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Increasing Access to Immunization Services in AFRO, an Overview

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Increasing Access to Immunization Services in AFRO, an Overview Final Report 2nd African Regional Conference on Immunization (ARCI) Ouagadougou, Burkina Faso 06 - 08 December 2010 Contents Page Abbreviations……………………………………………………………………………... 3 Executive Summary of Conference Outcomes…………………………………………..5 Summary of outcomes……………..……………………………………………………...5 Polio Eradication……………………………………………………………………. 5 Reaching Un/Under-Immunized Children in the African Region………………… 6 Accelerated Disease Control Initiatives in the African Region……………………... 7 Session 1: Opening Ceremony…........................................................................................ 9 Session 2: Polio Eradication……………………………………………………………… 11 Parallel session: Interrupting endemic & re-established transmission…………. 14 Parallel session: Preventing new international spread & outbreaks……………. 16 Session 3: Reducing number of un /under-immunized children ……………………… 20 Parallel session: Routine immunization………………………………………… 26 Parallel session: New vaccines…………………………………………………. 30 Parallel session: Immunization Financing……………………………………… 35 Session 4: Accelerated Disease Control Initiative in the African Region……………... 38 Session 5: Closing Ceremony…………………………………………………………….. 45 Annexes 1. List of Participants ……………………………………………………………………… 47 2 Abbreviations ACPE Advisory Committee on Poliomyelitis Eradication AFP Acute Flaccid Paralysis ARCC African Regional Certification Commission ARCI Annual Regional Conference on Immunization BMGF Bill and Melinda Gates Foundation bOPV bivalent Oral Polio Vaccine CDC Centers for Disease Control and Prevention cVDP circulating Vaccine-Derived Poliovirus DoV Decade of Vaccines EPI Expanded Programme on Immunization EU European Union FRR Financial Resource Requirements GAP.III Third edition of the Global Action Plan to minimize post eradication poliovirus facility-associated risk GIVS Global Immunization Vision and Strategy GPEI Global Polio Eradication Initiative GPLN Global Polio Laboratory Network GPMT Global Polio Management Team ICC Interagency Coordinating Committee IPD Immunization Plus Day IST Intercountry Support Team iVDPV Immunodeficiency-Associated Vaccine-Derived Poliovirus JSI John Snow Incorporated LGA Local Government Area 3 LQAS Lot Quality Assurance Sampling MDGs Millennium Development Goals mOPV Monovalent Oral Polio Vaccine NGO Non Governmental Organization NID National Immunization Day OPV Oral Polio Vaccine PCV Pneumococcal Conjugate Vaccine RED Reaching Every District SAGE Strategic Advisory Group of Experts on Immunization SIA Supplementary Immunization Activity SIAD Short Interval Additional Dose SNID Sub-National Immunization Day TAG Technical Advisory Group tOPV trivalent Oral Polio Vaccine UNICEF United Nations International Children Emergency Fund VAPP Vaccine-Associated Paralytic Polio VDPV Vaccine -Derived Poliovirus VPD Vaccine-Preventable Disease WHA World Health Assembly WHO World Health Organization WPV Wild Poliovirus 4 Executive Summary of Conference Outcomes The second African Regional Conference on Immunisation was convened in Ouagadougou, Burkina Faso from 6 to 8 December 2010. The conference was officially opened by the Prime Minister His Excellency Mr. Tertius Zongo, in the presence of the chairman of the 60th Session of the Regional Committee the Honourable Minister of Health from Equatorial Guinea, the Minister of Health for Burkina Faso, WHO Director General, the President of the Global Health Program of the Bill and Melinda Gates Foundation, WHO Regional Director for Africa, the Acting CEO of GAVI, Parliamentarians from DR Congo and Cameroun, Traditional Leaders from Nigeria, National EPI programme managers, UN agencies, immunization partners, donors, and TFI members. Three core themes on immunization in Africa were thoroughly reviewed and discussed and the main outcomes are highlighted below: (1) Polio Eradication: The conference commended Nigeria for the significant progress made in reducing wild poliovirus (WPV) cases. The meeting also recognised the efforts made by Chad and the importation countries in West Africa in limiting the circulation of WPV. Concerns were however raised with continued circulation of WPV in DR Congo and Angola, the outbreak in Congo Brazzaville affecting mostly adults and the poor surveillance in Kenya/Uganda border and East DR Congo evidenced by missed circulation of WPV (orphan viruses). The conference proposed the following actions: 1. The conference commended the coordination efforts in West Africa by WHO, UNICEF and countries and requested that this model be adopted in all countries and sub regions experiencing polio outbreaks. 2. The conference recognized the institutionalization of Independent Monitoring (IM) in Polio SIA and the use of the generated data in tracking progress towards achieving the global polio eradication milestones. The conference called upon WHO and partners to support countries fully implement corrective measures whenever shortcomings in SIA quality are identified through IM. 3. Recognizing the high level advocacy that lead to the development of the 6-months Polio Emergency Plan currently being implemented, the conference called upon Angola to review and intensify implementation in 2011 4. The conference noted with concern the intense transmission of WPV in DR Congo and urged the country to urgently develop and implement an Emergency Plan to address chronic SIA gaps and sub-national surveillance weaknesses. Additionally, WHO should provide technical assistance to improve the performance of the National Polio Laboratory in DR Congo 5 5. Nigeria and Chad should develop and implement aggressive mop ups strategies to reach high risk areas, migrant and mobile populations in order to interrupt transmission in line with the set milestones. 6. Countries with the support from partners should develop a comprehensive package that includes social economic and communication factors to address surveillance, SIA gaps and create demand for better delivery of immunization services. Communications indicators should be included in this package. 7. The risk assessment model presented to the conference offered an opportunity for the region to predict polio outbreaks. However, changes in the intensity of polio transmission and data quality seem to affect the accuracy of predictability of the model. Efforts should be made to revise the model and address its limitations. There is also need to initiate consultations before its use. 8. WHO and partners should promote social, operational and applied research in order to reach the unreached populations and also to address population immunity gaps including adults and migrant / mobile populations 9. WHO and UNICEF should ensure: a) Adequate supply of appropriate types of OPV for use in polio outbreak response in the region. b) Continued and enhanced support for pre-qualification and licensure of additional products to increase vaccine security in the market and at the country-level (2) Reaching Un/Under- Immunized Children in the African Region- Progress, Challenges and Opportunities The Conference noted with satisfaction the progress that had been made in reducing the number of un/under immunized children in the African Region. New innovations had been implemented in some countries such as Ethiopia resulting in significant reduction in the number of unimmunised children in 2010. However, the conference expressed concern on the declining or stagnating performance of routine immunization in a number of countries. In addition, inadequate financing of immunization services in general and routine immunization in particular pose a threat to the maintenance or sustenance of coverage and the introduction of new vaccines. Discrepancies between WHO/UNICEF immunisation coverage estimates and those reported annually by countries were also highlighted. The conference welcomed efforts by countries and immunisation partners in supporting the introduction of new vaccines such as Pneumococcal and Rotavirus vaccines in the region. However there is urgent need to accelerate introduction so that progress towards MDG 4 attainment in the African region could be achieved. 6 The conference proposed the following actions 10. Countries with support from partners should implement all components of RED and other innovative strategies to reduce the number of unimmunized children, especially in the top ten countries with large number of un/under immunized children. 11. Countries should continue working to improve data quality and utilize fora such as EPI managers and regional consultations meetings to identify and address the challenges. 12. The conference welcomed the “Decade of Vaccines” (DoV) and proposed active consultation with the Regional Office and countries in the development and formulations of the delivery component of DoV. 13. Countries with the support of WHO and partners should adopt a holistic approach to synergize immunization with the control of pneumonia and diarrhea within the primary health care context as elaborated in the Alma Ata and Ouagadougou Declarations to accelerate attainment of MDG 4. 14. WHO and partners should support countries to strengthen surveillance capacity for new vaccines for advocacy and support decision making on new vaccines introduction 15. WHO and Partners should support countries to develop local mechanisms to increase funding for immunization services and maintaining immunization as a public health priority. 16. To strengthen logistic and delivery of vaccines, the conference proposed that WHO and partners should consider introducing for discussion a document
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