GAVI Support for Measles and Rubella Immunisation

Helen Evans

Deputy CEO, GAVI Alliance

GAVI Support for Measles and Rubella Immunisation

11th Annual MeetingMeasles & Rubella InitiativeWashington D.C18 September 2012

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Overview

1. About the GAVI Alliance

2. GAVI support to Measles & Rubella immunisation

3. Communicating with Countries

4. Advocacy

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The GAVI Alliance: an innovative partnership

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GAVI’s mission and four strategic goals

Accelerate the uptake and use of underused and new vaccines

Contribute to strengthening the capacity of integrated health systems to deliver immunisation

Increase the predictability of global financing and improve the sustainability of national financing for immunisation

Shape vaccine markets

Mission: To save children’s lives and protect people’s health by increasing access to immunisation in poor countries

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What Countries have achieved with GAVI Alliance support

Supported the immunisation of 326 million children

Contributed to preventing over 5.5 million future deaths

Accelerated vaccine introductions in over 70 countries

Strengthened health systems to deliver immunisation

Helped shape the market for vaccines

Source: These estimates and projections are produced by the WHO Department of Immunization, Vaccines and Biologicals, based on the most up-to-date data and models available as of 30 September 2011.*Includes deaths averted by GAVI-supported vitamin A supplementation programmes.

Future deaths averted

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Key GAVI policies

Country eligibility policy:

Threshold for 2012 is $1,520 GNI per capita (World Bank, Atlas method) – updated annually

Catalytic new vaccine introduction grant and operational support for campaigns policy – not recurrent operational support

Co-financing policy geared to programme ownership & financial sustainability

In development:

Country-by-Country Approach: introducing more flexibility

Access to acceptable vaccine prices for lower middle income countries

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GAVI vaccines support

Vaccines currently supported 2013 and later

PentavalentPneumococcal conjugateRotavirusMeasles second doseMeningococcal A conjugate (campaigns)Yellow Fever (routine & campaigns)

New in 2012:HPV (national introduction & demo project)Rubella (MR campaigns)Measles SIAs in selected countries and outbreak response

Also: meningitis and yellow fever vaccine stockpiles

Japanese encephalitis

Typhoid

Future decisions

•Malaria•IPV•Cholera•Dengue•Others

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GAVI supports the world’s poorest countries

Type and value of support, 2000–2011

Source: GAVI Alliance , 2012

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GAVI cash-based support

GAVI supports health system strengthening (HSS) through the Health System Funding Platform

Focus on strengthening the capacity of integrated health systems to deliver immunisation outcomes

Resolve major constraints to delivery

Increase equity in access to services

Strengthen civil society engagement

New performance based approach being introduced

Countries and partners will be updated by end 2012

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GAVI vaccine introduction grant and operational support for campaigns policy – revised amounts from 1 Sept 2012

Facilitate timely, effective implementation of critical activities: Preparing for new vaccine introductions: US$ 0.80 per target

(for HPV: US$ 2.40 per girl) Supporting delivery of campaigns: US$ 0.65 per target

One-time investments, covering a share of the cost. Does not cover recurrent costs Driven by country needs

Flexible, simple, separate from other cash support, not to be used for co-financing

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Overview




4. Advocacy

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GAVI’s integrated commitents to prevent rubella and measles

US$ 176 million from 2004-2008 through Measles Initiative to support campaigns

Investments in health systems to improve immunisation coverage

Routine measles second dose (11 countries receiving support, 3 more applied this year)

Measles-rubella through wide-age campaigns and adoption of routine (9 countries have applied this year)

Performance-based funding with measles coverage indicator

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Background and aim of increased GAVI engagement

Estimated measles mortality has plateaued around 140,000 deaths

Increased routine coverage critical to sustainably preventing measles

Outbreaks possible (e.g. every 3–5 years) unless coverage is high

GAVI support: Long-term strategy to prevent deaths in six countries through high

routine coverage

Bridging: help avoid further measles resurgence before and during the MR vaccine roll-out

Outbreak prevention

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June 2012 GAVI Board decision on GAVI support for measles

The GAVI Alliance will provide additional funding to control and prevent measles outbreaks

US$ 55 million of this support will be for outbreaks and other emerging needs requiring rapid responses

Six large countries at high risk of measles outbreaks (Afghanistan, Chad, DR Congo, Ethiopia, Nigeria and Pakistan) can exceptionally apply for GAVI support for preventive measles vaccination campaigns

This support comes in addition to GAVI’s existing support for introducing the second dose of measles into routine immunisation

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GAVI support for rubella and measles vaccines

Measles-Rubella Measles Second Dose Measles SIAs

All GAVI eligible countries: GNI < US$ 1,520

Routine MCV1 ≥ 80% (or)Last measles SIA ≥ 90% (admin) (or)Survey of acceptable methodology

coverage ≥ 80%

Catch-up campaigns with a wide age range (9 mth-14 yo boys and girls)

Introduction into routine programme

GAVI covers vaccine costs, operational costs

GAVI covers one time introduction grantCountry covers vaccine & operational costs

Combines measles vaccination with rubella to prevent CRS and

reinvigorate measles campaigns

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coverage ≥ 80%

MCV1 > 80% DTP3 ≥ 70%






GAVI covers vaccine costs for 5 years and introduction grantCountry covers operational costs & all vaccine costs after 5 years



On-time delivery of the first dose remains the highest priority, but

reaching all children with two doses of measles vaccine should

become standard for all immunisation programmes


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For six large countries at risk of measles outbreaks: Afghanistan, Chad, DR Congo, Ethiopia, Nigeria, Pakistan


coverage ≥ 80%

MCV1 > 80% DTP3 ≥ 70%




Bridging: SIAs until MR implemented or 2017, whichever is earlier



GAVI covers vaccine costs for 5 years and introduction grantCountry covers operational costs & all vaccine costs after 5 years

Support determined following country discussions, with the maximum as per the GAVI policy on campaigns costs



On-time delivery of the first dose remains the highest priority, but

reaching all children with two doses of measles vaccine should

become standard for all immunisation programmes

To strengthen the impact of comprehensive GAVI support to prevent

measles deaths through a country specific and integrated focus, including

HSS, financial sustainability, routine delivery of MSD and introduction of MR


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The GAVI application and reporting cycle

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Overview




4. Advocacy

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Overview of GAVI country communication

Maintaining an ongoing dialogue around GAVI policy, processes and vaccine evidence base

Information dissemination and feedback loops adapted to the content, context and audience Written documents: guidelines, FAQs, briefs, letters, etc.

Available at: http://www.gavialliance.org/support/apply/

With countries and partners:

WHO/UNICEF in country and regional GAVI Alliance members

GAVI Secretariat CROs responsible for specific countries

Discuss new policy and technical developments

Consult and coordinate to resolve implementation bottlenecks

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Contact points for information

www.gavialliance.org GAVI Country Responsible Officers

GAVI Alliance Partners (WHO, UNICEF, CDC,..)

Access to information on:

How to apply for GAVI support

GAVI guidelines, policy and processes

Vaccine impact

Links to partner sites for more information:WHO, UNICEF, MRI, etc

Contact for country specific detail on:

Implications of GAVI policy and processes

Information and follow up on the review of applications and reports

Updates on existing approved support

>> Contact country officer at GAVI or [email protected] or [email protected]

Contact for technical support on:

Assistance in preparing applications to GAVI

Implementation of GAVI support

Technical resources and vaccine evidence base

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Overview




4. Advocacy

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Objectives:Position immunisation, global health and development in public policy agenda – value of investing in immunisation, new vaccines is understood amongst key influencers and stakeholders

Mobilize network of advocates and policy partners in countries and globally to inform policies, support fundraising and help achieve strategic goals of the Alliance

GAVI Alliance’s aim to be catalytic

What role does the GAVI Alliance play in advocating for immunisation?

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Advocacy building blocks

GAVI Alliance became named partner of Measles & Rubella Initiative (August 2012)

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Synergies and shared learnings

Polio eradication

Polio eradication

Traditional vaccines

Traditional vaccines

Regional vaccinesRegional vaccines

New vaccines

New vaccines

Measles eliminationMeasles

eliminationR&D: vaccine improvementsR&D: vaccine improvements

R&D: future vaccines

R&D: future vaccines

The immunisation landscape

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Thank you

www.gavialliance.org

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Communication around the application cycle

Countries contacted with

information on IRC recommendations and any required

clarifications

Coordination with partners for technical

assistance and support in completing

forms

The Board considers and approves IRC

recommendations

Updates on GAVI Alliance Board decisions

and deliberations by email, media and

multiple other channels.

Dialogue with countries and

partners to inform decision-making

Dissemination of application guidelines,

forms, other supporting information to countries and partners via email

and web site, with specific follow up

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The Global Vaccine Action PlanGuiding Principles Strategic objectives of the Decade of Vaccines Goals

Shared responsibility

and partnership

Country ownership

Equity

Integration

Sustainability

Innovation

All countries commit to immunizations as a priority

Strong immunization systems are an integral part of a

well-functioning health system

The benefits of immunization are equitable extended to all

people

• Achieve a world free of poliomyelitis

• Meet global and regional elimination targets

• Meet vaccination coverage targets in every region, country and community

• Develop and introduce new and improved vaccines and technologies

• Exceed the Millennium Development Goal 4 target for reducing child mortality

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3

4Immunization programs have

sustainable access to

predictable funding, quality

supply and innovative

technologies

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Country, regional and global research and development innovations maximize the benefits of immunization

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Individuals and communities understand the value of vaccines

and demand immunization as both their

right and responsibility

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Source: Bill & Melinda Gates Foundation

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June – Dec 2012 key events at a glanceJUN JUL AUG SEPT OCT NOV DEC TBD

Child Survival Event. DC, 14-15 June

Financing for Health: Health & Finance Ministers AFDB Meeting, Tunis, 4-5 July

UNGA – UNSG EWEC MCH , New York and Clinton Global Initiative (CGI)Sept 23-25,

Finance Ministers Meeting GAVI/WB (at Annual IMF/WB meeting ) Tokyo, 12-14 Oct

12 Nov--World Pneumonia Day 2012

Partners’ Forum& DoV, Dar es Salaam, 5-7 Dec

Pledging Conference first anniversary

WEF, Tianjin, 11-13 Sept

Africa – French parliamentarian visit

Senegal/Sudan – MEP visit

Burma- Australian/NZ parliamentarian visit

Tanzania – German parlt visit

BOARD MEETING

High-Level Meeting of Asian Health Ministers Jakarta, 3-5 September

AFRO Regional Meeting, Luanda, 22-26 Oct

BOARD MEETING

Djibouti-PCV introduction

Moldova- Rota introduction

Nigeria-Penta introduction

Madagascar, Pakistan, Congo Rep, Zambia, Zimbabwe-PCV introduction

Yemen-Rota introduction

Bangladesh, Cambodia, Eritrea, Gambia- MSD introduction

Korea DPR, Myanmar-Penta introduction

Armenia-Rota introduction

Sao Tome and Principe-MSD introduction

Timor-Leste-Penta introduction

Georgia-Rota introduction

Zambia-MSD introduction

Angola, Sao Tome-PCV introduction Malawi-Rota introduction

Sudan, Senegal, Benin, Ghana- MenA introduction

Tanzania-PCV (and Rota?) introduction

Burundi-MSD introduction

Ethiopia-Rota intro

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Session Chart

Wednesday Thursday Friday

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GAVI Board Mtg

Closing Session

Special

Plenary 2

SessionsSessionsSpecial Sessions

Workshops

Workshops

Panel

Panel

Panel

8:00 – 9:30

12:30 – 14:00

14:30 –

16:00

16:00 – 17:30

9:00 – 13.00

16:00 – 18:0016:00 – 18:00

18:30 – 21:0018:30 – 20:30

Workshops

16:30 - 17:30

13:30 – 15:3013:30 – 15:30

Welcoming Ceremony by Tanzania government

Draft Session Chart

Wednesday Thursday Friday

0

GAVI Board Mtg

Consultations

and Satellite Events

Award Dinner

Closing Session

Plenary 1

Special

Plenary 2

10:00 –

11:30

14:30 –

16:00

Lunch Lunch

Sessions Special Sessions

Workshops

Workshops

Symposia

Symposia

Symposia

GM-NM Dialogue

8:00 –9:30

12:30 – 14:00

14:30 –

16:00

16:00 – 17:30

9:00 – 13.00

15:30– 17:00

18:30 – 21:0018:30 – 21:00

Workshops

16:30 - 17:30

13:30 – 15:00

Opening Plenary17:30– 18:00

Welcoming Ceremony by Tanzania government

Transport to State House

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Partners’ Forum – themes focused around GVAP – measles and rubella sessions

World Immunisation Week

World Health Assembly and Regional Committees – reporting on progress

IPA Congress in Australia

GAVI Alliance mid-term review

Aligning advocacy efforts

Documents

GAVI Support for Measles and Rubella Immunisation