Immunization: An Entry Point for Improving Health Globally

Dr. Ariful Bari Chowdhury Core Faculty Member & Lecturer North South University

Immunization: Potential to prevent one in four child deaths

10 million child deaths annually

Immunization 101:
Vaccines in national immunization programs
BCG against Tb DPT diphtheria, pertussis (whooping cough),tetanus, Polio Mumps, Measles, Rubella (MMR) Tetanus toxoid Hepatitis B Yellow fever Haemophilus influenzae type b (Hib) Pneumococcal conjugate vaccine (pneumo) Rotavirus Others: HPV, typhoid, meningitis
traditional New or underutilized

WHO standard schedule for routine immunization

Age of Contact
Birth 6 weeks 10 weeks 14 weeks 9 months
* total

Vaccine
BCG, OPV-0, Hep B* DPT1**, OPV1, Hep B* DPT2, OPV2, Hep B* DPT3, OPV3, Hep B* Measles, Hep B*, YF

of 3 doses with timing dependent upon local epidemiology ** Some DTP vaccines now are combined with hep B and/or Hib

Sustainable Immunization System

Practices Support Supervision
Management

Financing
Community Action

Policies

Supplies & Logistics Training

Monitoring & Surveillance

Advocacy & Communications

Reaching Every District approach

ON

LE SH ER AD

Monitoring

NA TI CO OR DI

Supervision

Community Linkage

IP

Reaching Target Population Planning

INTEGRATION

IMMUNIZATION Plus

Plus WHAT?

Plus other services Plus messages about other services Plus access to other commodities Use of integrated tools to manage services

vitamin A

e.g.,

birth spacing

e.g.,

vouchers for HCC

e.g.,

integrated health cards

e.g.,

Continuum of Immunization Strategies

ROUTINE Single intervention ROUTINE Integrated CAMPAIGN Integrated CAMPAIGN Single intervention

Fixed & outreach immunization only

Pulse immunization

Multi-antigen Campaigns with SIAs as platform

Fixed & outreach EPI & other interventions

Periodic campaigns to boost routine coverage

Single antigen campaigns

Considerations In Linking Interventions to Health System

- High level political will - Supportive national policies - Assured financial and logistical support - Multiple Skilled Health Workers - Supportive PHC structures - Clear responsibilities to monitor - Combining interventions that doesnt disrupt/over-burden the system

Pneumonia kills more children than any other childhood disease. In high mortality areas of Africa and South Asia up to 5% of all children born will die from pneumonia before their fifth birthday. In 2005 approximately 2 million children under 5 years of age died from pneumonia, more than from AIDS, TB and malaria combined. This is completely unacceptable.

How we can prevent children from dying of pneumonia

Case management
Strategies aimed at detecting and treating pneumonia cases Integrated Management of Childhood Illness (IMCI).

Vaccination
Two new vaccines that are now available (Hib and pneumococcal conjugate vaccine Streptococcus pneumonia)

Reduced risk factors

Poor nutrition Smoke from indoor cooking fires

What should be done now

Provision of effective case management. Provision of vaccines for the prevention of pneumonia Implementation of programs to improve childhood nutrition

More research to identify better methods to prevent and treat pneumonia.

International spending on public health and research in this field is inadequate. Increased support is needed to save the lives of children and protect them from the suffering associated with the effects of pneumonia.

Rotavirus Vaccines

Zinc Treatment

Enhanced Diarrheal Disease Control

Sanitation/ Hygiene ORT/ Breastfeeding

Source: Rotavirus ADIP website

Packaged volumes of vaccines, per dose

(source: PATH, GAVI)
Vaccine BCG (diluent outside cold chain) Administration Reconstitution Vial size 10 Volume (cm3) 1.2

Diphtheria-Tetanus-Pertussis (DTP)
Oral polio Measles (diluent outside cold chain) Tetanus toxoid Hepatitis B DTPw-Hib combined DTPw-HepB liquid + Hib DPTw-HepB + Hib Pneumococcal 7-valent (pre-filled syringe) Rotarix (25 mono-dose pack, diluent in cold chain) Rotarix (25 mono-dose pack, diluent OUTSIDE cold chain) RotaTeq (in 2 mono-dose pack) RotaTeq (in 10 mono-dose pack)

Liquid
Liquid Reconstitution Liquid Liquid Liquid Reconstitution Reconstitution Liquid Reconstitution Reconstitution Liquid Liquid

10
10 10 10 10 10 10 2 1 1 1 1 1

3.0
2.5 3.0 3.0 3.8 2.3 5.3 9.7 59.7 111.6 11.4 85.2 80.9

Impact On Cold Chain: Rotavirus Vaccine

Global Alliance for Vaccines and Immunization

GAVI Alliance

Improve access to sustainable immunization services Expand use of all existing costeffective vaccines Accelerate R & D and introduction of new vaccines Assure injection safety for immunization

Types of GAVI support available to 72 poorest countries

Immunization Services Support cash support at $20/child immunized with DTP3 New and under-utilized vaccines Hib, Hep B, Yellow Fever, pneumococcal, rotavirus Injection safety 3 year limit Health System Support to address broad obstacles to immunization coverage in the health system Civil Society Support

GAVI Support for Financing New Vaccines

Minimal country co-payment/dose of 1st co-financed vaccine
2008 2009 2010 2011 2012 2013 2014 2015

Poorest countries

$0.20 $0.2 0

$0.20 $0.3 0

$0.30 $0.30 $0.3 0

$0.3 0

Intermediate

$0.30 $0.3 0
5

$0.30 $0.4 $0.40 $0.40 $0.4 0 0

6 0

$0.4 0
0

Least poor $0.30 $0.3 $0.40 $0.4 $0.53 $0.61 $0.7 $0.8

Fragile

$0.10 $0.1 0

$0.10 $0.1 $0.15 $0.15 $0.1 5 5

$0.1 5

GAVI Health System Strengthening

To achieve and sustain increased immunisation coverage, through strengthening the capacity of the health system to provide immunisation and other health services (with a focus on child and maternal health) Three main themes:
Health workforce Supply, distribution and maintenance Organization and management

Maximum impact at periphery In demand: 80% of HSS funds obligated to 40+ countries within first 1.5 years of funding

GAVIs new support to Civil Society Organizations (CSOs)

TWO types of support: 1. Strengthen CSO engagement on GAVI policy dialogue at regional and national level: mapping, meetings, representation. 2007 2009. Lump sum available $10,000 100,000 USD Support for CSO involvement in comprehensive multiyear plan for immunisation (cMYP) and/or GAVI health system strengthening (HSS). Available in ten pilot countries: Afghanistan, Bolivia, Burundi, DR Congo, Ethiopia, Georgia, Ghana, Indonesia, Mozambique and Pakistan

2.

An ounce of prevention is worth a pound of cure

The first cost-benefit ratio (1:16)