Presentation - European Vaccine Action Plan 2015–2020: opportunities and threats, and potential for joint action in south-eastern Europe
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Presentation by Dr Zsuzsanna Jakab, WHO Regional Director for Europe at the South-eastern Europe Health Ministerial Meeting on Immunization in Podgorica, Montenegro, 20 February 2018
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Presentation - European Vaccine Action Plan 2015–2020: opportunities and threats, and potential for joint action in south-eastern Europe
- 1. European Vaccine Action Plan 2015–2020: opportunities and threats, and potential for joint action in south-eastern Europe South-eastern Europe Health Ministerial Meeting on Immunization Podgorica, Montenegro, 20 February 2018 Dr Zsuzsanna Jakab WHO Regional Director for Europe
- 2. Outline of presentation • How far we have come • Unfinished business • Future prospects and opportunities 2
- 3. Progress towards European Vaccine Action Plan (EVAP) goals
- 4. 4 Sustain poliomyelitis-free status Eliminate measles and rubella Control hepatitis B Disease-specific goals On track Off track On track By the end of 2016
- 5. Steady progress towards measles and rubella elimination goal 0 10 20 30 40 50 2013 2014 2015 2016 0 10 20 30 40 50 2013 2014 2015 2016 #ofMemberStates #ofMemberStates Member States that interrupted endemic measles transmission ≥12 months Member States that interrupted endemic rubella transmission ≥12 months Data source: 2017 meeting report of the European Regional Verification Commission for Measles and Rubella Elimination Note: Verification process not initiated in 2 Member states 79% of Member States achieved interruption 70% of Member States achieved interruption Additional member states verified to have interrupted measles transmission for the year Additional member states verified to have interrupted rubella transmission for the year
- 6. 6 Meet vaccination coverage targets Make evidence-based decisions to introduce new vaccines Achieve financial sustainability Immunization systems-related goals Stalled On track On track By the end of 2016
- 7. Regional coverage with diphtheria, tetanus and pertussis (DTP3) vaccine has decreased by 4% from 2013 7 96 95 94 95 96 96 93 93 92 70 75 80 85 90 95 100 2008 2009 2010 2011 2012 2013 2014 2015 2016 DTP3 coverage, WHO European Region, 2008–2016 EUR DTP3 coverage EVAP envisions that >90% of the districts in the Region should attain DTP3 coverage of ≥95%. In 2016, of all the districts: • only 85% had ≥95% coverage; • 7% had <80% coverage. Subnational coverage inequities exist in the WHO European Region
- 8. Infants and children were still missing primary vaccination in 2016 8 Infants missing any DTP vaccination in the Region, 2016 Ukraine included Ukraine excluded 1 in 21 infants 1 in 45 infants Children missing first dose of measles-containing vaccine (MCV1) in the Region, 2016 Ukraine included Ukraine excluded 1 in 15 infants 1 in 22 infants Data source: WHO/UNICEF JRF 2016 data
- 9. 9 Meet vaccination coverage targets Make evidence-based decisions to introduce new vaccines Achieve financial sustainability Immunization systems-related goals Stalled On track On track By the end of 2016
- 10. Countries taking advantage of health gains offered by new and underutilized vaccines • Countries are introducing new vaccines based on NITAG recommendations. • By the end of 2016: – 40 Member States had introduced pneumococcal conjugate vaccine (PCV) – 32 Member States had introduced human papillomavirus (HPV) vaccine – 18 Member States had initiated universal immunization with rotavirus vaccine • Three middle-income countries are set to introduce the HPV vaccine with Gavi support in 2017. 10 MIC=middle-income countries MS = Member States 30 35 40 45 50 2014 2015 2016 2017 Figure: Member States with established national immunization technical advisory group (NITAG) #ofMemberStates
- 12. 0 5,000 10,000 15,000 20,000 25,000 30,000 35,000 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Number of measles cases in the Region, 2007–2017* Data source: WHO/Europe centralized information system for infectious diseases, extracted 2 February 2018 12 France 19 997 Ukraine 14 079 Kyrgyzstan 18 097Georgia 11 060 2016: 5273 cases in 34 countries Bulgaria 24 410 * Data for 2017 is preliminary 2017: 21 315 cases in 42 countries Romania 5562 Italy 5006 Ukraine 4767 Measles deaths: 35 (2017*), 13 (2016)
- 13. a According to 2015 gross national income (World Bank) b MCV1 = first dose of measles-containing vaccine Middle-income countries without Gavi support have highest number of unvaccinated children in the Region Income level categorya Average no. of antigens accommodated /country Average no. of new vaccines introduced/ country DTP3 coverage (population- weighted average) Unvaccinated infants (DTP3) MCV1b coverage (population- weighted average) % of Region # of infants High-income countries (n=33) 12.5 2.0 96.5% 24.7% 182 250 94.2% Middle-income countries (no Gavi support) (n=13) 10.4 0.5 88.7% 70.2% 518,850 91.8% Middle-income countries (Gavi support) (n=7) 13.0 2.6 97.3% 5.1% 37 270 97.9% Regional average or total # 11.9 1.6 93.4% 738 370 93.6% 13 Data source: WHO/UNICEF Joint Reporting Form, 2015
- 14. Challenges faced by middle-income countries • Lack of adequate financial commitment to immunization due to competing priorities – This is exacerbated by noneligibility for external funding (for example, from the Gavi Alliance). • Difficulty in accessing vaccines at affordable and optimum prices, including due to global supply shortages – This also includes delays in procurement, which relies on domestic financial resources. • Difficulty making evidence-informed decisions, introducing new vaccines and sustaining the performance of current programmes • Anti-vaccine sentiment and vaccine hesitancy affecting uptake 14
- 15. Securing access to affordable vaccine supply in countries of south- eastern Europe (SEE) for measles-mumps-rubella (MMR), first dose 15 $0.00 $2.00 $4.00 $6.00 $8.00 2013 2014 2015 2016 UMIC40 HIC77 LMIC187 UMIC245 UMIC190 $12.63 $7.20 $7.17 $4.16 $3.97 $2.81 $1.80 $1.32 $0.69 $0.23 -$0.80 -$7.91 -$10.00 -$5.00 $0.00 $5.00 $10.00 $15.00 PCV 1-dose DTaP-Hib-IPV Rabies 1-dose HepB (ped) 1-dose HepB )adult) 1-dose IPV 1-dose Influenza (adult) 1-dose bOPV1.3 20-dose MMR 1-dose BCG 10-dose DTaP-IPV 1-dose DTaP-HepB-Hib-IPV Extra price paid by SEE country group MMR price paid by individual countries
- 16. Future prospects and opportunities 16
- 17. Collaborative areas • Pricing divergence, joint/pooled procurement • Vaccine demand and acceptance • Sustained financing and resource mobilization • Evidence-based decision-making • Equitable extension of immunization 17
- 18. The way forward – proposed action • Voice commitment and set an ambitious agenda • Collectively safeguard the health gains made • Engage in roadmap development and goal-setting • Lead – as ministries – in assuring these goals are met 18
- 19. For further information: euvaccine@who.int Twitter: @WHO_Europe_VPI Facebook: https://www.facebook.com/WHOEurope 19 Vaccination – we must not take the benefits for granted Joint statement by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, and Dr Vytenis Andriukaitis, Commissioner for Health and Food Safety, European Commission Thank you
Notas del editor
- I will be considering the progress of the region against the goals and objectives of the European Vaccine Action Plan. Reflecting on the challenges we are yet to overcome and prompting us to think about the future opportunities and the potential for collaboration. I would like to encourage us to think how we can fully realize the full potential of the European Vaccine Action Plan and go a step further in setting an ambitious course to get your countries across the line. SLIDE CHANGE
- After a rigorous round of consultations with regional stakeholders, the European Vaccine Action Plan was endorsed at the Regional Committee in September 2014. The Plan represents a regional adaptation of the Global Vaccine Action Plan, harmonized with Health 2020, and tuned to the European Regional context, along with a detailed monitoring and evaluation plan. That framework enables us to take stock of progress in the Region at the mid-point in 2018. At the Regional Committee in Rome in September this year, the mid-term evaluation will be presented and thereafter disseminated. The following slides depict the progress made and the particular challenges that affect your countries. SLIDE CHANGE
- Let us first look at the 3 disease-specific goals of the European Vaccine Action Plan. We have enjoyed a regional polio-free status since 2002. The region has seen this status threatened with circulation detected in Tajikistan, Israel and Ukraine over the past decade, but thanks to a concerted effort and the wealth of work and investment towards strengthening our preparedness and improving the sensitivity of surveillance these threats were contained. Such investment and political commitment will be crucial as we keep on track to contain all polioviruses in secure facilities at a critical moment in the global eradication of this dreaded disease. In 2015 the Regional Committee endorsed a viral hepatitis action plan for the Region. Hepatitis b vaccination goals and incidence goals were included and in 2016 a hepatitis b verification committee was established to measure our progress against this goal. In this sense, we are on track. However, we in the Region missed the 2015 measles and rubella elimination goal despite tremendous progress that has been made by our Member States over recent years. SLIDE CHANGE
- The number of countries that have interrupted measles since 2013 has doubled and progress against rubella elimination is also very promising. But we need to keep this momentum up and as many of the countries with us today are aware, measles outbreaks are ongoing in some your countries, indicating immunization programme shortcomings and affecting susceptible pockets of population not protected from this dangerous disease. Dr John Simpson, member of the Regional Verification Commission for measles and rubella elimination, will highlight, at lunch, the synergies between a well functioning health system, sustaining measles - rubella elimination, and health security. SLIDE CHANGE
- In terms of system related goals we are falling short as a region to meet vaccination coverage targets. SLIDE CHANGE
- This is an alarming picture. Regional diphtheria, tetanus and pertussis vaccination coverage has decreased in the recent years to less than 95%. In our region, 14 countries in 2013 while 22 countries in 2016 achieved less than 95% DTP3 coverage, falling short of the vaccination target outlined in the European Vaccine Action Plan. This, despite a resurgence of both diphtheria and pertussis in the region since 2014. National coverage masks sub-national pockets of much lower vaccination coverage – with 7% of our European districts with lower than 80% coverage – failing to afford communities the herd-immunity they could benefit from. The decline of vaccination coverage in the Region is concerning and it is uneven. SLIDE CHANGE
- With a population of 47 million Ukraine’s very low immunization rates at national and oblast levels, significantly affects the overall status of the Region. Ukraine is not represented here today as we have a dedicated immunization plan that is being implemented with our key partners (some of them represented here today in UNICEF and US CDC) to assist the Ministry recover and improve the delivery of the immunization programme in that country. After Ukraine, some of the most concerning coverage of immunization programmes are in your countries, hence this initiative today and the need for a positive outlook and collective effort amongst us. SLIDE CHANGE
- In terms of system related goals we are falling short as a region to meet vaccination coverage targets. SLIDE CHANGE
- National Immunization Technical Advisory Groups (NITAGs) are established in 45 countries – on track towards the European Vaccine Action Plan goal and presenting every Member State with a National Immunization Technical Advisory Group to make evidence-informed decisions for new vaccine introduction, taking into account disease burden and cost-effectiveness. In some of the countries represented here today, decisions you are currently taking to introduce HPV, pneumococcal vaccine and rotavirus vaccine will be considerably aided by these groups. SLIDE CHANGE
- We would not be here unless there were challenges that continue to elude us. SLIDE CHANGE
- Huge reductions in disease burden prompted the Region to set an elimination goal for measles and rubella. Following the lowest number of cases in history in 2016, 2017 has again seen a set-back. When this happens it is critical that we take adequate measures to contain the outbreak as soon as possible and consider how we could enforce our commitment. Bulgaria and Romania have experienced large scale outbreaks and many countries in Southeastern Europe are currently suffering, including Serbia – with over 3000 reported cases. We need to actively take control and collectively respond to this. Particularly in this sub-region. SLIDE CHANGE
- Middle-income countries without Gavi support, of which 8 are with us today, represent 38% of the total population in the Region. The number of vaccines on their programmes are lowest, the coverage of DTP and measles containing vaccines is lowest, the percentage of unvaccinated infants is highest in these countries Additionally, 55% of the total measles cases in 2016 were from these countries SLIDE CHANGE
- Many of your challenges are shared and specific to this context: These challenges include: Lack of adequate financial commitment to immunization due to competing priorities Difficulty in accessing vaccines at affordable and optimum prices Supply shortage and procurement delays are affecting your programmes and anti-vaccine sentiment and vaccine hesitancy are affecting uptake This is not a helpless situation. We would like this event to serve as a catalyst to develop a roadmap for you to overcome these challenges, bring donors to the table to support the partners in providing you with amplified technical assistance, coordinated across the sub-region, striving together towards common goals. The topics chosen for the discussion sessions today highlight these challenges and what we are going to do about them. SLIDE CHANGE
- Collectively, the countries represented in the room here today, pay a higher price for most vaccines, as compared to other middle income countries. The extra price paid reached 12.6 dollars per pneumococcal vaccine. Additionally, the price you pay as individual countries shows large variations revealing potential inefficiencies and room for improvement. Collaboration, transparency and joint strategic work on addressing key bottlenecks (from product choice to regulations, budgeting and procurement procedures) is the only approach that will alleviate these two issues.
- We have all the ingredients to set a new course for the sub-region: We have a strong and active sub-regional SEEHN network, We have an enabling policy environment: with Health 2020 and the European Vaccine Action Plan to draw upon We have collective commitment to progress against EVAP goals We have the necessary collaborative spirit and we Recognize that shared threats are best tackled through joint action. CHANGE SLIDE
- I actively encourage us to set a new set of goals for this sub-region. Recognizing your unique environment and situation. Goals that include: Pricing divergence and exploring joint/pooled procurement Driving and maintaining vaccine demand and acceptance Securing sustained financing and resource mobilization Establishing bodies that will assure that evidence-based decision are made regarding our programmes, And, equitably extending the benefits of vaccination so that everyone has access to inclusive immunization services. Ultimately, we need to enhance sub-regional cooperation in immunization in Southeastern Europe through support of national immunization investments in the areas where they can show an impact on overall health status and are associated with improved investment opportunities that contribute to growth. Dr Thomas Cherian will highlight, at lunch, the full potential of immunization with regard to the SDGs, to health and beyond, including economic growth, employment and education.
- Ownership and political commitment will be key to success; and that’s where we start today. I urge you to support the initiative to develop a sub-regional roadmap and to commit to engaging your immunization programmes and ministries in development of the Roadmap. The clearest signal you can give is your initial affirmation of the Statement of Intent you have received and which we will invite you to endorse later today. I sincerely feel with this commitment of yours to offer the full potential of immunization to the population in this sub-region, each one of you are contributing in-turn to the laid down sustainable development goals we all have committed to. I would like to highlight this initiative at the Regional Committee in September during the immunization session as an excellent example of how true political commitment is voiced, translated into action and tailored to specific challenges that can only be overcome through collaboration and partnership. I applaud you for your engagement and thank you for your attention. CHANGE SLIDE