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"Reaching the unreached: new challenges and promising approaches in equitably
immunizing the world's children”
Overview: Routine immunization
strengthening & new vaccines-- links with global pneumonia
& diarrheal disease prevention and the MDGs
Lora Shimp Senior Technical
Officer, JSI
WFPHA Conference 26 April 2012 Addis Ababa, Ethiopia
Source: WHO/UNICEF coverage estimates 1980-2010
Global immunization DPT3 coverage, 1980-2010
Africa SE Asia
Full immunization rates by socio-economic status
0
10
20
30
40
50
60
70
80
Sub-Saharan
Africa
South Asia MiddleEast and
NorthAfrica
East Asiaand
Pacific
Europeand
CentralAsia
LatinAmerica
andCaribbean
AllCountries
(44countries)
Richest Quintile Poorest Quintile
Source: Gwatkin, Rutstein, Johnson, Pande and Wagstaff (2000) Socio-economic Differences in Health, Nutrition, and Population. World Bank.
New Decade of Vaccines global initiative and GAVI Alliance partnership
Decade of Vaccines Collaboration will: Support countries for increasing immunization coverage
and worldwide introduction of new vaccines Support new and under-utilized vaccine
introductions/expansions (including pneumococcal and rotavirus vaccines); strategies to achieve high immunization coverage; integration with other prevention, protection and control efforts for vaccine-preventable diseases
Partners involved: Partners globally: GAVI Alliance, WHO, UNICEF, Bill &
Melinda Gates Foundations, USAID, JSI, PATH, & others
Global Child Mortality: Role of Vaccine Preventable Diseases (2008 data)
8.8 million deaths in children < 5 years 17% (1.5 million) from vaccine preventable diseases
Source: Black RE at all, Global, regional, and national causes of child mortality in 2008: a systematic analysis, Lancet. 2010 Jun 5;375(9730):1969-87. Epub 2010 May 11. * WHO/IVB estimates
1.5 million deaths among children from vaccine preventable disease by WHO regions, 2008
Source: Black RE at all, Global, regional, and national causes of child mortality in 2008: a systematic analysis, Lancet. 2010 Jun 5;375(9730):1969-87. Epub 2010 May 11. * WHO/IVB estimates
Framework: Protection, prevention and treatment strategies for pneumonia &
diarrhoea
Reduce pneumonia and
diarrhoea morbidity and
mortality
Children becoming ill from pneumonia or diarrhoea
Vaccines: pertussis, measles, Hib, PCV and rotavirus
Cotrimoxazole prophylaxis for HIV-infected and exposed
children
Zinc & Vitamin A supplementation
PREVENT
Children by Providing Healthy Environment
Exclusive breastfeeding for 6 months
Adequate and complete nutrition
Hand washing with soap
Safe water and sanitation
Reduce indoor air pollution
Prevent low birth weight
PROTECT
Children who are ill with pneumonia and diarrhoea
Improved care seeking and referral
Case management at the health facility and community level
Supplies: Low osmolarity ORS, Zinc, antibiotics & oxygen
Continued feeding (including breastfeeding)
TREAT
Planning and management of resources
Reaching the target
populations
Linking services with communities
Supportive supervision
Monitoring for action
• Flexible approach • Countries/districts to
tailor it to fit their situation
• Use of data, human and financial resources, capacity building, improved access & use of services
• Intensity of implementing each component varies from country to country
...the five components are not mutually exclusive
“Reaching Every District” (RED) - five operational components
What works? Some examples: 1) Drivers for strengthening routine
immunization in Africa 2) Experience in improving immunization
coverage through RED and Pneumococcal vaccine introduction in Kenya
3) Addressing equity and reaching the underserved and unreached with immunization services in India