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
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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)
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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