14–15 February 2020Manila, Philippines

Meeting Report

INFORMAL TECHNICAL CONSULTATION ON THE FUTURE POLIO VACCINATION SCHEDULE

IN THE WESTERN PACIFIC REGION

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR THE WESTERN PACIFIC

RS/2020/GE/14(PHL) English only

MEETING REPORT

INFORMAL TECHNICAL CONSULTATION ON THE FUTURE POLIO VACCINATION SCHEDULE IN THE WESTERN PACIFIC REGION

Convened by:

WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC

Manila, Philippines 14–15 February 2020

Not for sale

Printed and distributed by:

World Health Organization Regional Office for the Western Pacific

Manila, Philippines

May 2020

NOTE

The views expressed in this report are those of the participants of the Informal Technical Consultation on the Future Polio Vaccination Schedule in the Western Pacific Region and do not necessarily reflect the policies of the conveners.

This report has been prepared by the World Health Organization Regional Office for the Western Pacific for Member States in the Region and for those who participated in the Informal Technical Consultation on the Future Polio Vaccination Schedule in the Western Pacific Region in Manila, Philippines from 14 to 15 February 2020.

CONTENTS

SUMMARY ............................................................................................................................................................... 1 

1. INTRODUCTION ................................................................................................................................................. 2 

1.1 Meeting organization ....................................................................................................................................... 2 

1.2 Meeting objectives ........................................................................................................................................... 2 

2. PROCEEDINGS .................................................................................................................................................... 2 

2.1 Opening session ............................................................................................................................................... 2 

2.2 Global update ................................................................................................................................................... 3 

2.3 Regional update ................................................................................................................................................ 3 

2.4 Root causes for emergence and circulation of VDPV in the Western Pacific Region, 2015–2020 .............. 3 

2.5 Impact of mOPV2 use in the African Region: key lessons from the African experience regarding VDPV2 emergence after mOPV2 use ................................................................................................................................. 3 

2.6 Impact of mOPV2 use in Mindanao, Philippines ............................................................................................ 4 

2.7 Strategies for prevention of emergence and outbreaks of cVDPV ................................................................. 4 

2.8 Update on recent discussions in the Strategic Advisory Group of Experts working group on polio regarding future polio vaccine schedules .............................................................................................................. 4 

2.9 Plan for OPV cessation in the Region of the Americas .................................................................................. 4 

2.10 Discussion on cVDPV risks and polio vaccination schedule in Papua New Guinea ................................... 5 

2.11 Discussion on cVDPV risks and polio vaccination schedule in Pacific island countries and areas ............ 5 

2.12 Global IPV supply status and future plans .................................................................................................... 5 

2.13 Implications of the new Gavi strategy for Member States in the Western Pacific Region in terms of IPV and immunization programme support .................................................................................................................. 5 

2.14 Follow-up actions by WHO in the Region after the consultation ................................................................. 6 

ANNEXES ................................................................................................................................................................. 7 

Annex 1. Meeting timetable 

Annex 2. List of participants 

Keywords:

Immunization / Poliomyelitis / Poliovirus / Vaccination

ABBREVIATIONS

AFP acute flaccid paralysis

cVDPV circulating vaccine-derived poliovirus

cVDPV1 circulating vaccine-derived poliovirus type 1

cVDPV2 circulating vaccine-derived poliovirus type 2

IPV inactivated polio vaccine

mOPV2 monovalent oral polio vaccine type 2

OPV oral polio vaccine

SAGE Strategic Advisory Group of Experts

SIA supplementary immunization activity

VDPV vaccine-derived poliovirus

WPV wild poliovirus

WPV1 wild poliovirus type 1

WPV2 wild poliovirus type 2

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SUMMARY

The Informal Technical Consultation on the Future Polio Vaccination Schedule in the Western Pacific Region was held in Manila, Philippines, on 14–15 February 2020. The main goal of this informal consultation was to discuss the current risks for eradication of poliomyelitis (polio) in the Western Pacific Region related to the outbreaks of circulating vaccine-derived polioviruses and identify possible options for the polio vaccination schedule in the Region in 2021–2030.

Since 2000, the Western Pacific Region has successfully maintained its polio-free status. However, in recent years an emerging challenge for the Region has been the risk of emergence and outbreaks of circulating vaccine-derived polioviruses due to inadequate routine immunization levels with oral polio vaccines coupled with subnational gaps in surveillance in several countries (Cambodia, Lao People’s Democratic Republic, Philippines, Papua New Guinea, Viet Nam). Since 2000, emergence and circulation of vaccine-derived polioviruses have been reported in the Philippines (2001), China (2004, 2011 and 2012) and Cambodia (2005). Recent emergence and circulation of vaccine-derived polioviruses in the Lao People’s Democratic Republic (2015–2016), Papua New Guinea (2018), China, the Philippines and Malaysia resulted in outbreaks that required significant public health efforts and human and financial resources to respond to rapidly and comprehensively.

During the technical consultation, the proposed strategic directions in the polio vaccination schedule in the Western Pacific Region were deliberated. After thorough discussion and deliberation, the following key actions will be taken by WHO in the Region:

The Vaccine-Preventable Diseases and Immunization unit will continue closely working with the high-level expert groups and other stakeholders to formulate possible options for the Region.

The proposed strategic approach will be presented to the Technical Advisory Group meeting in June 2020 for member comments and recommendations on further steps.

The WHO Regional Office for the Western Pacific will be closely working with other polio-free regions (Region of the Americas and European Region) to exchange experiences and share lessons for better planning and preparation for the switch in schedule in the Region to inactivated polio vaccine only.

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1. INTRODUCTION

1.1 Meeting organization

Since 2000, the Western Pacific Region has successfully maintained its polio-free status. However, a challenge for the Region in recent years has been the risk of emergence and outbreaks of circulating vaccine-derived polioviruses (cVDPVs) due to continuously suboptimal routine immunization levels with oral polio vaccine coupled with subnational gaps in surveillance. An informal technical consultation was held to identify and propose strategic directions for the vaccination schedule for poliomyelitis (polio) in the Region in 2021–2030.

The consultation brought together the renowned experts with wide expertise and extensive experience in global and regional polio eradication initiatives. The consultation facilitated the discussion about regional polio eradication challenges, identification of possible strategies to address these challenges and development of technical recommendations.

The meeting agenda and list of participants are available in Annexes 1 and 2, respectively.

1.2 Meeting objectives

The objectives of the consultation were:

1) to review the current global and regional situation about the outbreaks of cVDPVs;

2) to identify and evaluate the risks related to cessation of oral polio vaccine use in the Western Pacific Region in advance of certification of global polio eradication; and

3) to propose strategic directions in the polio vaccination schedule in the Western Pacific Region in 2021–2030.

2. PROCEEDINGS

2.1 Opening session

Dr Yoshihiro Takashima, Coordinator, Vaccine-Preventable Diseases and Immunization unit, WHO Regional Office for the Western Pacific, delivered the opening remarks, welcoming all the participants to the meeting. He gave a chronology of the polio eradication initiative in the Region since 1988, mentioning that the Region was certified as free from wild poliovirus (WPV) in 2000 and has sustained that status to date. However, the Region has since experienced several events of WPV importation and emergence and circulation of vaccine-derived poliovirus (VDPV) that have resulted in outbreaks. He highlighted that oral polio vaccine (OPV) continues to be used in the Region for maintaining WPV-free status and responding to the VDPV outbreaks. He pointed out that monovalent oral polio vaccine type 2 (mOPV2) is being used for the first time in the Region since October 2019 to respond to the cVDPV2 outbreak in the Philippines. He expressed his concerns about: the large-scale vaccine-derived poliovirus type 1 (VDPV1) outbreaks in the Region; the emergence and massive circulation of vaccine-derived poliovirus type 2 (VDPV2) during the last eight months in the Philippines and Malaysia; and the introduction of mOPV2 in the Western Pacific Region, regarding the current situation as a crisis of the Polio Eradication Initiative in the Region and the global level at large. He was of the view that it is imperative to take appropriate actions now to mitigate the risk of further VDPV outbreaks in countries and areas with low immunization coverage and high-risk populations with poor sanitation and hygiene conditions.

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Considering the stated background, he finished his opening remarks by posing questions for the attending experts and participants: Until when and how will the Region continue massive utilization of OPV while there is no current transmission and the risk of importation and circulation of WPV in the Region is very low? Secondly, what are the implications of continued use of OPV in routine immunization for countries with low immunization coverage and/or areas of high-risk populations with poor sanitation and hygiene conditions? Thirdly, can we can stop the use of OPV in routine immunization programmes of the countries mentioned earlier? And lastly, can we limit the utilization of OPV, only for outbreak response to interrupt transmission during outbreaks?

2.2 Global update

The number of WPV cases in Pakistan and Afghanistan, as well as the number of cVDPV2 cases and infected countries sharply increased in 2019. A dramatic increase was seen in the number of new emergences (more than 40 in 2019 alone) disproportionately in Central Africa. Multiple emergences of VDPV2 were reported without obvious sources. A new cVDPV2 outbreak response strategy has been developed by the Global Polio Eradication Initiative (GPEI) to improve the quality of the response to multiple cVDPV2 outbreaks. The Emergency Committee under the International Health Regulations reaffirmed the status of public health emergency of international concern for polio outbreaks on 11 December 2019.

2.3 Regional update

The Western Pacific Region has remained free from indigenous WPV since 2000. However, since 2015, the Region has been faced with outbreaks due to type 1 and 2 cVDPVs affecting several Member States. Several factors may contribute as favourable conditions for the cVDPV outbreaks, including immunity gaps at national and subnational levels, continued use of OPV in countries with low immunization coverage, suboptimal performance of acute flaccid paralysis (AFP) surveillance, insufficient human and financial resources and capacities, and insufficient compliance with the requirements of the WHO Global Action Plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use, or GAPIII. The session concluded with the key considerations for the Region to explore options of OPV cessation and switch to an IPV-only schedule in advance of certification of global eradication of polio.

2.4 Root causes for emergence and circulation of VDPV in the Western Pacific Region, 2015–2020

The recent outbreaks of cVDPV in the Lao People’s Democratic Republic, Papua New Guinea, China, the Philippines and Malaysia were presented as case studies. The root causes and risk factors contributing towards these outbreaks were discussed. The presence of continuously underserved and high-risk populations greatly contributes to the spread of poliovirus – and other vaccine-preventable diseases. The continuous use of OPV in these populations creates favourable conditions for the emergence and circulation of VDPVs. Low-quality AFP surveillance is a common contributor to the late detection of cVDPVs. Well-functioning environmental surveillance for polioviruses proved to be important in the early detection of poliovirus circulation in the absence of well-performing AFP surveillance.

2.5 Impact of mOPV2 use in the African Region: key lessons from the African experience regarding VDPV2 emergence after mOPV2 use

Sharp increases in the number of new VDPV2 emergences have been observed disproportionately in Central Africa, many without obvious sources. However, as there is no better option available currently,

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mOPV2 should be used to respond to all these emergences. More divergent VDPVs are considered more neurovirulent and more transmissible than Sabin or “younger” VDPVs. The way forward is to complete the development and implementation of a new outbreak response strategy that highlights: more IPV use; rapid deployment of mOPV2 and increased scope and quality of mOPV2 supplementary immunization activities (SIAs) in a situation of mOPV2 and IPV supply shortage; accelerated development and regulatory review of novel OPV2; and accelerated establishment of immunodeficiency-related vaccine-derived poliovirus (iVDPV) surveillance among non-paralyzed immunodeficient persons.

2.6 Impact of mOPV2 use in Mindanao, Philippines

Philippines is responding to the current cVDPV2 outbreak in Mindanao with mOPV2. The emergence of distinct VDPV2 (13 nucleotide difference) was detected within 4–6 weeks of the first use of mOPV2 in the region, from a stool sample of a healthy child in the area of type 2 response. Within four weeks of mOPV2 use in Mindanao, Sabin-like type 2 (SL2) virus with four nucleotide differences was isolated from an environmental sample in Manila city, where mOPV2 SIA was not implemented. Sabin 2 virus rapidly mutates into VDPV, representing a further risk of circulation of the new virus. The quick appearance of Sabin-like type 2 virus outside of type 2 response areas indicates intensive movements of the population within the country and the potential for a quick spread of the new viruses.

2.7 Strategies for prevention of emergence and outbreaks of cVDPV

The key strategies to prevent the future emergence and circulation of VDPV includes: maintaining high (> 95%) coverage with three doses of routine polio vaccines; maintaining high sensitivity and quality of AFP surveillance; improving sanitation and hygiene in the population; “reaching the unreached” (protecting ethnic population groups or other high-risk groups regularly not accessed by the health-care services); and stopping the use of OPV in the routine immunization schedule and switching to IPV-only schedule.

2.8 Update on recent discussions in the Strategic Advisory Group of Experts working group on polio regarding future polio vaccine schedules

The 18th Strategic Advisory Group of Experts (SAGE) working group meeting was held in February 2020. The objectives also included a review of IPV-only vaccination schedules in polio-free regions. Three WHO regions (Western Pacific, Europe, Americas) are considering a switch to IPV-only schedules and are looking towards SAGE for recommendations. Two-dose IPV fractional dose schedules and SAGE early schedule of 3–4 full doses were deliberated. IPV provides excellent individual protection, but poor mucosal intestinal immunity, leading to risk of silent circulation. The SAGE working group expressed caution about countries from moving to IPV-only schedules as a general principle in the current context, specifically when there is still not sufficient IPV supply to cover IPV schedules of more than two doses. – and also because of the current widespread circulation of cVDPV2 and the risk of importation. The SAGE working group recommended that regions or countries that wish to proceed to an IPV-only schedule take a gradual approach and first introduce a second dose of IPV into the routine immunization schedule, if feasible financially and supply-wise.

2.9 Plan for OPV cessation in the Region of the Americas

The risk of emergence and circulation of VDPVs is high in several countries of the Region of the Americas. The Region acknowledged the growing risk of cVDPV outbreaks in the presence of weak routine immunization, low-quality campaigns, lack of access and population movement. WHO in the

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Region of the Americas is considering organizing similar consultation of experts to pave the way for removal of OPV from the immunization schedules of the countries in the Region. Close coordination between the Region of the Americas and the Western Pacific Region is required. The TAG recommended in July 2019 that the 19 countries that currently use only one dose of IPV introduce a second IPV dose into their routine immunization schedules. The Regional Commission for the Certification of Poliomyelitis Eradication reiterated the TAG recommendation at their session in October 2019 and recommended to urgently implement two doses of IPV-containing vaccine (full or fractional) and achieve optimal coverage levels at country and district levels.

2.10 Discussion on cVDPV risks and polio vaccination schedule in Papua New Guinea

Routine coverage with OPV in Papua New Guinea was suboptimal for many years, which resulted in the big outbreak of cVDPV1 in 2018. Following the introduction of IPV in 2016, coverage is still low at below 40%. After a comprehensive response to the outbreak of cVDPV1, population immunity against type 1 and 3 polioviruses is now very high in the country. The current situation is favourable for the country to switch to IPV-only schedule. However, the introduction of a full IPV schedule will require some US$ 2 million annually to support training, operation costs and other logistics. High coverage with three IPV doses might not be reached until several years.

2.11 Discussion on cVDPV risks and polio vaccination schedule in Pacific island countries and areas

Polio vaccination schedules and vaccines used in the Pacific island countries and areas are divergent, making it impossible to have a universal schedule for all Pacific islands. Currently, eight countries are still using OPV in their routine vaccination schedules. A switch to IPV-only schedule in these countries might be easier than in the rest of the Western Pacific Region, but several challenges exist. The countries might not be able to financially sustain an IPV-only schedule as it requires higher spending. Health-care worker capacity to deliver three injectable vaccines in one session is not sufficient. Technical and financial support will be required.

2.12 Global IPV supply status and future plans

There have been chronic shortages of IPV since 2015 that required SAGE guidance on prioritization for allocations. The current IPV supply is sufficient for at least one dose in all countries. Demand continues to increase considering the introduction of the second dose starting 2021 and ongoing use during SIAs in outbreak and endemic countries. A cautious approach is thus required to secure a sustainable supply. New suppliers are expected to enter the market, which will increase the global supply of IPV. Prices from current suppliers increased between the 2014–2018 and 2019–2022 tenders, but the pipeline suppliers are expected to offer products at lower prices. In the longer run, there may be considerable game-changing scenarios regarding the fragile balance between global supply and demand, such as switching from a mixed schedule to an all IPV schedule in countries, introducing hexavalent vaccine and expanding the use of IPV in outbreaks and in case of mOPV2 stock-outs.

2.13 Implications of the new Gavi strategy for Member States in the Western Pacific Region in terms of IPV and immunization programme support

The global introduction of one dose of IPV was completed in all 194 Member States in April 2019. Since the full roll-out in 2019, there have been no disruptions in supply for routine immunization. The current SAGE IPV prioritization from the polio working group meeting in August 2019 includes: routine immunization programmes, catch-up activities and interruption of WPV transmission in

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endemic countries. Gavi, the Vaccine Alliance, will continue its support to countries for catch-up vaccination with IPV beyond 2020. It will support the introduction of the second dose of IPV starting 2021. In the next 3–4 years, Gavi might be supporting the introduction of hexavalent vaccine containing IPV.

2.14 Follow-up actions by WHO in the Region after the consultation

The Vaccine-Preventable Diseases and Immunization unit of the WHO Regional Office for the Western Pacific will continue working closely with the high-level expert groups and other stakeholders to formulate possible options for the Region. The proposed strategic approach will be presented to the TAG meeting in June 2020 for member comments and recommendations on further steps. WHO in the Western Pacific Region will be working closely with other polio-free regions (Americas and Europe) to exchange experiences and share lessons for better planning and preparation for the switch to IPV-only schedule in the Region.

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ANNEXES

Annex 1. Meeting timetable

INFORMAL TECHNICAL CONSULTATION ON THE FUTURE POLIO VACCINATION SCHEDULE IN THE WESTERN PACIFIC REGION

Manila, Philippines

14-15 February 2020

AGENDA

14 February 2020, Friday

Session I: Introduction

09:00-09:10 Objectives, key points and expected outcome/s Dr Yoshihiro Takashima

Session II: Overview of current situation

09:10-09:30 Global Update on wild poliovirus (WPV) and circulating

vaccine-derived poliovirus (cVDPV) 2015-2020

Dr Ondrej Mach

09:30-09:45 WPV and cVDPV in WPR 1988-2000 and 2001-2020 Dr Tigran Avagyan

09:45-10:00 Discussion

10:00-10:30 COFFEE BREAK

Session III: Case Summary & Analysis: cVDPV Outbreaks in WPR

2015-2020

10:30-10:45 cVDPV1 in Lao People's Democratic Republic 2015-2016 Dr Tigran Avagyan

10:45-11:00 Discussion on root causes

11:00-11:15 cVDPV1 in Papua New Guinea 2018 Dr Deborah Bettels

11:15-11:30 Discussion on root causes

11:30-11:45 cVDPV1 in China 2018-2019 Dr Yang Hong

11:45-12:00 Discussion on root causes

12:00-13:00 LUNCH

13:00-13:15 cVDPV1 and cVDPV2 in the Philippines 2019-2020 Dr Tigran Avagyan

13:15-13:30 Discussion on root causes

13:30-13:45 cVDPV1 and cVDPV2 in Malaysia 2019-2020 Dr Syeda Kanwal Aslam

13:45-14:30 Discussion on root causes

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Session IV: Emergence of VDPV2 after mOPV2 use

14:30-14:45 Impact of monovalent type 2 oral polio vaccine (mOPV2) use

in

African Region (Key lessons from African Region experience

regarding VDPV2 emergence after mOPV2 use)

Dr Ondrej Mach

14:45-15:00 Impact of mOPV2 use in Mindanao, Philippines Dr Syeda Kanwal Aslam

15:00-15:15 Discussion on strategies for prevention of emergence and

outbreaks of cVDPV

15:15-15:45 COFFEE BREAK Session V: Polio vaccination and IPV vaccine use

15:45-16:00 Pacific island countries and areas Dr Ilisapeci Tuibeqa

16:00-16:15 Papua New Guinea Professor John Vince Dr Deborah Bettels

16:15-17:00 Discussion

15 February 2020, Saturday

Session VI: Other considerations

09:00-09:20 WPV and cVDPV updates and plan for oral polio vaccine

(OPV) cessation in the American Region

Dr Ana Elena Chevez

09:20-09:40 Update on recent discussions in SAGE working group on

polio regarding future polio vaccine schedules

Dr Ondrej Mach

09:40-10:00 Discussion

10:00-10:30 COFFEE BREAK Session VI: Other considerations (cont.)

10:30-10:50 IPV supply current status and future plans Mr Abu Eltayeb

10:50-11:10 Implications of GAVI new strategy for WPR Member States

in terms of IPV and immunization programme support

Mr Alejandro Ramirez-Gonzalez

11:10-11:30 Identification of possible risks Dr Tigran Avagyan

11:30-12:00 Discussion

12:00-13:00 LUNCH

13:00-13:45 Session VII: Prevention and preparedness for spread of imported

(or emergence) of cVDPV in Pacific island countries and areas

and

Papua New Guinea

Surveillance

Vaccination

Supply of OPV for outbreak response

Other

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13:45-14:30 Session VIII: Next steps

Cost analysis for cVDPV outbreak response versus strengthening routine immunization IPV use (switch from IPV+OPV to all IPV)

Key recommendations by participating experts on switch from IPV+OPV to IPV only strategy for WPR: (i) countries to be prioritized; (ii) timing; (iii) RI Schedule options (iv) Assessment of possible risk; etc

Others

14:30 Closing Remarks Dr Yoshihiro Takashima

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Annex 2. List of participants

INFORMAL TECHNICAL CONSULTATION ON THE FUTURE POLIO VACCINATION SCHEDULE IN THE WESTERN PACIFIC REGION

Manila, Philippines

14-15 February 2020

LIST OF TEMPORARY ADVISERS, REPRESENTATIVES AND SECRETARIAT

1. TEMPORARY ADVISERS

Dr Nobuhiko Okabe, (Chairman, Regional Certification Commission), Director General, Kawasaki City Institute for Public Health, Life Science and Environment Research, 2F 3-25-3 Tono-Machi Kawasaki-ku, Kawasaki City Kanagawa 210-0834, Japan; Tel no.: +81 4 4 2444985; Fax no.: +81 4 2462602, Email: okabe-n@city.kawasaki.jp; okabenobu46@gmail.com

Dr Olen M. Kew (via videoconference), Coordinator, National Poliovirus Containment Coordinator, 270 North Peak Drive, Alpharetta, Georgia 30022, United States of America; Tel no.: +1 770 993 3069; Fax no.: +1 404 639 4011 Email: omk1@cdc.gov; omk1@bellsouth.net

Dr Hiroyuki Shimizu, Chief, Laboratory of Enteroviruses, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjuku-ku, Tokyo 162-1640, Japan; Tel no.: +81 42 5610771; Email: hshimizu@nih.go.jp

Dr Bruce Robinson Thorley, Senior Medical Scientist, Head, WHO Polio Regional Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, The Doherty Institute, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia; Tel no.: (613) 9342 9607; Fax no.: (613) 9342 9665; Email: bruce.thorley@vidrl.org.au; bruce.thorley@mh.org.au

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Dr Ilisapeci Tuibeqa, Head Department of Paediatrics, Colonial War Memorial Hospital Box 115, Suva, Republic of Fiji; Tel no.: +67 7522778; Email: beth.vereti@gmail.com

Professor John Vince, Deputy Dean (Academic), Director of Postgraduate and Research, School of Medicine and Health Sciences, University of Papua New Guinea, P.O. Box 5255, Boroko; Tel no.: +67 5 73260185; Email: johndvince@gmail.com

Dr Wen Ning (via video conference), Deputy Director, National Immunization Programme, Chinese Center for Disease Control and Prevention, No. 27, Nanwei Road, Xuanwu District, Beijing, Tel no.: +86 10 63024905, Email: wenning@chinacdc.cn

2. REPRESENTATIVE

UNITED NATIONS CHILDREN'S FUND

Mr Abu Obeida Eltayeb, Health Specialist, Immunization and Health Security, UNICEF Regional Office for East Asia and Pacific, 19 Phra Atit Road, Bangkok 10200, Thailand; Tel. No.: +662 356 9207; Mobile : +6692 00 55942; Fax No.: + 662 280 3563 Email : aeltayeb@unicef.org

3. SECRETARIAT

WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC (WPRO)

Dr Huong Thi Giang TRAN, Director, Division of Programmes for Disease Control, World Health Organization, Regional Office for the Western Pacific, United Nations and Taft Avenues, 1000 Manila, Philippines, Tel no. :(632) 5289701; Fax no. :(632) 5211036; Email : tranh@who.int

Dr Yoshihiro TAKASHIMA, Coordinator, Vaccine-Preventable Diseases and Immunization, World Health Organization, Regional Office for the Western Pacific, United Nations and Taft Avenues, 1000 Manila, Philippines, Tel no. :(632) 5289746; Fax no. :(632) 5211036; Email:takashimay@who.int

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WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC (WPRO) (continued)

Dr Tigran Avagyan, Technical Officer, Vaccine-Preventable Diseases and Immunization, World Health Organization, Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines; Tel no.: +63 2 8528 9737; Fax no.: +63 2 8526 0279; Email: avagyant@who.int

Dr Syeda Kanwal Aslam, Short-term Consultant, Vaccine-Preventable Diseases and Immunization, World Health Organization, Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines; Tel no.: +632 5288001; Fax no.: +632 5211036; Email: saslam@who.int

WHO CHINA Dr Robert Kezaala (via video conference), Medical Officer, Vaccine-Preventable Diseases and Immunization, WHO Representative Office in China, 401 Dongwai, Diplomatic Office Building, 23 Dongzhimenwai Dajie, Chaoyang District Beijing 100600; E-mail: kezaalar@who.int

Dr Zuo Shuyan (via video conference), National Professional Officer, Vaccine-Preventable Diseases and Immunization, WHO Representative Office in China, 401 Dongwai Diplomatic Office Building, 23 Dongzhimenwai Dajie, Chaoyang District Beijing 100600, Tel. No.: +8610 6532 7190 Fax No.: +8610 6532 2359, E-mail: zuos@who.int

WHO PAPUA NEW GUINEA Dr Deborah Bettels, Team Coordinator, Vaccine-Preventable Diseases and Immunization, WHO Representative Office in Papua New Guinea, 4th Floor, AOPI Centre, Waigani Drive Port Moresby; Telephone: +20-2-22765196; E-mail: bettelsd@who.int

WHO HEADQUARTERS GENEVA

Dr Ondrej Mach, Team Lead, Clinical Trials and Research, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland; Tel no.: +41 22 791 1863 Email: macho@who.int

Dr Chris Maher (via video conference), Senior Adviser, Office of the Chef de Cabinet, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland, Tel no.: +41 22 791 2643; Email: maherc@who.int

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WHO HEADQUARTERS GENEVA (continued)

Mr Alejandro Ramirez-Gonzalez, Technical Officer, Essential Programme on Immunization, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland; Tel no.: +41 22 791 3452; Email: ramirezgonzaleza@who.int

Dr Rudolf Tangermann, Short-term Consultant, Vaccine-Preventable Diseases and Immunization, World Health Organization, Avenue Appia 20 CH-1211 Geneva 27, Switzerland; Tel no.: +632 85288001; Fax no.: 632 85211036; Email: rudi.tangermann@gmail.com

WHO |REGIONAL OFFICE FOR THE AMERICAS

Dr Ana Elena Chevez (via video conference), Immunization Advisor, 525 Twenty-third Street, N.W., Washington, D.C. 20037, United States of America; Email: chevezana@paho.org

www.wpro.who.int