The Challenge of Getting Vaccines Delivered and Used

Robert Steinglass

Technical DirectorIMMUNIZATIONbasics

JSI Research & Training Institute

Discovery, Development and Delivery: The Promise and Challenge of Vaccine Innovations

Global Health Council 33rd Annual Conference 2 June 2006

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Should I re-inventShould I re-invent the wheel?the wheel?

Estimated Deaths: Ebola Virus in Democratic Republic of Congo, 1995

= 350 People

Estimated Deaths: Ebola Virus vs. Measles in D.R. Congo, 1995

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= 350 People

The “Twin Engines”

The Twin Engines

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Sustainable Immunization Systems

Communications

Management

Supplies& Logistics

PoliciesPractices

Financing

Training

Monitoring

& Surveillance

Global Immunization 1980-2004, DTP3 coverageglobal coverage at 78% in 2004

2023

26

3844

4952

5663

6875

71 70 7073 74 73 73 72 71

75 76 76 77 78

0

10

20

30

40

50

60

70

80

90

100

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

% c

ove

rag

e

Global African American

Eastern Mediterranean European South East Asian

Western Pacific

Source: WHO/UNICEF estimates, 2005

192 WHO Member States. Data as of September 2005

Date of slide: 12 September 2005

Countries with national DTP3 coverage in infants ³ 80% for each of last three years (2000-2002)

Source: WHO & UNICEF estimates of National Immunization coverage

DTP380%

DTP3<80%

Not WHO member

DPT3 coverage, under 1, by State 2005, Nigeria

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0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Pla

teau

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wa

Ben

ue

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ara

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er

FC

T, A

bu

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i

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rno

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be

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am

aw

a

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ba

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mb

e

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aw

a

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fara

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ko

to

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o

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bi

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ina

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un

a

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ug

u

Ab

ia

Imo

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on

yi

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am

bra

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a

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a Ib

om

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ss R

iver

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ers

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i

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os

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do

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n

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un

% D

PT

3 C

ov

era

ge

2006 target

National Average: 37.5%

NC NE NW SE SS SW

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Gap in actual coverage

113

33

63

94

93

94

101

60.6

21.7

61

80

38.3

90.1

23

Andhra Pr

Bihar

Delhi

Kerala

Madhya Pr

Tamil Nadu

Uttar Pradesh

0 20 40 60 80 100 120 140Reported Evaluated

Prices of Newer Vaccines Increase Vaccine Costs Exponentially for Under-ones

02468

1012

Routine Basic Routine Basic +HepB

Routine Basic +DTP-HepB

Routine Basic +DTP-HepB+Hib

$

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Immunization in Urban Areas

Lesson Learned:

Improving health services in high-risk, urban areas requires strategies that address epidemiologic, institutional, and political concerns.

Immunization coverage is not enough !

Was potent vaccine administered safely and efficiently in a timely manner before exposure to disease?

Hop on board! There is always room for one more.

Gas powered and gas dependent

WHO

An Arab Proverb

“Don’t count your children until they have had measles”

Slowly he would cruise Slowly he would cruise the neighborhood, the neighborhood, waiting for that waiting for that occasional careless occasional careless child who confused child who confused him with another him with another vendor.vendor.

Quality of Immunization Services

Improving Injection Safety:

•12 billion injections 12 billion injections annually in developing annually in developing countriescountries

•Over 50% unsafe Over 50% unsafe HIV, Hepatitis B, HIV, Hepatitis B, Hepatitis CHepatitis C

•Immunization Immunization injections: 10% of total injections: 10% of total but EPI leading push but EPI leading push for safe injectionfor safe injection

Source:WHOSource:WHO

Examples of Auto-Disable Syringes

Technologies for Sharps Waste Management are Needed

Injection Safety

Lesson Learned:

Concerted advocacy is needed to raise awareness and promote ownership and action for an unpopular problem.

“We know in our hearts that we are in the world for keeps, yet we are still tackling 20-year problems with 5-year plans staffed by 2-year personnel working with 1-year appropriations. It’s simply not good enough.”

“We know in our hearts that we are in the world for keeps, yet we are still tackling 20-year problems with 5-year plans staffed by 2-year personnel working with 1-year appropriations. It’s simply not good enough.”

- Harlan Cleveland (President, World Academy of Art and Science)

EVERY CHILD SHOULD BE A VIP: Vaccinated, Immunized and Protected

THANK YOUTHANK YOU