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The information contained in this Newsletter depends upon your contributions Please send inputs for inclusion to: [email protected] 30 January 2007

TECHNICAL INFORM ATION 2007. The first one has already begun in some countries, and has the main objectives of: ñ Reviewing the situation in each trainee‘s CAPACITY BUILDING & TRAINING district, and 30/01/07 from Chris Nelson, Merck: Request ñ Identifying main problems to be resolved. for Applications: Merck Network œ In addition to the interactive CD-ROM with a Africa (MVN-A) revision of the courses trainees have had during MVN-A is an initiative designed to provide training November 2006, they will receive three distance for mid- to high-level immunization program learning CD-ROMs. The first one which focuses on managers focused on improving immunization , NIP budget, costs and efficiency coverage for children. In 2003, the Merck will be delivered in March 2007. Company Foundation awarded two grants to establish MVN-A training Centers in Kenya and Mali. GLOBAL ADVISORY COMMITTEE The Merck Company Foundation recently proposed ON VACCINE SAFETY (GACVS) expanding the scope of MVN-A to include an 30/01/07 from Philippe Duclos, WHO/HQ: additional training center in a GAVI-eligible country The GACVS was established by WHO to deal with in Africa. The application deadline is 26 February vaccine safety issues of potential global 2007. The RFA and Training Grant Application importance independently from WHO and with th Form may be found at: scientific rigour. GACVS held its 15 meeting in www.merck.com/cr/enabling_access/developing_w Geneva, on 29-30 November 2006. orld/. The committee discussed a number of general For more information, contact Kris Natarajan at +1 issues: Discussions of vaccine-specific issues 215 652 7487 or [email protected] pertained both to longstanding vaccines as well as 30/01/07 from Anais Colombini, AMP: The new vaccines or vaccines still under development. fourth session of EPIVAC training program ended These issues included the safety of vaccine in November 2006, with the Operational Research formulations; problems with coincidental Thesis viva. It took place at the WHO Regional pathologies and safety assessments when Institute for Public Health (IRSP) in Ouidah, Benin. vaccinating adolescents and young adults; safety The international board of examiners was of vaccine strains, safety of BCG vaccine composed of teachers from the two universities in HIV-infected children; safety of Japanese which deliver the diploma (Paris Dauphine and Encephalitis in , and the safety of Cocody-Abidjan universities), as well as teachers conjugate pneumococcal vaccines. The report of from EPIVAC beneficiary countries‘ universities. Of the meeting was published in the WHO Weekly the 41 thesis‘s defended, 39 passed. Epidemiological Record in English and French on At the same time, the fifth EPIVAC session has 19 January 2007: begun with a four week course on Vaccinology and http://www.who.int/vaccine_safety/reports/GACV Management of Vaccine Preventable Diseases. This S_report_WER_Jan07.pdf session has 50 attendees from Benin (7), Burkina At the request of SAGE, the committee reviewed Faso (6), Cote d‘Ivoire (6), Mali (6), Mauritania (5), the safety of pneumococcal conjugate vaccines. A Niger (7), Senegal (7) and Togo (6). comprehensive review of all evidence on the It will be followed by four supervisions for each safety of pneumococcal conjugate vaccines was trainee, between mid-January and September conducted and presented. Data from 62 studies,

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including randomized controlled trials and post- HIB, PNEUMOCOCCAL DISEASES & marketing studies were included in the review. YELLOW FEVER While there has been a weak and inconsistent 30/01/07 from Patrick Zuber, WHO/HQ: signal of increases in reactive airway conditions in WHO website on Hib disease prevention œ some studies, these apparent effects have not WHO has developed a prototype website on been consistently observed. Haemophilus influenza type b (Hib) disease The evidence on the safety of the 7-valent prevention (www.who.int/nuvi/hib). The website pneumococcal and other includes up-to-date information on disease burden pneumococcal conjugate vaccines is reassuring. data, and graphs and maps to assist local Reports since the licensure of the 7-valent decision-makers and their technical advisers on pneumococcal conjugate vaccine in 2000 and decision-making. widespread use in the and in Canada The website complements the Hib Initiative and some European countries, have not identified website, having information on vaccine utilization, any major safety concerns. There is substantial disease burden and surveillance including evidence that when introduced into developing estimates of mortality, countries with sentinel countries, the presently available pneumococcal sites, indicators for measuring progress, and other conjugate vaccines will have a considerable impact programmatic aspects such as decision making, on pneumococcal disease and overall infant vaccine products and financing. In addition, the mortality. Nevertheless, as with the introduction of site has updated information on upcoming events any new vaccine, it will be important to conduct related to Hib and links to other useful resources surveillance for possible rare and unexpected side on Hib vaccines. effects. 30/01/07 from Patrick Zuber, WHO/HQ: On the issue of coincidental pathologies and safety Forum on Hib, pneumococcal diseases and assessments when vaccinating adolescents and yellow fever for Francophone African young adults, there is likely to be an increased countries œ was convened by the Regional Office focus on the vaccination on adolescents both for for Africa in Brazzaville, Congo from 17-19 new vaccines, such as HPV vaccines, and for some January 2007. The meeting gathered technical previously available vaccines. The committee was staff and senior decision makers from 18 presented with preliminary modelling work Francophone and two Portuguese-speaking performed using health utilization data from a African countries. Like previous regional forums health maintenance organization (a type of private on Hib, the key elements for decision-making and health insurer) in the United States. This work implementation of Hib vaccines were discussed in indicates there is a high likelihood of the detail through plenary presentations and group coincidental occurrence of various pathologies in work. close proximity to . This is especially The recent WHO position paper, GAVI phase 2 the case for gynaecological and autoimmune policies, and improving vaccine supply were all disorders, such as observations may lead to public elements that provided great encouragement to concern about vaccine safety. The committee the delegations about heptavalent pneumococcal recognized that this issue deserves more attention. vaccine were also presented. At the end of the Countries moving towards introducing vaccines meeting, each country had disease control in aimed at adolescents and young adults should 2007. This included the finalization of the cMYP, endeavour to secure population-specific and age- preparation of applications to GAVI, specific baseline rates of specific conditions in the communication and advocacy plans, relevant age-group (for example, the rates of strengthening of surveillance systems and for the autoimmune disease). This will assist any six countries that have already introduced the investigation of safety issues that may surface. Any vaccine, completing post-introduction evaluations signal generated by surveillance will require and vaccine impact assessments. thorough investigation using appropriate The last day of the meeting was dedicated to the epidemiological methods before conclusions can be acceleration of yellow fever control in Africa. drawn. Discussions addressed the GAVI investment case All GACVS reports and additional material relating on yellow fever, vaccine availability and access to the topics discussed at its meetings are posted and a perspective for yellow fever control from on the Committee‘s website at: GIVS. Participants were sensitized on the problem http://www.who.int/vaccine_safety/en/. The of yellow fever in the African region, and were majority of the site is available in Arabic, Chinese, also updated on the strategies for its control. French, Russian and Spanish, in addition to They were also informed of the opportunity of the English. The latest material will be translated and GAVI support for campaigns in 12 countries. posted in the coming weeks. The meeting identified key action points for the implementation of the strategy. Countries committed themselves to the acceleration of

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yellow fever control activities in the African region, The Initiative's strategy consists of four and signed a declaration to that effect. components: the provision of one dose of 30/01/07 from Layla Lavasani. JHSPH: vaccine for all infants via routine health services; WHO Eastern Mediterranean Regional Forum a second opportunity for measles immunization on Hib and use: The for all children, generally through mass inter-country meeting on Hib and Pneumococcal vaccination campaigns; effective surveillance for vaccines-use in the Eastern Mediterranean region measles; and enhanced care, including the was held in Cairo, Egypt from 20-21 November provision of supplemental vitamin A. 2006. WHO/EMRO, the Hib Initiative and the Accelerated measles control activities are also PneumoADIP organized the forum. The meeting contributing to the development of health goal was to increase awareness on pneumonia and infrastructure to support routine immunization burden, share experiences in Hib and other health services through promotion of vaccine use and assess the needs of countries that safe injection practices, increased "" have yet to make a decision concerning the capacity for , and the development vaccine. Sustainability, supply, financing of a global public health laboratory network. mechanisms and surveillance were discussed. Furthermore, measles vaccination campaigns are Participants from over 10 countries, UNICEF, WHO contributing to the reduction of child deaths from and vaccine manufacturers were present, including other causes. They have become a channel for representatives from ministries of health, finance the delivery of other life-saving interventions, and planning. Large contingencies from GAVI such as bed nets to protect against malaria, de- eligible countries were present including Pakistan worming medicine and vitamin A supplements. and Sudan. The next challenge is to reach a new global goal: Many countries from the region are planning to the reduction of global measles deaths by 90 per introduce in their routine EPI within cent by 2010, compared to 2000 levels. This the next year, including Libya, Morocco and means that the gains made in countries that have Djibouti. Other countries like Sudan and Pakistan implemented accelerated measles control have also made a decision to introduce the vaccine strategies must be sustained, and that similar in the near future, with GAVI support. strategies should be implemented in countries with high numbers of measles deaths, such as MEASLES India and Pakistan. 30/01/07 from Alison Brunier & Peter Measles was the first health issue mentioned in Strebel, WHO/HQ: the Director-General's address to the WHO Measles Goal Achievement: A Historic Executive Board on 22 January. Dr Chan termed Victory for Global Public Health the sharp reduction in deaths a "spectacular On 18 January, a press teleconference involving success story." She said that cumulatively, from high-level representatives of the Measles Initiative 2000 to end 2005, WHO estimates that was held to announce the achievement of the accelerated measles immunization activities, 2005 measles mortality reduction goal. WHO was supported by the Measles Initiative, averted 2.3 represented by the Director-General, Dr Margaret million deaths. What made the difference was the Chan, who called the achievement a "historic commitment of leaders, and the caring and cash victory for global public health." of a dedicated partnership. In addition, measles Several print and audio-visual communications control efforts had benefited from the materials were issued, including a joint Measles eradication infrastructure especially the dedicated Initiative news release. These can be found at: field staff. She said she viewed this initiative as a http://www.who.int/immunization/newsroom/meas model of what can be achieved through les/en/index.html. Further information is available integrated service delivery. "This is a value-added on the Measles Initiative web site: approach that amplifies the power of public health," she stated. Director-General's Address to www.measlesinitiative.org th The press conference and release highlighted the 120 Executive Board: great success in reducing measles deaths http://www.who.int/dg/speeches/2007/eb120_op worldwide - a 60 per cent decrease during six ening/en/index.html years of accelerated activities. According to new For more information on the Measles Initiative, WHO data, global measles deaths fell from an please see: http://www.measlesinitiative.org estimated 873 000 deaths in 1999 to 345 000 in 2005. In Africa, the progress has been even POLIO greater, with measles deaths falling by 75 per 30/01/07 from Oliver Rosenbauer, cent, from an estimated 506 000 to 126 000. The WHO/HQ: The New WHO Director-General, Dr. data was published in the Lancet on 20 January Margaret Chan is calling an urgent consultation of (www.thelancet.com). all major stakeholders in polio eradication, to be held on 27-28 February 2007 in Geneva,

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Switzerland. The consultation will critically examine vaccines offering similar or wider protection the capacity to address the operational and becomes available, countries can decide whether financial challenges to finishing polio eradication. to switch to another formulation. The use of PCV- In her invitation letter to stakeholders, Dr. Chan 7 is expected to facilitate the introduction of emphasized that an immediate and fresh surge of future pneumococcal vaccines. commitment is urgently needed from the last four SAGE recognizes that pneumococcal disease is an polio endemic countries and major stakeholders. important cause of serious illness and death The consultation comes as new, targeted among infants and children as well as among eradication strategies are launched in the four older individuals, and particularly those with HIV. remaining polio-endemic countries œ India, Nigeria, The burden of disease is greatest in underserved Pakistan and Afghanistan (See GIN issue populations in developing countries. December 2006). With indigenous transmission of SAGE recognizes that pneumococcal conjugate polio geographically restricted to key, identified vaccines have been shown to be safe and populations in these countries, the new strategies effective in numerous settings in industrialized aim to —zero in“ on the remaining polio viruses in and developing countries. 2007, by accelerating eradication efforts in the SAGE considers that including pneumococcal most targeted manner possible. conjugate vaccine in national immunization These new and targeted eradication efforts will programmes should be a priority and supports the have significant financial implications, and a key to introduction of the currently licensed PCV-7 success will be ongoing financial support of the vaccine. This recommendation is based on international donor community and polio endemic epidemiological data and vaccine-impact data countries, to rapidly make available the necessary from a number of different settings. financial resources. The Global Polio Eradication Countries with mortality among children under Initiative now faces a global funding gap of age of five years of >50 dealths/1000 births, or US$575 million for 2007-2008; of this, US$100 with >50,000 annual deaths among children, million is needed by March 2007, to ensure should make the introduction of PCV-7 a high activities in the first half of the year can proceed priority for their immunization programmes. as planned. Countries are encouraged to conduct appropriate A full update of the External Financial Resource surveillance for pneumococcal invasive disease in Requirements (FRR) reflecting the new budgetary order to establish a baseline and to monitor the needs will be published in late January 2007, and impact of vaccination, including the occurrence will also be available online at and magnitude of replacement disease. The www.polioeradication.org. importance of surveillance during early introduction in developing countries was SAGE MEETING – NOVEMBER 2006 emphasized. 30/01/07 from Philippe Duclos, WHO/HQ: The incidence of preventable disease should be The Strategic Advisory Group of Experts (SAGE) on used to anticipate the likely impact of Immunization met on 20-22 November 2006 in pneumococcal conjugate vaccine. Where country- Geneva, Switzerland. Excerpts from the published specific estimates of the incidence of preventable conclusions and recommendations are highlighted pneumococcal disease are not available, they may below. be approximated using data from Regional Priorities and Major Policy epidemiologically similar populations. Technical Implementation Issues: Reports were provided assistance to derive such estimates for local by the Regional Offices for the Americas, Europe decision-making will be available through WHO and the Western Pacific. All three regions have and its partners. aligned their priorities to the WHO-UNICEF Global The burden of pneumococcal disease is Immunization Vision and Strategy framework and substantially higher among individuals infected are in the process of strengthening countries‘ with HIV. Since pneumococcal conjugate vaccines surveillance capacities. have been shown to be safe and efficacious in Pneumococcal conjugate vaccines: A safe, HIV-infected children, SAGE recommends effective, licensed 7-sero-type conjugate vaccine introducing PCV-7 in countries where HIV is a (PCV-7) exists and is being introduced in a number significant cause of mortality, and SAGE of industrialized countries. Despite the absence of encourages evaluation of the impact of some serotypes in PCV-7 that are important causes vaccination among the HIV-infected population. of pneumococcal disease in developing countries, Populations with a high prevalence of other this vaccine may nonetheless prevent substantial underlying conditions that increase the risk of mortality and morbidity in these countries. A pneumococcal disease, such as sickle cell disease, recommendation to introduce PCV-7 in developing should also be targeted for vaccination. countries will promote increases in production and Consistent with WHO‘s position on new vaccines, reductions in price. Once other pneumococcal PCV-7 can be easily integrated into routine

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vaccination schedules, and it may be administered aims that should be reached by individual at the same time, though at a different site, as countries with the support of regions and other vaccines in infant immunization programmes, immunization partners. including DTP, hepatitis B, Hib and polio vaccines. The vision of the global framework is that by 2010 Routine immunization with PCV-7 should be there should be an integrated epidemiological, initiated before the age of 6 months to maximize laboratory and programme-monitoring network the benefits of the vaccine, and it may start as for the surveillance of vaccine-preventable early as 6 weeks of age. diseases and monitoring of the performance of Clinical efficacy has been demonstrated in 2 immunization programmes. This network will schedules: a 6-week, 10-week, 14-week schedule provide high quality information to measure the and a 2-month, 4-month, 6-month schedule, which impact of vaccination and maximize the safe, was followed by a booster dose at 12œ15 months effective and equitable use of vaccines at country of age. Further information on the cost level, regional level and global level to reduce or effectiveness of other potential schedules (for eliminate the burden of vaccine-preventable example, using different numbers of doses or diseases. different intervals between doses, and with and SAGE endorses the global framework documents without boosters) should be obtained. Other with some modifications. Modifications suggested schedules (such as 2 doses in a primary series plus included: expanding the linkages to the IHR by a booster dose) are being used in some countries providing examples of how some vaccine- whose experiences may be important as GAVI- preventable diseases fit into the new IHR because supported countries begin introducing PCV-7 or they constitute a public health emergency of review its use. Although a late dose (around the international health concern; including operational first birthday) may be challenging operationally for guidance on ways to implement this strategy at GAVI-eligible countries, there may be suitable the local level in the —Way forward“ section; opportunities when a dose of PCV-7 could be defining key epidemiological data used in the given, such as at the same time as measles furtherance of mathematical modelling; and vaccination. Countries should evaluate this emphasizing recent developments on surveys to information once it is available and select the most monitor programmes and to validate estimates appropriate schedule based on the anticipated (for example, it is now recommended that impact, cost effectiveness and programmatic Multiple Indicator Cluster Surveys take place feasibility. every 3 years instead of every 5 years). Global framework on immunization Optimizing immunization schedules: An monitoring and surveillance: The overview presentation of IVB‘s research agenda circumstances of epidemic-prone disease and on optimizing immunization schedules highlighted vaccine-preventable disease surveillance are 3 main projects that are under way: assessing the changing. Surveillance of epidemic-prone diseases timing of infant vaccination in the developing is now based on the dual concepts of threat- world, optimizing immunization schedules for specific surveillance of epidemic and emerging conjugate vaccines, and updating and completing diseases (requiring effective linkage between the Immunological basis for immunization series. epidemiological and laboratory systems), such as The overall goal of the work being undertaken to meningitis and haemorrhagic fevers, and event optimize immunization schedules is to understand detection, verification, risk assessment, which schedules will lead to the greatest communication and response. The global reductions in disease at the lowest overall cost. framework on immunization monitoring and Results of the first phase of a 2-phase project to surveillance and the new International Health examine immunization schedules were presented. Regulations should be based on a common Demographic and Health Survey data (1997œ platform and should work together and support 2005) from 55 countries for children aged 24 each other. Within the overall context of global months to 35 months were used to look at delays surveillance, the global framework could also in vaccination. The median delays (and 75th support a coordinated investment in the core percentiles) were 1 month (2.9 months) for DTP1, functions of surveillance; strengthening capacities 1.5 months (4 months) for DTP2, 2.2 months (5.4 in preparedness, surveillance, monitoring and months) for DTP3, and 1.3 months (4 months) for response; and co-investment in laboratory , where the true median ages of infrastructure and cross-training. administration are 3 months, 4 months, 6 months The global framework describes 2 strategic areas, and 10 months. More than 25% of DTP3 vaccine surveillance for vaccine-preventable diseases and are delivered >5 months late. The second phase immunization monitoring. The ancillary function of of the project will include linking the timing of funding surveillance and monitoring is added as a vaccination to disease incidence, and it will also third section. The background and status sections include additional survey data (for example, using of the global framework are followed by detailed Multiple Indicator Cluster Surveys).

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SAGE welcomed the work being done in this area with partners in countries in regions, and and looks forward to receiving updates. The through examination of data. analysis of age at vaccination should be expanded ñ Introducing these vaccines will generate to include examination of birth doses where this additional infrastructure costs, not all of which information is available, to look at intervals can be covered within current GAVI funding between DTP doses, to include more recent data windows, such as health system from as many countries as possible, and to show strengthening. the results on a regional basis. ñ Surveillance systems must be strengthened to Other topics discussed included the following: document impact and to monitor possible Pandemic influenza vaccines; Polio eradication; adverse events. Measles mortality reduction; immunization The Board approved the proposed overall strategy financing and advance market commitments; for accelerating introduction of pneumococcal and : risk of short supply and rotavirus vaccines between 2007 and 2015. They potential use of fractioned doses in context of also approved an envelope of $200 million for the health emergencies; and horizon scanning of HIV, GAVI Secretariat to support the first four years of tuberculosis and malaria vaccines. introduction for those vaccines. The Board The full report of the SAGE meeting was published authorized to extend the ADIPs for rotavirus and in English and French in the May 26 issue of the pneumococcal vaccines by one year (through end Weekly Epidemiological Record and can be 2008) and requested the Secretariat to map non- downloaded from the following link: vaccine costs related to the introduction of these http://www.who.int/immunization/sage_conclusion vaccines and the extent of the funding gap for s/en/index.html. The report is being further presentation at the next Board meeting. translated to Arabic, Chinese, Russian and Spanish. Enhancing Civil Society in the GAVI Alliance: The Board was briefed on the proposal to increase GAVI-RELATED INFORMATION civil society engagement in the Alliance. Civil society organizations have the capacity to support GAVI‘s mission by addressing targeted, country- ALLIANCE BOARD specific needs. The Board: 30/01/07 from Lisa Jacobs, GAVI Secretariat: ñ Approved in principle the provision of The GAVI Alliance Board met on 28-29 November additional financing within the HSS window for 2006 in Berlin, Germany. A summary of civil society groups in 10 —pilot“ countries, with recommendations from the meeting is highlighted a two-year (2007-2008) financial envelope of below: US$22 million. 2007-2010 Roadmap including 2007 ñ Approved an envelope of up to US$7.2 million Workplan: The joint Boards postponed approval of to strengthen coordination and enhance civil the 2007 Work Plan budget, and agreed to the society representation at the country level. following procedures: ñ Requested the Secretariat and the civil society ñ The Secretariat and Working Group will develop task team to work with the Working Group to an interim —stopgap“ budget in order to ensure finalize the pilot countries and develop the no interruption in activities. The interim budget precise funding mechanisms. will be presented to the GAVI Fund Executive GAVI‘s engagement in fragile states: It was Committee as soon as possible. discussed that it is important that GAVI find better ñ The revised 2007 budget will be presented to ways to support countries in conflict or post- the GAVI Fund Board on 7 February 2007. conflict situations, and that solutions must be Investment cases for Rotavirus and broadly coordinated among in-country partners Pneumococcal Vaccines: The Board received and work to strengthen the overall delivery of briefings on the scope of the investment cases, and basic health services. Countries in conflict and the following points were discussed: post-conflict categories all have unique ñ The quality of investment case submissions infrastructure and delivery challenges. It is not have improved dramatically; both investment likely that one single solution will be applicable, cases are bold and innovative, focused on and GAVI should support robust consultations in major childhood killers, and include sound, each of these countries. complete analysis. The Board: ñ Broad partner support will be critical, both to ñ Adopted the proposed classification system for promote country ownership and evidence-based fragile states based on the World Bank Low decision making. WHO especially will have an Income Countries Under Stress (LICUS) model. integral role to play. ñ Adopted two sub-categories of countries ñ Co-financing levels for these new vaccines are requiring special treatment: Post conflict now being determined, based on consultation countries and Conflict Countries.

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GAVI Procurement Policy: A new GAVI London on 26 February 2007. Proposals were procurement of goods and services including those sought from groups that were able to design and provided by partners in the context of the GAVI implement studies that contribute to the work plan was adopted, pending several understanding of the burden of Hib disease in adjustments. It will be brought back for review by areas where this remains uncertain. the Alliance and Fund Boards after one year of implementation. REVIEW PROCESS Update on the IFFIm: In its inaugural issue, demand for IFFIm bonds was over-subscribed by Next Review Dates: 75%; the subscriber base also spanned several FIRST REVIEW 2007: ISS, INS, New sectors and geographical regions. Many subscribers Vaccines & Measles 2nd Dose: The deadline for highlighted the ethical dimension as a key factor in receiving applications is 12 January 2007. The their decision to purchase IFFIm bonds. applications will be reviewed from 22-31 January Immunization Data: Due to efforts of partners 2007. like UNICEF and WHO, there have been encouraging improvements in immunization data FIRST REVIEW 2007: HSS Applications: The collection and reporting in recent years. In specific, deadline to receive applications for HSS is 2 the joint reporting form provides a common March 2007. The applications will be reviewed template to record and track country number of from 13-23 April 2007. children reached, coverage and other information.

Partnerships such as the Health Metrics Network SECOND REVIEW 2007: ISS, INS, New are working to strengthen and align global health Vaccines & Measles 2nd Dose: The deadline for information systems, but more work is still needed receiving applications is 20 April 2007. The in this area. Partners should encourage country applications will be reviewed from 21-30 May ownership of data collection by emphasizing its 2007. importance and applications.

New GAVI Alliance Board Members: The SECOND REVIEW 2007: HSS Applications: Board: The deadline to receive applications for HSS is 11 ñ Selected Dr. Tatul Hakobyan, Deputy Minister May 2007. The applications will be reviewed from of Health of Armenia and Hon. Dr Tedros 1-11 June 2007. Ghebreyesus, Minister of Health of Ethiopia to

fill the two vacant seats on the developing MONITORING REVIEW: The deadline for country government constituency. receiving annual progress reports is 15 May ñ Selected Dr. John Clemens, Director-General of 2007. The APRs will be reviewed from 18-27 the International Vaccine Institute to fill the June 2007. vacant seat on the research and technical

health institute constituency. THIRD REVIEW 2007: ISS, INS, New ñ Approved the following recommendations Vaccines & Measles 2nd Dose, HSS: The regarding donor government representation on deadline for receiving applications is 5 October the GAVI Alliance Board: 2007. The applications will be reviewed from 24 o Increase number of donor government October to 2 November 2007. seats from four to five;

o Move to a self-selected constituency based representation; o Allow donor government seats to rotate every two years instead of three. ñ WHO committed to strengthen communication channels between the GAVI Alliance Board and SAGE, in order to ensure SAGE input into the definition of a GAVI supported research agenda.

HIB INITIATIVE 30/01/07 from Layla Lavasani. JHSPH: Hib Initiative Request for Proposals (RFP): As a final step in the Hib Initiative RFP process that began in August 2006, the Hib Initiative is reviewing full proposals. A final decision will be made after the external reviewers meeting in

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COUNTRY INFORMATION1 BY 30/01/07 from AFRO West: The cMYP has been finalized. REGION BURKINA FASO AFRO CENTRAL 30/01/07 from AFRO West: The cMYP has been finalized. BURUNDI COTE D’IVOIRE 30/01/07 from AFRO Central: 30/01/07 from AFRO West: The draft cMYP is ñ Passed DQA with verification factor of 94%. well on track and the costing and financing part ñ The cMYP has been finalized. has been done. ñ Support for injection safety will be financed

partially by UNICEF and partially by the Government. GAMBIA 30/01/07 from AFRO West: An EPI review CAMEROON will be conducted in preparation for drafting the cMYP, and technical assistance has been 30/01/07 from AFRO Central: requested for this activity. ñ The cMYP has been finalized.

ñ Support for injection safety will be provided by the Government. LIBERIA 30/01/07 from AFRO West: CENTRAL AFRICAN REPUBLIC ñ The cMYP has been finalized. UNICEF will finance injection safety. 30/01/07 from AFRO Central: ñ

ñ The cMYP has been finalized. ñ Support for injection safety will be provided MALI by the Government. 30/01/07 from AFRO West: ñ An EPI review has been done, and the first CHAD draft of the cMYP is on track including the costing component. 30/01/07 from AFRO Central: A team of The Government will take over financing for consultants will start working on the cMYP which is ñ injection safety in 2007. expected to be finalized by March 2007.

DR CONGO MAURITANIA 30/01/07 from AFRO West: 30/01/07 from AFRO Central: The cMYP has An EPI review has been done. been finalized. ñ ñ The Government will take over financing for

RW ANDA injection safety in 2007. ñ The DQA has been postponed to the first 30/01/07 from AFRO Central: quarter of 2007. ñ The cMYP has been finalized.

ñ The Government is funding injection safety. NIGER

SAO TOME & PRINCIPE 30/01/07 from AFRO West: ñ The cMYP has been finalized. 30/01/07 from AFRO Central: ñ The Government will take over financing ñ Technical assistance has been requested to injection safety in 2007. finalize the cMYP.

ñ Injection safety will be funded by UNICEF. NIGERIA

30/01/07 from AFRO West:

ñ The cMYP has been drafted. AFRO W EST ñ The Government will take over financing injection safety in 2007. BENIN ñ The DQA has passed with a verification factor of 89%.

1 ICP = Inter Country Programme SENEGAL ISS = Immunization Services Support INS = Injection Safety Support 30/01/07 from AFRO West: NVS = New Vaccine Support ñ The cMYP has been finalized. DQA = Data Quality Audit ñ The Government will take over financing DQS = Data Quality Self Assessment FSP = Financial Sustainability Plan injection safety in 2007. RED = Reach Every District cMYP = Fully costed multi-year plan

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SIERRA LEONE the Hib Initiative and 30/01/07 from AFRO West: Programme. ñ The cMYP has been finalized. Finally, the RWG reviewed their Terms of ñ The Government and partners will take over Reference and decided to revise these to reflect financing injection safety in 2007. the new elements in the GAVI Phase 2 support. ñ The country was expected introduce fully liquid The ToR will be expanded to include monitoring in January 2007. of immunization systems strengthening and new vaccines, and to incorporate the co-financing TOGO aspect. The RWG also discussed including more 30/01/07 from AFRO West: partners in the group to accommodate the health ñ The first draft of the cMYP is available systems strengthening component. ñ The Government will take over financing On the basis of the meeting, the RWG decided injection safety in 2007. that they should assist the eligible countries in starting their planning for new vaccines EUROPEAN REGION introduction at an early stage; that the RWG should have a proactive role in advocacy; and

that a RWG sub-group should discuss how best to REGIONAL INFORMATION support the eligible countries with developing 30/01/07 from EURO: The GAVI European health system strengthening applications and how Regional Working Group (RWG) met in to address issues of new RWG partners and future Copenhagen, Denmark on 7 December 2006. coordination. The meeting participants were updated on recent developments and decisions related to the GAVI support of Phase 2. W ESTERN PACIFIC REGION The RWG members were informed about the development of the cMYPs and the technical KIRIBATI support provided to countries in that relation. The 30/01/07 from WPRO: The cMYP has been cMYP is an important supporting document to all developed and is in the process of finalization. applications, and the role of the RWG will be to provide technical assistance, assist in the pre- LAO PDR screening of country applications and assist with 30/01/07 from WPRO: The first draft of the the management of post application requirements. cMYP has been sent to WPRO, and WPRO will The RWG also reviewed the status of the collection assist with applications to GAVI. of evidence and introduction of new and under- utilized vaccines as well as the collaboration with

Produced by WHO, in collaboration with UNICEF and the GAVI Alliance:

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LIST OF MEETINGS & KEY EVENTS RELATED TO IMMUNIZATION

Regional Meetings & Key Events Related to Immunization: 2007 to 2009

Responsible Title of Meeting Start Finish Location Region Partner Feb-07 GAVI Alliance and GAVI Fund GAVI Joint Fund Executive Committee 07-Feb 07-Feb Washington DC Specific Secretariat Meeting Global Immunization Meeting 13-Feb 15-Feb New York UNICEF Global Joint Polio Containment St. Julians, 20-Feb 22-Feb EURO EUR Laboratory Network Malta Measles European Regional 26-Feb 26-Feb tbd EURO EUR Reference Laboratory WHO SEARO Intercountry training on the new alternate protocol for rapid detection of 26-Feb 03-Mar Mumbai, India SEARO SEAR polio viruses - Capacity Building of the Polio Laboratory Network HSS Workshop/Orientation 26-Feb 28-Feb Ouagadougou AFRO AFR Buenos Aires, PAHO Workshop on Influenza 26-Feb 28-Feb PAHO PAHO Argentina Seventh Annual Meeting of American RED 27-Feb 28-Feb Washington DC Global Partners for Measles Advocacy Cross Mar-07 WPRO Hepatitis B Expert Group 05-Mar 06-Mar Tokyo, Japan WPRO WPR Meeting AFRO EPI Managers Meeting for 12-Mar 16-Mar Harare AFRO (E&S) AFRO East and Southern Blocks Second Integrated Polio and Measles/ Laboratory Ashgabat, 13-Mar 16-Mar WHO/EURO EUR Network Meeting for NIS Turkmenistan Countries HSS Workshop/Orientation 19-Mar 21-Mar Harare AFRO AFR European Technical Advisory Copenhagen, Group of Experts (ETAGE) 26-Mar 27-Mar EURO EUR Denmark meeting PAHO Sub-Regional Workshop 26-Mar 28-Mar Lima, Peru PAHO PAHO on Influenza Apr-07 HSS Workshop/Orientation 02-Apr 04-Apr Libreville AFRO AFR GAVI Review for HSS GAVI Applications (Deadline: 2 March 13-Apr 23-Apr Geneva Specific Secretariat 2007) Strategic Advisory Group of 17-Apr 18-Apr Geneva WHO/HQ Global Experts (SAGE) meeting SEARO Regional Workshop on Vaccine Procurement and Introduction of Guidelines for 16-Apr 20-Apr Bangkok SEARO SEAR "Expedited Approval of Vaccines used in National Immunization Programme" European Immunization Week 16-Apr 22-Apr tbd EURO EUR European Programme Managers 23-Apr 25-Apr tbd EURO EUR Meeting

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Bi-Regional (SEARO&WPRO) Ho Chi Minh meeting on Japanese 25-Apr 26-Apr SEARO/WPRO SEAR/WPR City, Vietnam Encephalitis European Regional ICC Meeting 26-Apr 26-Apr tbd EURO EUR GAVI East & South African Sub- April April tbd AFRO (E&S) AFR Regional Working Group Meeting May-07 GAVI Quarterly Fund Executive GAVI 11-May 11-May Geneva Specific Committee Meeting Secretariat GAVI Joint Alliance & Fund Board GAVI 12-May 12-May Geneva Specific Meetings Secretariat EMRO RTAG Meeting 13-May 16-May Abu Dhabi EMRO EMR European Human Papilloma Virus Copenhagen, 14-May 15-May EURO EUR Meeting Denmark GAVI Review for ISS, INS, NVS & GAVI Measles 2nd Dose Applications 21-May 30-May Geneva Specific Secretariat (Deadline: 20 April 2007) GAVI Eastern Mediterranean 27-May 27-May Muscat, Oman EMRO EMR Regional Working Group Meeting EMRO EPI Managers Meeting 28-May 31-May Muscat, Oman EMRO EMR Jun-07 16th Meeting of Virologists from June June New Delhi SEARO SEAR SEARO Polio Laboratory Network GAVI Review for HSS Proposals GAVI 01-Jun 11-Jun Geneva Specific (Deadline: 11 May 2007) Secretariat Central America and USMB 05-Jun 08-Jun tbd PAHO PAHO Regional EPI Managers Meeting Global Advisory Committee of 12-Jun 13-Jun Geneva WHO/HQ Global Vaccine Safety (GACVS) Meeting European Regional Certification Commission for Poliomyelitis 13-Jun 15-Jun tbd EURO EUR Eradication New and Under-Utilized Vaccines 18-Jun 20-Jun Geneva WHO/HQ Global Introduction Retreat GAVI Review of Annual Progress GAVI 18-Jun 27-Jun Geneva Specific Reports (Deadline: 15 May 2007) Secretariat WPRO EPI Managers Workshop 19-Jun 22-Jun tbd WPRO WPR Jul-07 SEAR EPI Managers Meeting on New Vaccines and Injection 03-Jul 04-Jul New Delhi SEARO SEAR Safety Twelfth Meeting of SEAR Technical Consultative Group 05-Jul 06-Jul New Delhi SEARO SEAR (TCG) on Polio Eradication and Vaccine Preventable Diseases GAVI South East Asian Regional 10-Jul 11-Jul Pyongyang SEARO SEAR Working Group Meeting Aug-07 First Meeting of the Virologists of the regional JE Laboratory Network and Training in Laboratory procedures for August August Bangalore, India SEARO SEAR diagnosis of Bacterial Pathogens causing Acute Encephalitis Syndrome (AES) South America Regional EPI 07-Aug 10-Aug tbd PAHO PAHO Managers Meeting Sep-07

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EMRO Regional Working Group 10-Sep 12-Sep Cairo, Egypt EMRO EMR on Rotavirus Surveillance GAVI Quarterly Fund Executive GAVI 12-Sep 12-Sep Washington DC Specific Committee Meeting Secretariat GAVI Review of Annual Progress GAVI 24-Sep 28-Sep Geneva Specific Reports Secretariat Ninth Meeting of International Certification Commission for Polio 27-Sep 29-Sep New Delhi SEARO SEAR Eradication Oct-07 GAVI Review for ISS, INS, NVS & GAVI Measles 2nd Dose Applications 24-Oct 02-Nov Geneva Specific Secretariat (Deadline: 05 October 2007) GAVI Eastern Mediterranean 28-Oct 29-Oct Tripoli, Libya EMRO EMR Regional Working Group Meeting EMRO ICM on Measles and 30-Oct 01-Nov Tripoli, Libya EMRO EMR Rubella HPV Planning Policy Meeting for Late Early tbd PAHO PAHO Latin America and the Caribbean Oct Nov Nov-07 EMRO RTAG Meeting 02-Nov 02-Nov Tripoli, Libya EMRO EMR Strategic Advisory Group of 06-Nov 08-Nov Geneva WHO/HQ Global Experts (SAGE) meeting GAVI Quarterly Fund Executive GAVI 12-Nov 12-Nov Johannesburg Specific Committee Meeting Secretariat EMRO RTAG Meeting 12-Nov 12-Nov Libya EMRO EMR GAVI Joint Alliance & Fund Board GAVI 13-Nov 15-Nov Cape Town Specific Meetings Secretariat Caribbean EPI Managers Meeting 13-Nov 16-Nov tbd PAHO PAHO GAVI South East Asian Regional 27-Nov 28-Nov Thimphu SEARO SEAR Working Group Meeting EURO TAG Meeting 28-Nov 29-Nov tbd EURO EUR Dec-07 Global Advisory Committee of 12-Dec 13-Dec CICG WHO/HQ Global Vaccine Safety (GACVS) Meeting 2008 Meetings Strategic Advisory Group of 08-Apr 10-Apr Geneva WHO/HQ Global Experts (SAGE) meeting Strategic Advisory Group of 03-Nov 05-Nov Geneva WHO/HQ Global Experts (SAGE) meeting 2009 Meetings Strategic Advisory Group of 07-Apr 09-Apr Geneva WHO/HQ Global Experts (SAGE) meeting Strategic Advisory Group of 27-Oct 29-Oct Geneva WHO/HQ Global Experts (SAGE) meeting

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