Immunization highlights: 2010
Vaccine research and development and innovation in immunization supply systems
A first generation malaria vaccine on the horizon
In 2010, WHO's Joint Technical Expert Group on Malaria Vaccines reviewed progress from a phase 3 trial of the most advanced candidate vaccine (RTS,S/AS01) against the most deadly form of human malaria, Plasmodium falciparum. The vaccine has already shown 40-60% efficacy in reducing all episodes of clinical malaria in infants in phase 2 trials. This is higher than previous candidate vaccines.
The phase 3 trial, which began in May 2009, is ongoing in seven countries in sub-Saharan Africa. Based on the current trial schedule, the phase 3 trial data required in order for WHO to consider making a policy recommendation is expected to become available to WHO in early 2015, with interim reports expected in late 2011 and late 2012.
WHO also works in support of malaria control interventions such as: prompt and effective treatment with artemisinin-based combination therapies; use of insecticidal nets by people at risk; and indoor residual spraying with insecticide to control the vector mosquitoes.
Developing country manufacturers supply vaccines during influenza pandemic
In accordance with the Global Pandemic Influenza Action Plan (GAP), which aims to decrease the gap between vaccine supply and demand during an influenza pandemic, WHO continued supporting the efforts of vaccine manufacturers in 11 developing countries to produce and license influenza vaccines. The impact of this support is clear: since the effort began, Indonesia has produced and licensed a seasonal influenza vaccine, and India, the Republic of Korea and Romania did the same for H1N1 monovalent vaccines during the 2009-2010 pandemic. Indeed, during the H1N1 influenza pandemic, in just the third year of the project, more than 25 million doses of pandemic vaccines were distributed in countries in three continents by manufacturers in participating countries.
WHO is also helping to facilitate the integration of domestically-produced influenza vaccines into national immunization programmes and to ensure country and regional sustainability and independence of vaccine production in the long-term. Sustainability can only be achieved by licensing of the new seasonal trivalent vaccines. Therefore, WHO is now focusing, in the context of this project, on:
- maintaining financial and technical support for those manufacturers already supported until market authorization is received for the new vaccines;
- strengthening the capacity of the grantee countries' national regulatory authorities to license and regulate domestic influenza vaccines: and
- providing financial and technical support for additional manufacturers from regions without production capacity, such as Central Asia and sub-Saharan Africa.
Senegal launches the "moving warehouse"
"It is still early days, but it is already clear that this integrated system will help us meet demand for vaccines and medicines much more quickly and efficiently than we have in the past." Dr Mamadou Diop, the Regional Medical Officer in Saint Louis
An innovative system through which insulated trucks deliver vaccines and other health products directly from regional warehouses to health centres, without interim stocking at district level, was launched by the Minister of Health and Prevention of Senegal, Mr Modou Diagne Fada, in October.
In the Saint Louis district, deliveries are now being made, for the first time, according to needs identified by health centres, with delivery teams able to provide on-site supportive supervision and maintenance of equipment when stocks are replenished. Stock management is computerized, with real-time, web-based information exchange between the moving warehouse, health centres, and regional and national storage facilities. The districts of Podor and Pete are expected to be the next to introduce the moving warehouse system.
The moving warehouse is one of the projects supported by the WHO/PATH project, Optimize, in collaboration with partner countries.
Albania uses mobile phones for vaccine monitoring
The Albanian Institute of Public Health (IPH) developed an innovative immunization information system, enabling health workers to register and track all vaccine lots and the immunization status of all children in a central database. The database can be accessed on the web or through a mobile phone-based application. The system was tested and approved by the IPH in November and is now being deployed in a pilot region, Shkoder. Use of the database is expected to:
- improve the quality of monitoring data;
- enable better defaulter tracking through nurse and patient reminders;
- improve vaccine safety; and
- optimize vaccine supply mechanisms.
If successful and cost effective, it will be scaled up nationally in the second half of 2011.
Another way in which the IPH is using mobile technology is to monitor the temperature of vaccines stored in fridges. During the year, 24 fridges were equipped with monitors to log temperature. The monitors send SMS alarms to health workers' mobile phones when the temperature moves beyond the required range for a certain length of time.
Initial findings point to benefits of working in this way. Problems with fridges are identified more quickly, with corrective action faster. Since use of this system began, several fridges have been replaced.
This project is being implemented with the support of the WHO/PATH project Optimize.