Global Immunization News (GIN) October 2016

In this issue News You can click on the article you are interested in and ac- Where are we with the implementation of the Global Vaccine Action Plan (GVAP) at cess it directly! mid-term of the Decade of Vaccines?

News Every year, the Decade of Vaccines  Updated resources for moni- 2 secretariat (see details below) pre- toring home-based records  Further, Faster, Fairer: Reach- 2 pares a report which summarizes ing every last child with im- the progress against each of the munization GVAP goals (coverage, disease elim-  New work with countries to 3 ination, vaccine prices, NITAGs…).

generate and use evidence on

This report is the best source of

vaccine delivery cost for

information available for a clear planning and budgeting

picture of the situation in all areas  Launch of Stop Pneumonia 3

website, a great resource of work in the immunization world

ahead of World Pneumonia (research, procurement, logistic,

Day 2016

delivery, demand…).  MSF rejects Pfizer PCV Dona- 4

tion offer This year, the GVAP Secretariat

report 2016 is composed of several Past meetings / workshops 5-13 pieces: 1. The usual GVAP secretariat re- Resources 14 port (all goals and strategic goal indicators) Calendar 15 2. Six regional progress reports 3. Seven priority countries pro- Links 16 gress reports 4. The Score Cards for immunization summarizing the immunization coverage for all antigens and for all countries from 2000 to GVAP and National Immunization coverage scorecards estimates for 2015 2015

All those documents serve as the basis for the independent review conducted by the Strategic Ad- visory Group of Experts on immunization (SAGE). The SAGE GVAP Assessment Report will be published soon and will then be discussed at the World Health Assembly.

The SAGE Decade of Vaccines (DoV) Secretariat Report 2016 and the National Immunization Coverage Scorecards for 2016 are now available and can be accessed via the WHO GVAP web page.

To facilitate an exploration of the data, a number of data visualizations that measure progress against the goals and strategic objectives of the GVAP have been made available on the TechNet- 21.org website. We encourage you to share your opinions or ask questions about these visualizations on the TechNet-21.org forum.

For further information on the Decade of Vaccines and the Global Vaccine Action Plan please see the GVAP webpage or email the DoV Secretariat.

SUBSCRIBE NOW Send an email to [email protected] with the following text in the body of the email: The Decade of Vaccines secretariat comprises the Bill & Melinda Gates Foundation, Gavi the Vaccine Alliance, subscribe GLOBALIMMUN- UNICEF, the US National Institute of Allergy and Infectious Diseases and the World Health Organization IZATIONNEWS (WHO).

Global Immunization News (GIN) October 2016

Updated resources for monitoring home-based records Marta Gacic-Dobo, WHO and David Brown, Brown Consulting Group International, LLC

Within primary healthcare service delivery, home-based records (HBRs) serve as an important recording tool and information resource (i) to enhance health professionals’ ability to make appropriate clinical decisions (e.g., which vaccinations have been received already and which vaccinations remain outstanding) and improve continuity of care across providers in the absence of other health records, (ii) to empower individuals or their caregivers as a vehicle for health education about which primary healthcare services have been received and those which remain outstanding as well as (iii) to support public health monitoring efforts. Map showing where HBRs are available as of 6 WHO continues to work with immunization programmes and its October 2016. Examples of HBRs for Madagascar, partners to increase awareness of the importance of HBRs for Australia and Bangladesh. immunization programmes. Current challenges exist in many countries where the HBR is not made available, not adopted and/or not appropriately utilized by caregivers and/or health workers, all of which prohibit the HBR from being able to fulfil its intended purpose. Currently, the updated electronic repository contains HBRs from 164 countries, and the website of all and current HBR ownership preva- lences has been updated. In addition, an online wiki has been developed. Efforts are on-going to improve the usability and functionality of these online resources.

The WHO continues to encourage countries to consider including monitoring of HBR availability and adoption or ownership among other programme performance indicators.

Further, Faster, Fairer: Reaching every last child with immunization Kirsten Mathieson, Save the Children

19.4 million children under one year old globally are still missing out on immunization – that is one in seven children excluded from this critical health intervention. Save the Children’s new report, Further, Faster, Fairer: Reaching every last child with immunization, calls for accelerated action to achieve universal immunization coverage.

While progress over the past decade has been impressive – with 86% of children globally now receiving basic vaccinations – progress has recently slowed and the 2011–2020 Global Vaccine Action Plan (GVAP) is off-track. To fo- cus on the seventh child exposes systematic exclusion within countries. ‘Further, Faster, Fairer’ shows that these excluded children are from the poorest households, certain ethnic groups, living in neglected areas, and affected by conflict and emergencies.

The report argues that domestic policy and resource choices must ensure that immunization and other essential health services reach every last child, working towards Universal Health Coverage. It also explores other important issues that must be addressed for countries to make progress, including making sure every child is counted, tackling household and community barriers, as well as global factors (such as vaccine affordability) that affect countries’ ability to reach every last child.

Every child has the right to immunization as part of their right to health. But unless we do things differently, we will continue to fail every seventh child and further entrench systematic inequalities that leave him or her behind. Break- ing down the barriers that drive exclusion is possible – but requires renewed political commitment and investment. At the midpoint of the GVAP, more must be done to accelerate action. We must go further, we must act faster and we must be fairer to ensure that every last child is reached. Our new report puts forward recommendations to help drive this agenda forward.

Find our new report here. Page 2

Global Immunization News (GIN) October 2016

New work with countries to generate and use evidence on vaccine delivery cost for planning and budgeting Annette Ozaltin, ThinkWell

Great strides have been made in expanding the coverage of vaccines, in part through better understanding the cost of delivering immunization services. However, gaps in cost evidence remain and many countries still budget their national immunization programmes using historical funding levels rather than cost evidence. To achieve equitable, high- quality coverage and ensure efficient resource use, immunization delivery cost (IDC) evidence must not only be available, but also used in planning and budgeting processes. As more countries transition to self-financed immunization delivery programmes, the use of cost evidence will become essential to ensuring those programmes mobilize adequate resources to meet coverage goals and manage introduction of new vaccines.

ThinkWell and John Snow, Inc. kicked off a 3-year project focused on increasing the visibility, availability, understanding, and use of IDC evidence. Funded by The Bill & Melinda Gates Foundation, the project aims to build country capacity around use of cost evidence to work towards sustainable and predictable financing for vaccine delivery.

The project complements the EPIC costing studies, focusing on generating costs to address challenges that are at the top of the domestic health and immunization financing agenda to ensure programme and policy relevance. We are currently exploring opportunities with countries to undertake this type of analysis.

The project will work with countries to improve the use of IDC evidence in planning and budgeting processes. We will facilitate an immunization costing network, linked to the existing EPIC community of practice, to encourage knowledge sharing and co-production of effective strategies for IDC evidence generation and use. Finally, we will con- solidate and analyze IDC evidence and develop a user-friendly interface for countries.

We welcome hearing from others regarding experience and best practice in integrating cost evidence into country policy, planning, and budgeting dialogues. Please email us to share your lessons.

Launch of Stop Pneumonia website, a great resource ahead of World Pneumonia Day 2016 International Vaccine Access Center

World Pneumonia Day is right around the corner on November 12, 2016. The International Vaccine Access Center (IVAC) is excited to share some resources to help mark this important event. This year's theme is Keep the Promise. Stop Pneumonia Now, focusing on the intersection of pneumonia and the Sustainable Development Goals (SDGs). The world has an opportunity to keep the promise of the SDGs by stopping pneumonia and saving thousands of young lives.

IVAC has launched a new website, StopPneumonia.org, that provides tools for pneumonia advocacy. Content includes a Social Media Toolkit with key messages, social media posts, stories about child health, the WPD 2016 logo, and other materials for use in outreach. These resources will be updated over the coming weeks to share the activities of groups around the world and reflect the progress they are making in sending policymakers a strong message on the need to prioritize child health.

In November, IVAC will release its seventh annual Pneumonia & Diarrhea Progress Report that details the progress of the 15 countries with the greatest burden of under-5 pneumonia and diarrhea deaths in implementing high-impact interventions outlined in the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea.

Visit Stop Pneumonia

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Global Immunization News (GIN) October 2016

MSF rejects Pfizer PCV Donation offer François Servranckx, Médecins sans Frontières

On 10 October 2016, MSF officially rejected Pfizer’s PCV donation offer in a blog penned by Jason Cone, MSF Exec- utive Director in the USA.

This difficult decision came after years of negotiation and months of campaigning with Pfizer and GlaxoSmithKline (GSK) to reduce the price of the pneumonia vaccine to five dollars per child (for all three doses) for all humanitarian organizations and developing countries.

Unlike GSK which finally agreed in September 2016 to reduce the price of the vaccine to 9.15 USD per child for humanitarian organizations, Pfizer has kept pushing for Press Coverage of MSF decision to reject Pfizer’s PCV dona- more donations, without even providing a price quotation. tion offer.

MSF’s decision to reject a Pfizer donation is in line with the policies of WHO, UNICEF and Gavi, the Vaccine Alliance, which have clear terms governing corporate in-kind medical product donations. These policies aim to limit the nega- tive consequences of in-kind medical donations.

In the blog which was widely covered by media and started many online discussions, MSF details all the issues with drug donations and explains why it does not constitute a solution to reduce the price of the vaccine for the millions of children who need it. Read more.

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Global Immunization News (GIN) October 2016 Past Meetings/Workshops Re-validation of National Regulatory Authority self-assessment for vaccine and medicine regulation in Mongolia Uhjin Kim, Cheryl V. Legaspi, Syed Shah and Jinho Shin, WHO Regional Office for the Western Pacific and Byoungguk Kim, Ministry of Food and Drug Safety, Republic of Korea Location: Ulaanbaatar, Mongolia Date: 14-16 June 2016 Participants: 30 participants from the Ministry of Health and Sport (MOHS); Pharmaceutical and Medical De- vice Division (PMDD); Drug Regulatory Unit (DRU) of National Center for Health Develop-

ment (NCHD); General Agency for Specialized

Investigation (GASI); Central Joint Laboratory (CJL); National Centre for Communicable Dis- eases (NCCD); Mongolian National University of Medical Sciences (MNUMS); Public Health Insti- tute (PHI); Asian Development Bank (ADB); United Nations Children’s Fund (UNICEF)

Participants in the Re-validation of National Regula- tory Authority Self-assessment for Vaccine and Medicine Regulation in Mongolia Purpose: (1) To follow-up on the previous Nov/2013 NRA mission and institutional development plan (IDP) implementation; (2) To assess new capacity gaps in the regulatory system and relevant functions against the new WHO NRA Global NRA tool Ver.6.7 and published indicators in the area of vaccine and medicine regulation; and (3) To discuss the NRA strengthening plan with relevant regulatory institutions, focusing on the progress and constraints linked to vaccine and medicine regulatory functions and to develop workable action plans to address the identified gaps. Details: As part of regulatory systems strengthening, NRA assessment is the strategic approach to depict the country’s capacity to effectively regulate the manufacture, import, export, distribution and use of medical products including vaccines.

Mongolia procures EPI vaccines through UNICEF for their national use and very few are supplied in the private sector. Eighty percent of medicines used in the country are imported.

Sufficient legal provisions are in place to regulate medical products. However, there are several agencies involved in the regulatory activities. A high level of commitment was observed from the Government in building a competent and independent NRA as stated in the National Medicines Policy (NMP). Integrated adverse drug reactions (ADR) and AEFI monitoring surveillance, reporting and registration systems are being strengthened through the newly updated Ministerial De- cree 2015.

However, the major concerns were fragmented regulatory functions across different agencies. Technical staff are in place according to their respective function. It was noted that there is a serious under-staffing, quick turnover, and dependency on external experts for special tasks such as the review of licensing application files.

Strategic priorities were developed under NMP for five years from 2014-2018. Implementing details for achieving NMP strategic objectives were prepared according to a 2014 Ministerial Or- der. Page 5 Detailed findings and recommendations were endorsed by the Government.

Global Immunization News (GIN) October 2016

Meeting of the Regional certification commission for the polio endgame

Cristina Pedreira, Gloria Rey-Benito, Elizabeth Thrush and Andrea Villalobos, Pan American Health Organization Location: Washington DC, USA Date: 26-28 July 2016 Participants: Members from the Regional Certification Commission (RCC) and staff from the United States Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and PAHO’s Comprehensive Family Immunization Unit (FGL/IM).

Purpose: 1. To review the final country reports on the supervision of the Participants in the 5th Meeting of switch from the trivalent oral polio vaccine (tOPV) to the biva- the Regional Certification Com- lent oral polio vaccine (bOPV); and mission (RCC) for the Polio End- 2. To review the advances of the country reports for the con- game held in Washington DC, tainment of wild poliovirus (WPV), vaccine-derived polio virus USA, 26-28 July 2016. (VDPV) and the Sabin type 2 virus. Details: Summary of the revision of the country switch reports 36 countries in the Americas participated in the globally-synchronized switch from tOPV to bOPV in April 2016. All of the countries carried out independent monitoring of the switch in the two- week period following their national switch date and continued supervision of the switch in 100% of the warehouses and vaccination service points in the three months following the switch. For the revision of the final switch reports, the RCC considered the following essential information: • Signature of the country • Validation of the report by the national certification commission (NCC) with signature • 100% of warehouses supervised • 100% of the vaccination services supervised • Verification that all leftover tOPV was destroyed

The RCC concluded that 29 reports contained the essential information and requested additional information from five of these countries (Bahamas, Bolivia, Montserrat, Suriname, and Trinidad and Tobago). The rest of the country reports were not complete and will be revised again at the next RCC meeting.

Summary of the WPV/VDPV/Sabin2 Reports: The 23 expected reports on the containment of WPV, VDPV and Sabin 2, corresponding to 22 countries and one sub-regional report for the Caribbean include 13 countries, 6 UK territories and 3 associate member states.

Reports were shared with the RCC members prior to the meeting. The analysis of the reports included the verification of the content and the clarity of the information requested in the model report template.

As of July 2016, the RCC had received 22 of 23 reports (21 country reports and the sub-regional Caribbean report). Uruguay is the only country that had not presented the RCC a report on poliovirus containment.

Six countries have declared to have WPV/VDPV infectious material; nine countries have reported infectious Sabin 2 material; seven countries have reported potentially infectious WPV/VDPV materials and 13 countries reported potentially infectious Sabin 2 material.

Brazil, Canada, Cuba, Mexico and USA have notified interest in designating Poliovirus Essential Facilities (PEF).

PAHO will continue working with the countries in the Americas to finalize the inventory of facilities with infectious and potentially infectious WPV, VDPV and Sabin 2 material, related to Phase I of GAPIII, as well as consolidating the Phase II containment of these materials and the certification of the poliovirus essential facilities, as defined by the GAPIII. Page 6

Global Immunization News (GIN) October 2016

Workshop on the surveillance of diseases being eliminated and eradicated Yenny Rocio Neira, PAHO-Dominican Republic; Patricia Grullon, Zacarias Garib Arbaje, Ministry of Public Health- Dominican Republic Location: Santo Domingo, Dominican Re- public Date: 18-26 August 2016 Participants: Those responsible for epidemiological surveillance in municipal hospitals, epidemiologists in the provincial directorates (subnational level) and the team from the National Immunization Pro- gramme. Purpose: To strengthen the technical capacity of those responsible for epidemiology at the local and Participants in the regional subnational level on the epidemi- workshop in Barahona. August 2016. ological surveillance of febrile Credit: Yenny Neira - PAHO/WHO. rash illnesses (measles-rubella) and acute flaccid paralysis (poliomyelitis). Details: In the framework of the country’s national plan to sustain measles, rubella and congenital rubella syndrome elimination, and also considering recommendations from the International Expert Committee for the verification of the elimination of these diseases, it is a priority for the country to conduct activities that are oriented towards strengthening the epidemiological surveillance of vaccine-preventable diseases.

To this end, the Expanded Programme on Immunization (EPI), with support from PAHO/WHO, organized nine regional workshops focused on strengthening the technical capacity of epidemiologists at the local and subnational levels, emphasizing the surveillance processes (detection, reporting, research, control activities) in addition to information quality.

Two-hundred and seventy participants attended these nine regional workshops. Out of this total, 14.8% (40/270) were epidemiologists from the subnational level and 85.2% (230/270) were epidemiologists from hospitals at the local level.

The methodology established for these workshops included an evaluation of the participants with the objective of determining their knowledge on the surveillance procedures of these diseases, a description of the execution of the surveillance processes according to management level and the identification of factors that influence the accomplishment of these indicators.

Through interactive conferences and analyzing the reporting charts from different provinces, the participants identified aspects like case definitions, reporting opportunities, sampling, household research, development of control actions and data quality, as well as remembering the history of each of the diseases emphasized in the workshop.

During these workshops, the epidemiologists received a mini flipchart or “pocket flipchart” that will facilitate consulting on basic definitions and procedures, as well as facilitate the transference of knowledge to colleagues from other institutions.

Some of the most important results from this workshop were identifying the current challenges related to knowledge and the performance of epidemiological services at the local level, as well as possible improvement strategies that will allow for the establishing of an operational plan, the execution of which may positively influence results from the country’s indicators. Page 7

Global Immunization News (GIN) October 2016

Training workshop on Adverse Events Following Immunization monitoring Ananda Amarasinghe, Syed Shah and Jinho Shin, WHO Regional Office for the Western Pacific and Siddhartha Datta and Sengphet Phongphachanh, WHO Country office, Lao People's Democratic Republic

Location: Vientiane, Lao People's Democratic Republic Date: 23-25 August 2016 Participants: About 30 participants from the Ministry of Health of Lao People's Democratic Republic Food & Drug Food Department; National Im- munization Programme; Provincial government officials, and hospital clinicians Purpose: (1) to provide technical assistance on strengthening the country’s pharmacovigilance system to detect, report and respond to adverse events following immunization (AEFI) and

adverse drug reactions (ADR) ;

(2) to review AEFI surveillance practices in Lao PDR with an emphasis on identifying bottle necks in AEFI detection and reporting, and discuss corrective action using root cause analysis of AEFI under reporting and investigations of serious AEFI; and (3) to provide updates on the AEFI surveillance and communication guidelines published

by WHO’s Regional Office for the Western Participants in the Training Workshop on Ad- Pacific. verse Events Following Immunization Monitoring Details: The three-day workshop comprised of two components: (a) to conduct a two-day national- level training of trainers on adverse events following immunization monitoring and adverse drug reaction monitoring in the context of vaccine quality, and (b) a one-day field visit to a national hospital in Vientiane capital to gain a hands-on experience .

Overall, the country’s vigilance system is making progress in both ADR and AEFI surveillance. An institutional development plan is being implemented according to the roadmap developed after the June 2015 joint validation of NRA self-assessment. Yet further strengthening of AEFI detection, reporting and investigation, and causality assessments of serious AEFI are important, as safety concerns exist. Data quality and sharing processes need to be strengthened along with human resource management, supported by adequate and competent staffing to carry out vigilance activities in the country. This is particularly vital where the private sector is slowly growing to provide immunization services, requiring appropriate regulation to ensure quality-assured vaccines.

The next step for the government will be to establish a statutory national and provincial AEFI and/or ADR committee, to bring together all national stakeholders, enhancing AEFI case reporting of and response to both serious and non-serious events, and conducting subnational trainings at all provinces.

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Global Immunization News (GIN) October 2016

Meeting of a home-based record working group Marta Gacic-Dobo, WHO and David Brown, Brown Consulting Group International, LLC Location: Swiss Tropical and Public Health Institute, Basel, Switzerland Date: 8-9 September 2016 Participants: WHO, UNICEF, Gavi Secretariat, CDC, JSI, JICA, Swiss TPH, gravitytank, Claro Partners, Bill and Melinda Gates Foundation Purpose: To discuss the development of a roadmap for coordinating and prioritizing on-going and future work needed to improve the availability, adoption and appropriate utilization of well-designed home-based records within immunization service delivery and primary care more broadly. Participants at the HBR working group Details: A group of global stakeholders has been working to study and advocate for effective functional design and wider use of home-based records (HBRs) as a critical tool within immunization systems and primary care more broadly. Their activities have included raising awareness of the challenges in many communities, either because the HBR is not available, not adopted and/or not appropriately utilized by caregivers and/or health workers.

This overall effort has led to the development of online and physical repositories of HBRs, the development and publication of the WHO Practical Guide for HBR design; ongoing research on factors associated with HBR ownership; a collaborative workshop in South Asia focused on HBR re-design and opportunities therein; and on-going work by John Snow, Inc (JSI) to study HBR re- tention and use. In order to extend and increase the impact of their work, the stakeholders met to discuss the development of a joint agenda for action to improve coordination and alignment on priorities for both research and other activities going forward.

A summary of the 2-day discussion is located online. Additional developments will be highlighted as they become available.

SUBSCRIBE NOW VIEW PREVIOUS EDITIONS Send an email to [email protected] For previous editions of the GIN, with the following text in the body of the email: visit the GIN archive on the WHO website: subscribe GLOBALIMMUNIZATIONNEWS www.who.int/immunization/gin Page 9

Global Immunization News (GIN) October 2016

Statistical training on the 2015 WHO vaccination coverage survey reference manual Carolina Danovaro and Marta Gacic-Dobo, WHO Headquarters Location: Madrid, Spain

Date: 19-23 September 2016 Participants: Persons from National Bureaus of Statistics, Stats departments in Ministries of Health, Research Insti- tutes and independent consultants from Brazil, Burki- na Faso, Cambodia, Cameroon, Côte d’Ivoire, Ethio- pia, Indonesia, Laos, Lebanon, Mongolia, Nepal, Paki- stan, Spain, St. Lucia, Swaziland, Switzerland, and the United States (US), JSI and PATH. Facilitators from WHO, UNICEF, US Centers for Disease Control and Prevention (US CDC) and consultants to the Bill & Melinda Gates Foundation (BMGF). Purpose: To have participants: Participants in the statistical training on the 2015  Understand the recommendations from the WHO Vaccination coverage survey reference WHO Vaccination Coverage Cluster Survey Ref- manual erence Manual  Recognize the most common immunization indicators obtained from vaccination coverage surveys  Recognize the tasks in vaccination coverage survey planning which require statistician expertise  Make recommendations regarding sampling design and sample size in different settings  Determine appropriate adjustments to make when encountering challenges in the field  Calculate sampling weights and use them as well as the design features to conduct data analysis  Use “Vaccination Coverage Quality Indicators (VCQI)” or other analysis programmes to analyze survey data

Details: This training was one of the first activities aimed at preparing a cadre of statistics professionals who can be mentored to serve consultant or advising statisticians for vaccination coverage survey design and implementation using the 2015 working draft of the WHO Vaccination Coverage Clus- ter Survey Reference Manual. Work was organized in four groups using a mix of presentations and group work, using practical exercises and a case study. Evaluation forms completed by participants were very positive on the overall training.

While the statistical methods outlined in the Survey Manual (particularly related to probability sampling) are commonly used in large health surveys such as Demography and Health Surveys (DHS) and UNICEF’s Multiple-Cluster Indicator Surveys (MICS), immunization programmes are less familiar with them and will likely lack the expertise needed to properly conduct the sampling and analyses recommended in the Survey Manual. To this end, this training was a step towards exploring the concept of outsourcing survey data analyses to institutions with statistical expertise, in a manner that not only ensures technical quality, but also promotes capacity-building on survey statistics in countries where vaccination coverage surveys are to be implemented.

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Global Immunization News (GIN) October 2016

Fifth workshop for National Regulatory Authorities for vaccines in Western Pacific Re- gion Cheryl V. Legaspi, Jinho Shin and Syed Shah, WHO Regional Office for the Western Pacific Location: Manila, Philippines Date: 28-29 September 2016 Participants: Representatives from 12 member states (Australia, Cambodia, China, Lao People's Demo- cratic Republic, Malaysia, Mongolia, New Zealand, Papua New Guinea, Philippines, Republic of Ko- rea, Singapore, Viet Nam), 4 temporary advisers from WHO collaborating centres (Australia, Chi- na, Japan, Republic of Korea) and observers from Japan International Cooperation Agency (JICA), and WHO, Headquarter and Regional Office for Western Pacific and South-East Asia. Purpose: (1) to review the progress against the objec- Participants in the Re-validation of National Regula- tives of the Alliance; tory Authority Self-assessment for Vaccine and (2) to discuss and identify opportunities for Medicine Regulation in Mongolia the regional adaptation of newly proposed global

policy on regulatory assessment; and

(3) to review and identify options for collaborative actions for regulatory systems strengthening in the Region.

Details: The National Regulatory Authorities (NRAs) for vaccines in the WHO Regional Office for the Western Pacific meets annually to address regulatory issues, particularly on vaccines. The Fifth NRA Workshop acted as a window of opportunity to discuss the WHO reforms on regulatory systems strengthening policy, methodology, global benchmarking tool and pathway in accordance to World Health Assembly (WHA) resolution 67.20.

The Alliance, at its fifth meeting, reached a consensus on adopting the WHO NRA global benchmarking tool (GBT) and pathway for regulatory system strengthening with alignment to the WPR Universal Health Coverage (UHC) action framework, in addition to the regional framework for the implementation of the Global Vaccine Action Plan (GVAP).

The Alliance noted survey results from regional NRAs and approved the expansion of the scope of the Regional Alliance for NRAs from vaccines alone to include all other medical products gradually including essential medicine, diagnostics and traditional medicine. A consensus was also reached on establishing a technical group to review and amend the regional alliance’s concept paper for national regulatory authorities in the WPR.

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Global Immunization News (GIN) October 2016

Joint international and national EPI and Vaccine Preventable Disease Surveillance review in Myanmar 26 September to 08 October 2016 Rajendra Bohara and Sigrun Roesel, WHO Country Office, Myanmar Location: Myanmar Date: 26 September - 8 October 2016 Participants: 11 teams composed of international and national/subnational members; representing the Ministry of Health and Sports, WHO, UNICEF, US Centers for Disease Control and Pre- vention (CDC), Gavi, the Vaccine Alliance, and the Bill & Melinda Gates Foundation. Purpose: • To understand which children in Myanmar are not being fully immunized and the reasons this is occurring; • To determine if the VPD surveillance system meets national and global targets and is currently able to detect any VPD outbreaks;

• To determine if the strategies being implemented for achieving measles elimination and

rubella/congenital rubella syndrome control targets by 2020 are adequate to reach the targets; • To assess how EPI strategies and capacities need to be strengthened to sustain polio-free status and maternal and neonatal tetanus elimination, accelerate hepatitis B control and uni- formly increase coverage for all routine vaccines.

Details: Overall conclusions of the review included strong evidence of increasing government commitment with increased funding, committed and hard-working staff and successful introduction of new vaccines, with a dramatic decrease in VPDs. Still, complex factors lead to pockets of un- immunized children. The AFP surveillance is the strongest system but there are gaps; other VPD surveillance is adequate to detect outbreaks but has to be strengthened to guide the programme. There is a need to plan for sustainability after HSS2 and vaccine self-sufficiency by 2025.

In addition, this review was combined with an outbreak response assessment (OBRA), in follow-up to two polio cases caused by circulating type 2 vaccine derived poliovirus (9cVDPV2) reported from Rakhine State in 2015. A three-month OBRA conducted in early 2016 had mainly identified requirements for strengthening acute flaccid paralysis (AFP) performance and conducting a fifth round of polio supplementary immunization activities (SIA) to further close immunity gaps.

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Global Immunization News (GIN) October 2016

Seventh WHO & UNICEF meeting on “monitoring and analyses of National Immunization performance" Laure Dumolard and Jan Grevendonk, WHO HQ Location: Kigali, Rwanda Date: 11-14 October 2016 Participants: WHO: Country offices (DRC, Ethiopia, Ghana, Kenya, Nige- ria, Pakistan and Rwanda), AFRO ISTs, Regional Offices, Headquarters; UNICEF: regional offices (ESARO, MENA and WCARO), Headquarters; Ministry of Health representatives from DRC, Ethiopia and Rwanda; Partners: Bill & Melinda Gates Foundation (BMGF), Gavi, John Snow inc. (JSI), PATH, The Centers for Disease Control & Prevention (CDC) and the European Centre for Disease Prevention and Control (ECDC). Purpose: WHO & UNICEF jointly collect and disseminate annual infor- Participants in the 7th WHO & mation on the structure, policies, performance, and impact of UNICEF Meeting on “Monitoring national immunization systems. The first part of this meeting and analyses of National Immuniza- aimed to facilitate continued collaboration between WHO and tion Performance" UNICEF, to minimize the reporting burden on countries while ensuring that all relevant data to monitor immunization systems and vaccine-preventable diseases are systematically col- lected, and to ensure that data at all levels are consistent. The second part of the meeting served to discuss strategies for improving the quality and use of immunization and surveillance data, and to discuss ways to collaborate across an expanding network of partners to reach common data quality objectives. Details: During the first two days of the meeting, participants reviewed proposed modifications to the core reporting form for data collection during 2017-2018, agreed on actionable recommendations to strengthen the data collection and data validation processes, agreed on the modalities to share the subnational administrative coverage data with HQs, and established the schedule for finalization, transmission to national programmes, analysis, and dissemination of these data.

The main recommendations and outcomes of the meeting were to strengthen the WHO/ UNICEF collaboration in all steps of the Joint Reporting Form (JRF) process, to strengthen the governance of the JRF and to increase information sharing and communication, especially in the area of data use.

In the second part of the meeting, participants brainstormed on challenges and areas for improvement in the availability, quality, and use of data at local, national, regional, and global level. This resulted in a long list of detailed action points, which were grouped in these seven areas: 1. Strengthen methods and practices for Data Quality Assessment and Improvement Planning 2. Invest in workforce development using innovative adult learning methods and tools 3. Make tools and systems more user-centered and responsive to programme needs 4. Strengthen national monitoring and surveillance processes and governance 5. Strengthen global monitoring and surveillance processes and governance 6. Make better use of innovative visualizations and data for communications about immunization 7. Use targeted operational research to address the gaps in knowledge about barriers and solu- tions in data use and quality A detailed meeting report with more specific recommendations on how to achieve these aspira- tions will be published on the Technet21 website.

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Global Immunization News (GIN) October 2016 Resources Re-introducing the EPI country profiles Olivier Beauvais, Carolina Danovaro and Lau- re Dumolard WHO/HQ

Through the WHO platform for vaccine- preventable disease data, a range of monitoring information is available on all Member States, in an easily searchable format. Includ- ed is population data, numbers of reported cases, the percentage target population vac- cinated by antigen, the country’s latest available immunization schedule, and a full retro- spective of the WHO/UNICEF coverage estimates.

In a new development, the country profiles have just been updated to include graphs of indicators over time (since 1980!) that dis- play:  The reported occurrence of vaccine- preventable diseases by year DTP3 reported coverage and the WHO/UNICEF Estimates of National  Measles cases and MCV1 coverage, plus Immunization Coverage (WUENIC), with the number of doses SIAs for measles, in one graph administered.  Reported coverage and the WHO/ UNICEF Estimates of National Immunization Coverage (WUENIC), but also on the number of doses administered. These graphs allow you to have an idea of whether the coverage follows the number of reported doses (as it should be) or if there are funny patterns. For example, drops in number of doses given with no resulting drop in coverage or reported coverage that have jumps, that would alert you of data quality issues. As an example, see this link.  District classification based on levels of coverage data (NB. district level data is less reliable than national data, however can still offer an indication of improvement or not) In this example, you can see how the proportion of districts <50% decreases and the one >80% increases, example at this link.

Also available is a free immunization summary app, also offering full access to all of the WHO data and the new country profiles.

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Global Immunization News (GIN) October 2016

Calendar 2016

November

1-5 Regional Training Workshop on Improvement of Immunization Data Quality and Cairo, Egypt Implementation of Vaccination Cluster Coverage Survey 9-11 Twenty-Second Regional Commission for the Certification of Poliomyelitis Eradi- Australia cation in the Western Pacific Region 14-18 Global Sentinel Site Surveillance and Laboratory Meetings Geneva, Switzerland 15-17 22nd meeting of the regional commission for the certification of poliomyelitis Sydney, Australia eradication in the Western Pacific Region 17-18 Technical Advisory Group meeting of the WHO/PATH Maternal Influenza Im- Geneva, Switzerland munization Project 18Nov- Caribbean EPI Managers Meeting Grenada 2Dec 21-24 Ninth Meeting of the South-East Asia Regional Commission for the Certification New Delhi, India of Polio Eradication (SEA-RCCPE) 23-25 Gavi AFRO East and South Sub-Regional Working Group meeting Nairobi, Kenya 29-30 MNTE Stakeholders’ Meeting and technical meeting New York, USA

December

7-8 Meeting on Costing of Vaccine-Preventable Disease Surveillance Geneva, Switzerland 7-8 22nd meeting of the EMRO Regional Working Group on Gavi Amman, Jordan 7-10 9th Meeting of the South-East Asia Regional Commission for the Certification of Sri Lanka Polio Eradication (SEA-RCCPE) 8-9 AFRO Technical Advisory Group meeting Brazzaville, DRC 12-13 Regional Immunization Technical Advisory Group (RITAG) Dakar, Senegal 14-15 Gavi AFRO West and Central Regional Working Group meeting Dakar, Senegal

2017

January

10-11 Scientific Consultation on Zika Vaccine Development Rockville, MD USA 16Jan- 140th Executive Board Geneva, Switzerland 1Feb 24-26 Gavi Joint SEARO and WPRO Regional Working Group Meeting Bangkok, Thailand

April

25-27 Meeting of the Strategic Advisory Group of Experts (SAGE) on Immunization Geneva, Switzerland

May

15-31 70th World Health Assembly Geneva, Switzerland

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Global Immunization News (GIN) October 2016 Links Organizations and Initiatives

American Red Cross Sabin Vaccine Institute Child Survival Sustainable Immunization Financing

Agence de Médecine Préventive UNICEF Africhol Immunization EpiVacPlus LOGIVAC Project Supplies and Logistics National Immunization Technical Advisory Groups Resource Center USAID SIVAC Maternal and Child Health Integrated Program

Centers for Disease Control and Prevention WHO Polio Department of Immunization, Vaccines & Biologicals Global Vaccines and Immunization New and Under-utilized Vaccines Implementation ICO Information Centre on HPV and Cancer Johns Hopkins Immunization financing International Vaccine Access Center Immunization service delivery VIEW-hub Immunization surveillance, assessment and monitoring SIGN Alliance JSI IMMUNIZATIONbasics Immunization Center Other Maternal and Child Health Integrated Program (MCHIP) Coalition Against Typhoid Publications and Resources Dengue Vaccine Initiative Universal Immunization through Improving Family Health Ser- European Vaccine Initiative vices (UI-FHS) Project in Ethiopia Gardasil Access Program Gavi the Vaccine Alliance PAHO International Association of Public Health Logisticians ProVac Initiative International Vaccine Institute Measles & Rubella Initiative PATH Multinational Influenza Seasonal Mortality Study Vaccine Resource Library Network for Education and Support in Immunisation (NESI) Rotavirus Vaccine Access and Delivery TechNet-21 Malaria Vaccine Initiative Vaccines Today Meningitis Vaccine Project RHO Cervical Cancer WHO Regional Websites UNICEF Regional Websites Routine Immunization and New Vaccines (AFRO) Immunization (Central and Eastern Europe) Immunization (PAHO) Immunization (Eastern and Southern Africa) Vaccine-preventable diseases and immunization (EMRO) Immunization (South Asia) Vaccines and immunization (EURO) Immunization (West and Central Africa) Immunization (SEARO) Child survival (Middle East and Northern Africa) Immunization (WPRO) Health and nutrition (East Asia and Pacific) Health and nutrition (Americas)

Newsletters

Immunization Monthly update in the African Region (AFRO)

Immunization Newsletter (PAHO)

The Civil Society Dose (GAVI CSO Constituency)

TechNet Digest

RotaFlash (PATH)

Vaccine Delivery Research Digest (Uni of Washington)

Gavi Programme Bulletin (Gavi)

The Pneumonia Newsletter (Johns Hopkins Bloomberg School of Public Health) Page 16