WHO Challenges and priorities for immunization policy making

Philippe Duclos, WHOPhilippe Duclos, WHOScience and Technology Options Assessment,Science and Technology Options Assessment,STOA – AVIESAN Workshop, June 19STOA – AVIESAN Workshop, June 19thth 2012, 2012,European Parliament, BruxellesEuropean Parliament, Bruxelles

Health Statistics and Informatics: for information you can trust

Major causes of death in neonates and children under five globally – 2010

•7.6 millions deaths a year in children < 5 year •About one third of all child deaths linked to malnutrition

•Children in low-income countries about 18 times more likely to die

•63% (4.8 millions) infectious diseases

Crédit to Colin Mathers – Unpublished -confidential

The world is getting heavier!The world is getting heavier!

Source: World Health Statistics: A snapshot of Global Health, 2012, World Health Organization WHO/IER/HIS/12.1

“Climate change is the greatest global health threat of the 21st century”

University College London (UCL) Lancet Commission

Global coverage estimates, 1990-2010 DTP3, Measles, HepB3, Hib3, PCV3 and Rota

Source: WHO/UNICEF coverage estimates 2010 revision. July 2011

458,000 unvaccinated infants (DPT3) in EURO, 201029% live in countries eligible for GAVI Alliance funding

1,900 0 1,900950 Kilometers

Countries with % of districts achievingat least 80% DTP3 coverage, 2010

Countries with % of districts achievingat least 80% DTP3 coverage, 2010

100 % districts (59 countries or 31%)80-99 % districts (35 countries or 18%)50-79 % districts (32 countries or 17%) No data (43 countries or 22%)

Not applicable 0-49 % districts (24 countries or 15%)

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2012. All rights reserved

Source: WHO/UNICEF estimates and WHO/IVB database, September 2011193 WHO Member States. Date of slide : 12 June 2012.

European Region, reported measles incidence, 2011

European Region, reported measles incidence, 2011

The Global World and VaccinesThe Global World and VaccinesOpportunities

Rekindled political & public health interest

Resources allocated and innovative financing mechanisms – GAVI $4.3 billion

Progress made with coverage

Global targets set

"Pharma" engagement

Rich pipeline of new vaccines

Decade of Vaccines

Challenges

Conflicting priorities

Vaccine field tends to be vertical

Weak health services

Lack of transparency about costing

Changing epidemiology

Lacks grassroots activism

Threatened by vaccine "hesitancy"

“We envision a world where children, families, and communities enjoy life protected from the threat of disease. The purpose of the Decade of Vaccines is to extend the full benefits of immunization to all people, regardless of

where they live”

“We envision a world where children, families, and communities enjoy life protected from the threat of disease. The purpose of the Decade of Vaccines is to extend the full benefits of immunization to all people, regardless of

where they live”

WHO Vaccine Position PapersWHO Vaccine Position Papers

Position papers = Key reference documents

Developmental and review process (follow recommendations of SAGE, extensive peer review, evidence-base, periodic updating)

Format Weekly Epidemiological Record Current structure (Intro, background (Disease epidemiology, the pathogen, disease), info on vaccines (composition, safety, immune response, efficacy and effectiveness, cost effectiveness and any other relevant issue), WHO position on vaccine use)

Additional posting of information on the web: Grading of Recommendations Assessment, Development and Evaluation (GRADE) tables, references, summaries (one pager and PowerPoint presentation)

Aspects for which there is a lack of data to support decision making

Aspects for which there is a lack of data to support decision making

Effectiveness in developing countries and herd immunity

Adjust schedules: reduce number of doses, dose spacing and duration of protection (alleviate number of booster doses)

Vaccines co-administration

Risk groups: immunodeficient, pregnant women, very young and very old

Impact of vaccination strategies

Cost-effectiveness studies

Need good and coordinated surveillance

Communication methods for vaccine-hesitant populations

Use of vaccine in humanitarian emergencies

Accessibility to affordable vaccines and WHO's role

Use of vaccines in immunocompromised populations

Optimizing immunization schedules

Non specific effects of vaccines

Impact of introduction of new vaccines on strengthening of immunization and health systems

Maternal immunization to enhance the protection of mothers and infants

Involvement of the private sector

Strengthening of NITAGs

Thiomersal

Vaccine stockpiles

Recommendations on use of specific vaccines and monitoring of implementation and impact

New Challenges: SAGE’s Agenda 2012 -2014

New Challenges: SAGE’s Agenda 2012 -2014

Current political commitment does not translate into significant changesReporting transparency – some member states fail to report VPD cases or forward samples to regional laboratories for confirmation – political context"Denominator" remains a problem in several member statesSignificant (negative) impact of health system changes/reforms on immunization programme implementationNeed fair salaries for immunization and surveillance personnel including laboratory staff to maintain skilled workforce Expanding assistance to National Immunization Technical Advisory Groups Self-procuring member states face higher cost (e.g. >10USD per dose of pentavalent vaccine or MMR) in absence of competitionVaccination acceptance a raising problem with varying underlying causes

European Region: some specific challenges

WHO research priorities WHO research priorities Biomarkers

Assess performance, strategic information and support decision making – validate vaccine coverage and assess population susceptibility How to differentiate natural infection from vaccinationDefinition of correlates of protection

Implementation researchIdentify problems in programmes implementation and their determinants, develop and identify and implement solutionsPlatform for researchers to share research results, and assess their potential contribution to global immunization vaccine policies and practicesEstablish networks and intercountry collaboration

Decade of Vaccines R&D at global level to maximize vaccination benefits:

preliminary list of activities

Decade of Vaccines R&D at global level to maximize vaccination benefits:

preliminary list of activities

Short term New communication methodsRepresentative epidemiological and impact studies to guide cost-effectivess studiesOperational research on different approaches to immunize during the entire life course and in situation of emergencies

Mid termAdjuvants: access and know howAdministration without needlesThermostabilityNew production methodsRegulatory research

Long termImprove understanding of

innate and adaptative immunitymicroorganismscauses of variability in response to vaccines

Research and development of vaccine policies

Research and development of vaccine policies

Need to identify research priorities to facilitate decision making and adjustment of policies

Need for dialogue and exchange of information

Continuous process

Thank youThank you

With acknowledging the input and assistance provided by WHO colleagues and particularly that from Dina Pfeifer (EURO) and Laure Dumolard (HQ)

Current vaccines and vaccines on the horizon•

•1960 •1980 •2000•// •//•Diphtheria

•Pertussis

•Tetanus

•YF •Influenza

•Polio

•Measles

•JE•Rubella•HepB

•Hib (conj)•Typhoid

•Cholera•Pneumo (conj)•Rotavirus•HPV•Mening (conj)

•Dengue

•Malaria•TB

•HIV/AIDS

Traditional EPI

New and underused vaccines

Futurevaccines

•Source – WHO, 2005