorest
    developing countries.
  • Costs less than US 1.00 altogether for EPI
    vaccines
  • Additional US14.00 for other costs (transport,
    cold chain, laboratories, personnel, research,
    etc)

State of the worlds vaccines and immunization,
WHO and UNICEF, 1996
68
Vaccine Prices (prices/dose in US)
www.who.int/gpv-supqual/images/pahoprice.htm
69
Global Immunization and the Introduction of New
Vaccines
  • Immunization is the most cost-effective health
    intervention
  • Historical vaccines (main EPI vaccines) are
    produced in a wide range of laboratories and meet
    EPI vaccine standards
  • However, new vaccines and their technology pose a
    new challenge due to cost
  • HB vaccines is a relatively high cost new vaccine
    and only 45 of countries have adopted it into
    their immunization programs

www.who.int/gpv-supqual/
70
National Issues Relating to Vaccine Financing
  • competing priorities
  • decentralization
  • current financing and priority of immunization
  • perceived value of immunization
  • current structure for long-term planning
    (dependency on donors, budgets)
  • capacity to determine national priorities using
    data such as cost-effectiveness
  • immunization programme efficiency and rational
    use of vaccines

www.who.int/gpv-supqual/
71
WHOs role in FacilitatingGlobal Immunization of
New Vaccines
  • WHOs main role
  • information collector and disseminator
  • develop practical documents on potential options,
    strategies, and recommendations for
    implementation of new vaccines
  • strategies on financing and resource allocation
    options tailored to specific countries
  • assist countries through
  • review of current finances and estimate for
    introduction of new vaccine
  • review method of moving from donor financing to
    local financing
  • Loans for new vaccines
  • monies to help develop infrastructure building
    for the introduction of new vaccines

www.who.int/gpv-supqual/financing
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