The importance of childhood immunization and their role in

reaching the Millennium Development Goals

National workshop on immunization and influenza Belgrade, Serbia

22 December 2011

Dr Nedret EmirogluExecutive Manager

Division of Communicable Diseases, Health Security and EnvironmentWHO European Regional Office

WHO European Region 53 Member States (~890 million)

Goal 4: Reduce child mortality

Target 4A:

Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

• Under-five mortality rate

• Infant mortality rate• Proportion of 1 year-old children

immunised against measles

Millennium Development Goals

Good progress in achieving MDG 4 in the WHO European Region

In 2009 11 countries achieved MDG 4 target

Source: WHO European Region estimates; WHO, 2011

Probability of dying before the age of 5 per 1 000 live births

0

10

20

30

40

50

60

70

1980 1990 2000 2010

European RegionEuropean Union

Commonwealth of Independent States

Central Asian Republics

Source: WHO/Europe Health for all Database

Large discrepancies between countries

A big challenge …

Globally every year…

7,6 million children die before their 5th birthday– 3,2 million newborn babies in the first month of life– 2,4 million infants between 1 – 12 months

Silent tragedies that have to be prevented!

pneumococcus (30%)

measles (16%)

rotavirus (21%)

Hib (15%)pertussis (10%)tetanus (6%)

76% 24%

Meningococcus A (< 1%) other (<1%)

About a quarter of under-5 deaths globally are vaccine preventable*

10.4 million deaths under 5 years of age2.45 million or 24% deaths under 5 from vaccine preventable diseases• 1.16 million deaths under 5 years of age from diseases targeted by conventional EPI

vaccines• 1.29 million form diseases where licensed vaccine is available

*(Estimated annual childhood deaths, 2004)

The way forward…

By 2015:

Saving 16 million lives of women and children

Preventing 33 million unwanted pregnancies

Protecting 88 million children from stunting

Protecting 120 million children from pneumonia

1st time in documented history no. of children dying every year has fallen below ten million

Result of improved access to immunization, integrated delivery of essential health interventions, as well as clean water and sanitation.

Vaccine development is surging.

• Over 80 new products are in late stage clinical testing• Over 30 target diseases for which there is no vaccine currently. • Since 2000, the global vaccine market has tripled

A Global Outlook

Developing countries vaccine manufacturers playing a large role: now meet 86% of the global demand for traditional vaccines More than ever before, stringent measures are taken to ensure all people of the world have access to vaccines and immunization equipment that are safe, effective and of good quality.

There are significant direct savings associated with vaccination against major vaccine-preventable diseases.

A Global Outlook (cont.)

Immunization is more than just about preventing death

The most cost-effective intervention in public health

Keeping people healthy has benefits beyond the immediate health benefits and contributes to economic growth

I would be hard-hearted enough to let the sick die if you could tell me how to prevent others from falling sick- Mohandas Gandhi

WHO European Region: Immunization programmatic goals

Immunization Systems

Strengthening

• Stewardship/ sustainable financing

• Quality-assured vaccines, supply and safety

• Access to and utilization of immunization services

• Use of new and under-utilized vaccines

• Communication & Advocacy

Enhanced Surveillance &

Monitoring

• Surveillance for disease control and prevention

• Strengthening laboratory networks

• Communication & Advocacy

Accelerated Disease Control

• Diseases with eradication & elimination goals

• Priority bacterial and viral diseases

• Communication & Advocacy

Health 2020

Immunization Programme priorities WHO European Region

Measles and rubella elimination by 2015 Sustaining polio-free status Ensuring equity to safe, affordable vaccines Strengthening national immunisation programmes in the

context of overall health systems development Support for introduction of new and under-utilized

vaccines using safe injection practices Strengthening national VPD surveillance systems,

including laboratory networks

Regional immunization coverage estimates 1990-2010, WHO European Region

Source: WHO/UNICEF Coverage Estimates.

The challenge

Approximately 700,000 million children born each year in the European Region are not fully immunized, and

Since the year 2000, some countries with traditionally high vaccination coverage have reported decreased coverage rates, below the 95% threshold recommended by WHO.

Regional Measles and Rubella Elimination Goals

Resolution EUR/RC55/R7• Original target: 2010

Resolution EUR/RC60/R12

European Region Strategic Plan– New target: 2015

Renewed commitment to MR elimination by 2015 and sustained support for polio-free status

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Member States:

Commit and give goals high priority

Ensure required resources Strengthen routine immunization

– Focus on pockets with low coverage and mobilize

– European Immunization Week Strengthen health system

components Strengthen surveillance systems in

line with IHR– polio, measles and rubella

Renewed commitment to MR elimination by 2015 and sustained support for polio-free status

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WHO European Regional Office:

Provide leadership and strategic direction-Strategic Plan 2011-2015

Provide technical guidance to Member States

Work with Member States on addressing :

—vulnerable groups—increasing demand for

immunization

Progress in implementing Strategic Plan to eliminate measles and rubella in the

WHO European Region, 1990-2011

Data as of 1st Dec 2011; Source: monthly measles and rubella reporting to WHO EURO

Catch-up SIAs

Reported measles casesWHO European Region, 2004-2010

Continual transmission in western part of the Region

2004 2005 2006 2007 2008 2009 2010` 2011Data Source: Monthly Measles Rubella Surveillance data, CDS/WHO/EURO

Data as of 1 Dec 2011Month and year

Me

asl

es

case

s

France

Ukraine

Romania

Bulgaria

Major challenges to achieving measles and rubella elimination in the European Region

• Continued political commitment and transparency by governments

Required human and financial resources in face of competing public health priorities and economic situation

Increasing momentum of vaccine refusals– General complacency in absence of disease (low risk perception)– Variable public trust in vaccines– Multiple reasons but results are the same -> declining coverage

Marginalized and vulnerable groups require tailored approaches to increase uptake of vaccine

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European Immunization Week23-30 April 2011

52 participating Member States

Activities included multi-media information campaigns (in 30+ countries), competitions, outreach, launch events, congresses and seminars, and a host of other initiatives

550+ media “hits” across the European Region and globally(CNN and Al Jazeera)

2200+ views/listens/downloads of EIW multimedia materials

145+ members contributed blogs, comments & pictures to EIW campaign site

More than 10 million children were vaccinated in April

Statements of support from HRH Princess Mathilde of Belgium, HRH Crown Princess Mary of Denmark, Bill Gates, GAVI Alliance and many more……

eiw.euro.who.int EIW2012: 21-27 April

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0

10

20

30

40

50

60

2005 2007 2008 2009 2010 2011

Participating Member States

Confirmed wild poliovirus cases,WHO European Region*, 2010

Wild poliovirus type 1 Tajikistan: 458 cases Turkmenistan: 3 cases Russian 14 cases Federation Kazakhstan: 1 case

AFP cases Uzbekistan: 147 cases

Data as of 31 August 2010

Source: Weekly AFP reporting to WHO European Region* AFP cases in Uzbekistan

More than 55 million doses of mOPV1 and tOPV (in 5 Member States)

More then 9 millions of US $

25th Regional Certification Commission (RCC) conclusions 2011

The RCC commended countries’ actions, including the allocation of large amounts of staff and money to stop further poliovirus transmission.

There is no evidence of continued wild poliovirus transmission, there is no need to repeat the process of certifying polio eradication in the Region.

However, we must remain vigilant and acknowledge that some countries remain at risk due to sub-optimal coverage or a decline in quality of AFP surveillance

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Risk of transmission following importation of wild poliovirus: WHO European Region, 2010-2011

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Malta

1

2

3

4

56

7

8

1-Bosnia & Herzegovina2-Georgia3-Montenegro 4-Malta5-Turkey (Eastern) 6-Tajikistan 7-Ukraine 8-Uzbekistan

High riskIntermediate riskLow risk

Several new vaccines fighting serious diseases such as pneumonia, meningitis and some causes of childhood diarrhoea are currently being introduced in the European Region and are already showing their effect in reducing childhood mortality and morbidity.

As many as 50 countries in this Region have already introduced the vaccine against Haemophilus influenza type B that causes severe cases of meningitis in children under five.

In addition, 12 countries provide routine immunization against invasive pneumococcal diseases

Five countries have introduced rotavirus vaccines into their immunization programs.

New and under-utilized Vaccines (NUVI) in the European Region

Introduction of new and underutilised vaccines in WHO European Region

IntorducedPlan introductionNot introduced

Source: WHO/UNICEF JRF

Hib Vaccine implementation, WHO European Region, November 2011

Introduced

Plan introduction

Not introduced

Pneumococcal vaccine implementation, WHO European Region, 2011

Source WHO/UNICEF JRF

Introduced (20)Not intorduced

16-18 November 2010PMM, Istanbul, Turkey 29

Meningococcal C conjugate vaccine implementation, WHO European Region, 2010

Introduced (15)Not introduced

Source: WHO/UNICEF JRF

The boundaries and name shown and the designation used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimination of its frontiers of boundaries.

Cancer is responsible for 1 out of 8 deaths worldwide - more than AIDS, tuberculosis and malaria combined.

40% of the 12 million people diagnosed with cancer worldwide each year could avert the killer disease by protecting themselves against infections and changing lifestyles.

Vaccines can play a key role: about 21 percent of all cancers are due to infections like the human papillomavirus, or HPV (cervical cancer), and hepatitis infections (stomach and liver cancer).

Nearly 80 % of the world's cervical cancer deaths are in poor countries.

Introduction of HPV vaccine in WHO European Region

HPVIntroduced (20)Not introduced

Sources: JRF, WHO survey, EUVAC.NET

Cervical cancer screening programmes

Large differences in the region– From very effective organized public screening

programmes with high coverage (Finland, Iceland, Netherlands, Slovenia...)

– To opportunistic screening only in private clinics (e.g. Georgia)

Influenza vaccines

Influenza vaccines introduced 1940s Vaccination is primary means of preventing

influenza today Excellent safety record High efficacy:70-90% in healthy adults

…but lower in the elderly...- 60% in persons >60 years- 30-40% in persons >85 years

- More on this in Dr Dina Pfeifer’s presentation later…….

New vaccines introduction- WHO’s role

Support for establishing and reinforcing national immunization technical advisory groups (NITAGs)

Regional guidelines on new vaccines introduction

Capacity building of National Immunization Programme Managers

Support Member States to reinforce surveillance for diseases targeted by new vaccines

Build up laboratory networks for rotavirus and invasive bacterial diseases (Belarus and Russian Federation)

Summary

Strong regional immunization programmes overall due to efforts by Member States and partnerships

Increasing momentum of vaccine refusals Marginalized and vulnerable groups require attention, general

complacency in absence of disease (low risk perception), variable public trust.

Need to reframe activities within the adopted resolution to optimize coverage, meet elimination and eradication goals, effectively introduce new vaccines, and respond to outbreaks

Cannot afford to jeopardize progress made towards goals

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Thank you