Reaching the unreached: new challenges and promising ... WFPHA.pdf · "Reaching the unreached: new...
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"Reaching the unreached: new challenges and promising approaches in equitably immunizing the world's children”
Transcript of Reaching the unreached: new challenges and promising ... WFPHA.pdf · "Reaching the unreached: new...
"Reaching the unreached: new challenges and promising approaches in equitably
immunizing the world's children”
Overview: Routine immunization
strengthening & new vaccines-- links with global pneumonia
& diarrheal disease prevention and the MDGs
Lora Shimp Senior Technical
Officer, JSI
WFPHA Conference 26 April 2012 Addis Ababa, Ethiopia
Source: WHO/UNICEF coverage estimates 1980-2010
Global immunization DPT3 coverage, 1980-2010
Africa SE Asia
Presenter
Presentation Notes
1980s - massive effort to introduce new vaccines: Universal child immunization 1990: We didn’t learn how to report success and continue to defend the need for continued funding to sustain those successes.
Full immunization rates by socio-economic status
0
10
20
30
40
50
60
70
80
Sub-Saharan
Africa
South Asia MiddleEast and
NorthAfrica
East Asiaand
Pacific
Europeand
CentralAsia
LatinAmerica
andCaribbean
AllCountries
(44countries)
Richest Quintile Poorest Quintile
Source: Gwatkin, Rutstein, Johnson, Pande and Wagstaff (2000) Socio-economic Differences in Health, Nutrition, and Population. World Bank.
Presenter
Presentation Notes
The groups with highest SES are better vaccinated than the lowest SES group in each region.
New Decade of Vaccines global initiative and GAVI Alliance partnership
Decade of Vaccines Collaboration will: Support countries for increasing immunization coverage
and worldwide introduction of new vaccines Support new and under-utilized vaccine
introductions/expansions (including pneumococcal and rotavirus vaccines); strategies to achieve high immunization coverage; integration with other prevention, protection and control efforts for vaccine-preventable diseases
Partners involved: Partners globally: GAVI Alliance, WHO, UNICEF, Bill &
Melinda Gates Foundations, USAID, JSI, PATH, & others
Global Child Mortality: Role of Vaccine Preventable Diseases (2008 data)
8.8 million deaths in children < 5 years 17% (1.5 million) from vaccine preventable diseases
Source: Black RE at all, Global, regional, and national causes of child mortality in 2008: a systematic analysis, Lancet. 2010 Jun 5;375(9730):1969-87. Epub 2010 May 11. * WHO/IVB estimates
Presenter
Presentation Notes
17% of existing under-5 mortality can be prevented by vax. And our past successes in reducing mortality (those past successes aren’t shown on this type of graph which shows only the current causes) can’t be taken for granted. For example, one million newborns died of tetanus 30 years ago; compared to about 130,000 last year – an 87% reduction. And measles used to kill about 4 million annually, now down to less than 200,000. Those successes also must be maintained. We need to be able to report success and continue to defend the need for more resources to sustain those successes; constant attention, maintenance and repair are needed for sustained, effective and efficient performance. Past high accomplishment does not guarantee success in the future. As long as kids are born, they need to be vaccinated; so the job’s never finished. So we must develop sustainable services.
1.5 million deaths among children from vaccine preventable disease by WHO regions, 2008
Source: Black RE at all, Global, regional, and national causes of child mortality in 2008: a systematic analysis, Lancet. 2010 Jun 5;375(9730):1969-87. Epub 2010 May 11. * WHO/IVB estimates
Framework: Protection, prevention and treatment strategies for pneumonia &
diarrhoea
Reduce pneumonia and
diarrhoea morbidity and
mortality
Children becoming ill from pneumonia or diarrhoea
Vaccines: pertussis, measles, Hib, PCV and rotavirus
Cotrimoxazole prophylaxis for HIV-infected and exposed
children
Zinc & Vitamin A supplementation
PREVENT
Children by Providing Healthy Environment
Exclusive breastfeeding for 6 months
Adequate and complete nutrition
Hand washing with soap
Safe water and sanitation
Reduce indoor air pollution
Prevent low birth weight
PROTECT
Children who are ill with pneumonia and diarrhoea
Improved care seeking and referral
Case management at the health facility and community level
Supplies: Low osmolarity ORS, Zinc, antibiotics & oxygen
Continued feeding (including breastfeeding)
TREAT
Planning and management of resources
Reaching the target
populations
Linking services with communities
Supportive supervision
Monitoring for action
• Flexible approach • Countries/districts to
tailor it to fit their situation
• Use of data, human and financial resources, capacity building, improved access & use of services
• Intensity of implementing each component varies from country to country
...the five components are not mutually exclusive
“Reaching Every District” (RED) - five operational components
Presenter
Presentation Notes
See “Implementing the Reaching Every District Approach” guide at http://www.who.int/immunization_delivery/systems_policy/AFRO-RED-guide_2008.pdf
What works? Some examples: 1) Drivers for strengthening routine
immunization in Africa 2) Experience in improving immunization
coverage through RED and Pneumococcal vaccine introduction in Kenya
3) Addressing equity and reaching the underserved and unreached with immunization services in India
