2005

..

. .

Introduction of New and Underutilized Vaccines:

AssuringAssuring VaccineVaccine SuppliesSupplies forfor thethe AmericasAmericas

. Immunization Unit Family and Community Health 2005 ObjectivesObjectives

• Review Regional Program Strategies

• Discuss PAHO’s Approach of Technical Assistance to Countries

• Highlight importance of sustaining vaccine supplies for new products 2005 RegionalRegional ProgramProgram StrategiesStrategies

• Eliminate rubella and congenital rubella syndrome

• Sustain progress of measles elimination

• Sustain progress in polio eradication

• Strengthen information management

• Introduce new and underutilized vaccines 2005

FrameworkFramework forfor PolicyPolicy DevelDeveloopmentpment

Components PAHO Involvement InstrumentsInstruments TechnicalTechnical •• DiseaseDisease burdenburden •• Surveillance,Surveillance, capacitycapacity developmentdevelopment •• Cost-effectivenessCost-effectiveness datadata •• RiRisksk evalevaluatiuationon •• EconomEconomicic impactimpact •• AdverseAdverse eventsevents •• FinancialFinancial feasibilityfeasibility && sustainabilitysustainability AdvocacyAdvocacy ResultsResults •• Advocacy,Advocacy, DirectingDirecting CouncilCouncil •• PoliticalPolitical willwill ManagerManageriialal ManagementManagement •• RevolvingRevolving FundFund •• Post-marketingPost-marketing surveillancesurveillance •• PartnershipsPartnerships (( ICCs,ICCs, ADIPs,ADIPs, GAVI,GAVI, •• AccurateAccurate demanddemand forecastingforecasting IFFIm)IFFIm) •• LogisticalLogistical issuesissues •• ColdCold chain,chain, scheduleschedule •• PartnershipsPartnerships 2005 PAHO’sPAHO’s CChallenge:hallenge: PromotingPromoting EquityEquity 13

Industrialized countries 12 Influenza* Pneumococcal * 11 Latin America and the Caribbean Meningococcal*

Varicela 10 Haemophilus Influenzae b

9 Rubella Mumps 8 Hepatitis B** 7

6 Measles, DPT Poliomyelitis, BCG 5 1975 1980 1985 1990 1995 2000-5

*Estimated future use **Used in ~ 50% of global birth cohort 2005 RegionalRegional prioritiespriorities forfor introductionintroduction ofof newnew andand under-utilizedunder-utilized vaccinesvaccines

DefiniteDefinite prioritiespriorities (very(very LessLess definitedefinite (very(very lowlow highhigh diseasedisease burden)burden) perceptionperception ofof riskrisk oror lowlow diseasedisease burden)burden) •• PneumococcalPneumococcal vaccinevaccine •• VaricellaVaricella vaccinevaccine •• RotavirusRotavirus vaccinevaccine •• HepatitisHepatitis AA vaccinevaccine •• UnderutilizedUnderutilized YFYF andand ••IIPVPV influenzainfluenza vaccinesvaccines •• OthersOthers (e.g.(e.g. enteric)enteric) •• HPVHPV vaccinevaccine 2005 WhyWhy Rotavirus?Rotavirus?

•• GlobalGlobal partnershippartnership –– CCountryountry interestinterest –– GGAVI,AVI, IFFIm,IFFIm, Gates,Gates, andand DonorDonor countriescountries –– WWHO,HO, PAHO,PAHO, UNICEF,UNICEF, BanksBanks –A–ADDIIPP//RRVVPP –– VVaccineaccine supplierssuppliers

•• HospitalHospital basedbased surveillancesurveillance studiesstudies underwayunderway inin 1313 countriescountries ((HON,HON, VEN,VEN, ELS,ELS, PAR,PAR, TRT,TRT, GUY,GUY, SUR,SUR, STV,STV, URU,URU, ARG,ARG, CHI,CHI, COL,COL, GUTGUT && 33 othersothers scheduledscheduled forfor latelate 2005,2005, BOL,BOL, PER,PER, BRA)BRA)

•• VaccineVaccine availabilityavailability -- 2006:2006: GSGSKK (Rotarix),(Rotarix), MerckMerck (Rota(Rota Teq)Teq) 2005 EstimatedEstimated DemandDemand forfor RVRV VaccineVaccine inin thethe Americas,Americas, 20062006

25

20 67%

illion) 15 M (

s 10 e s o

D 5

0 Potential Demand Initial Forecast 2006

Other Countries Priority Countries+

+Priority Countries = GAVI Calculation: DPT Covg * <1yr *2dose *5%wastage countries **Source: PAHO 173 2005 PAHOPAHO DirectingDirecting CouncilCouncil PanelPanel withwith MinistersMinisters ofof HealthHealth && FinanceFinance SeptSept 28th28th

–– TheThe UnfinishedUnfinished Agenda:Agenda: – PAHO Representative AchievingAchieving thethe MDGsMDGs withwith – PAHO Representative ImmunizationImmunization

–– PPromotingromoting && StrengtheningStrengthening –– GGatesates FoundationFoundation Rep.Rep. PartnershipsPartnerships

–– PPolicyolicy Development:Development: –– IIMFMF RepresentativeRepresentative CreatingCreating FiscalFiscal SpaceSpace 2005 IntroductionIntroduction ofof InfluenzaInfluenza VaccineVaccine

Bermuda - 1999

Bahamas - 1994 Cuba - 1999 México - 1997 Cayman Islands - 1980

St. Vincent and the Grenadines - 2003

Honduras - 2003

El Salvador - 2004

Costa Rica - 2004

Colombia - 2005 Brasil - 1999

Paraguay 2005

Chile - 1975 Uruguay - 1996

Argentina - 1993

Source: EPI Managers survey 2005 LessonsLessons LearnedLearned

•• SuccessfulSuccessful experiencesexperiences introducingintroducing influenzainfluenza vaccinevaccine exist.exist. TargetTarget populationpopulation variesvaries byby country.country.

•• TheThe betterbetter useuse ofof vaccinesvaccines forfor seasonalseasonal epidemicepidemic willwill helphelp toto ensureensure thatthat supplysupply capacitycapacity meetsmeets demanddemand inin aa futurefuture pandemic.pandemic.

•• InternationalInternational biddingbidding andand procurementprocurement –– twotwo annualannual bidsbids (North(North vsvs SouthernSouthern Hemisphere)Hemisphere) –– IdentifyIdentify additionaladditional sourcessources ofof vaccinevaccine 2005

InfInfllueuenznzaa:: NNoo.of.of dosdoseess purpurcchhaasseedd,, prpricicee ttrreendnd && ccountountrriieess paparrtticicipaipattinging tthhrruu EEPPI-I-RRFF 1414 66

1212 55 ) ) s 1010 s

4 n 4 n s s e e i i illio illio r 8 r 8 m 33 m ( ( s s ount ount 6

6 e e C s C s o 44 22 o D 44 33 D 1 22 22 1

00 00 20032003 20042004 20052005 DDoosesses ppuurrchchasedased ForForeeccaasstteedd dedemmaandnd CCountountrriieess NNoo.. SSuupppplielierrss 2005 PolicyPolicy FrameworkFramework forfor InfluenzaInfluenza

• Assist countries in establishing and implementing strategies to increase routine vaccination coverage for people at high risk. • Goal: Vaccinate > 50% of the elderly by 2006 and >75% by 2010.

• Develop & implement national plans for preparedness plans for pandemic.

• Support research and development to improve influenza vaccines 2005

InfluenzaInfluenza PandemicPandemic •• GlobalGlobal andand RegionalRegional publicpublic healthhealth prioritypriority

•• VaccineVaccine supplysupply challengechallenge –– DDialogueialogue withwith supplierssuppliers toto createcreate aa strategicstrategic alliancealliance –– DDialogueialogue withwith countriescountries toto improveimprove accessaccess toto supplysupply (Pan(Pan Americanism)Americanism) –– SSupportupport clinicalclinical trialstrials e.g.e.g. useuse ofof adjuvantadjuvant toto decreasedecrease thethe antigenantigen dosedose –– SSupportupport technologytechnology transfertransfer (Brazil,(Brazil, Mexico)Mexico) –– PPromoteromote strategicstrategic stockpilestockpile

•• DemandDemand ForecastingForecasting –– EEstimatestimate countrycountry needsneeds inin ththee contextcontext ofof preparednesspreparedness planplan inin advanceadvance ofof thethe nextnext bidbid –– MMobilizeobilize resourcesresources 2005 ScenariosScenarios forfor InfluenzaInfluenza Pandemic,Pandemic, VaccineVaccine Requirements,Requirements, && CostsCosts

Scenarios Total Physicians Nurses Nurse Total Total doses (2 Total Cost US$ Population (millions) (millions) Aide Health doses scheme) millions (millions) (millions) Personnel (millions) (millions)

1 543 0.97 0.45 3.1 4.6 9.2 23

2 259 0.5 0.23 1.6 2.4 4.8 12

3 126 0.22 0.1 0.7 1.06 2.12 5.3

Assumptions: Vaccination of first responders (health workers and others)

Scenarios:

1.Latin America and the Caribbean 2.Excluding countries with production capacity: Brazil and Mexico 3.Excluding countries with purchasing power capacity: Brazil, Mexico, Colombia, Venezuela, Costa Rica, Chile, Argentina and Uruguay