3rd Global Meeting on Implementing New and Under-utilized Vaccines, 16-18 June 2009
I. Progress in implementing the Global New Vaccines Plan of Action
The Global New & Under-utiliized Vaccines Introduction Plan of Action is updated regularly based on outcomes and recommendations from the annual global NUVI forum. Highlights from NUVI in 2008 and 2009 include the following:
- GAVI applications for the introduction of Hib vaccine have been received from two countries with large populations: Nigeria and India
- First PCV introduction in a GAVI-eligible country: Rwanda
- The Advanced Market Commitment for PCV was signed
- WHO/SAGE recommended rotavirus vaccine for global use
- WHO/SAGE recommends HPV vaccine use where prevention of cervical cancer is a public health priority
- Accelerated Vaccine Introduction Initiative working
- Central African Surveillance Demonstration Project (SURVAC) initiated
However, there are two main challenges: The global financial crisis and the A(H1N1) pandemic. Countries also face numerous challenges, including competing priorities, compounded decision-making, questions around cost effectiveness, difficult planning processes, availability of more complex vaccines targeting disease syndromes, the need for new delivery systems, and other practical introduction challenges. It is important to document lessons learned and learn from the experiences of introducing other vaccines.
To confront these challenges, several initiatives have been undertaken and are being continued under the various areas of work under the NUVI plan of action. The main priorities for moving forward are the following:
- Achieve sustainable financial support
- Support integrated approaches to disease prevention and control
- Support Hib vaccine introduction in the remaining countries with a focus on countries with large birth cohorts
- Support rotavirus vaccine applications to GAVI and preparation for introduction
- Prepare for PCV10 & PCV13 introductions in 2010
- Establish HPV vaccine delivery systems and a joint surveillance platform for HPV prevalence and precancerous cervical lesions
- Balance new vaccines introduction and routine immunization strengthening
- Support National Immunization Technical Advisory Groups and National Regulatory Agencies and their coordination
- Provide a preferred product presentation profile to manufacturers
- Support country cold chain and logistics preparedness
- Expand regional surveillance networks and create an integrated surveillance platform for vaccine-preventable and other communicable diseases
- Monitor vaccine safety and establish AEFI crisis and pre-emptive communication
- Continue the work of the Accelerated Vaccine Introduction Initiative in a collaborative spirit
II. Financing health and new vaccines in times of Crisis
Financing health has been incurring chronic deficits under all sources and the Millennium Development Goals are at risk. While overall development assistance has been increasing by 128% between 2001-2005, development assistance to health increased only by 5%.
However, if contributions remain constant, GAVI would be able to cover all presently approved programmes (YF, Mening A, Workplan) to 2015 and pentavalent vaccine only to 2013. GAVI would not be able to cover pentavalent vaccine after 2014 and none of pneumococcal, rotavirus, HPV, typhoid, rubella or JE. Resource Mobilization is now GAVI's main priority, and new donors are coming onto the scene.
The way forward is to speak with one voice at national level and focus on the broader child survival interventions with immunization being the key driver. Increased domestic resource commitment is also key to sustainability.
III. Update on A(H1N1) situation and preparedness
In April 2009, a sustained person-to-person transmission with a new influenza A(H1N1) virus was reported in Mexico and U.S.A. In late April 2009, phase 5 of influenza pandemic alert was declared.. On 11 June 2009, the A(H1N1) situation was at phase 6 - pandemic status - during the time of the NUVI meeting. The virus was no longer being contained, and WHO's role was to mitigate the social and economic impact of the pandemic. People aged between 5-45 years were the most commonly affected.
The most efficient tool against this pandemic is a vaccine, however the main challenges for a pandemic influenza vaccine is the lag time between identification of the virus and the availability of the first doses of vaccine, which is between 4-6 months.
The Strategic Advisory Group of Experts for Immunization asserted that WHO should recommend vaccine viruses for vaccine development, and essential reagents be prepared as a priority. Manufacturers should prepare for potential commercial-scale production, however these activities should not interfere with the current production of seasonal vaccine.
The potential impact of this pandemic on NUVI work was discussed, focussing on vaccine introduction and deployment preparedness.