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Measles and Measles Containing Vaccine

Progress in Global Measles

Mortality Reduction

Vaccine Supplier MeetingCopenhagen, 3 - 4 April 2008

Edward Hoekstra, MD, MScSenior Health Specialist

Co-ordinator Global Measles ProgramUNICEF / New York


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Overview

Goal

Strategy

Achievements

3 - 5 year agenda

Future


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Malnourished girl hospitalized with post - measles encephalitis Kratie,Cambodia, 2001 (Photo: Keith Feldon)Estimated 1,700 children died in Cambodia of measles in 2001

Measles kills


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Corneal scarringcausing blindness

Encephalitis

Pneumonia &diarrhea

Measles disables


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Causes of 1.7 million global vaccine-preventable deaths among children, 2000

Source: World Health Report 2001

Measles

HIB

MNT

Pertussis

YF

Diphtheria

Polio


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No second opportunity for measles immunization (47)

98% of all measles deaths

We knew WHERE

Data year 1999

757,000 deaths from measles in 2000


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1. Strong routine immunization of > 80%

2. Provide a 2nd opportunity for measlesimmunization

3. Surveillance

4. Improved measles case management

We knew HOW


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Measles Control Goalsby WHO Region, 2008

2000

2010

2010 2012

Africa and SE Asia havemortality reduction goals

Americas, Europe, E. Mediterranean, W. Pacific have elimination goals

GIVS Goal:90% reduction in deathsby 2010 (vs. 2000)


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From 2001 - - 47 countries BEGAN


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Success To Date


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1st Dose Measles Coverage in 47 MeaslesPriority Countries, 2000 - 2006

50%

55%

60%

65%

70%

75%

80%

2000 2001 2002 2003 2004 2005 2006

Source: WHO / UNICEF coverage estimates, 1999 - 2006 as of August 2007

Percent

56 %

67 %

80 %

72 %Global Coverage 1st dose


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Measles Mortality Reduction47 UNICEF / WHO Priority Countries

2000

No second opportunity 2005 (47)

94 % of all measles deaths


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Measles Mortality Reduction47 UNICEF / WHO Priority Countries

2006

Nationwide second dose of measles introduced (42)

Partial implementation of second dose of measles introduced (3)

No second opportunity 2005 (2)


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Estimated measles deaths, 2000, 2006

Dots are randomly distributedin countries.

Data source: WHO/IVB, November 2007

2000 757 000 deaths

2006 242 000 deaths

= 500 deaths 74%


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Estimated Measles Deaths, 2000-2006

Global Measles Deaths

-

200,000

400,000

600,000

800,000

1,000,000

2000 2001 2002 2003 2004 2005 2006

68%reduction

2005Goal

Source: Morb Mortal Wkly Rep. 2007;56(47):1237-41. A Dabbagh et al.

2010Goal


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Reduction in Estimated Measles Deathsby WHO Region, 2000 to 2006

-100

-90

-80

-70

-60

-50

-40

-30

-20

-10

0

AFR SEAR WPR EMR GLOBAL

%r

educ

tion

68%81%91% 78%

90% 2010 reduction goal

26 %

Source: Morb Mortal Wkly Rep. 2007;56(47):1237-41. A Dabbagh et al.


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Integrated Campaigns

VitaminA

PolioVaccination

DewormingTablets

Bednets

> 87 million > 29 million > 30 million > 31 million

In 2007, 84% of the 37 campaigns were integrated with at leastone other intervention


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MR or MMR introduction

Higher income countries

One large scale introduction campaign

Followed up by 2 dose routine immunization

Not for Sub - Saharan Africa and South Asia

Will see most activities in East Asia


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IFFIm

IFFIm

IFFIm

IFFIm

MR Supplementary Immunization Activities(2007-2008)

Country Dates Target Age Target population Coverage

(reported)Armenia 1-13 Oct 07 6-27 yrs 942,767 96,8%

Turkmenistan 12-25 Nov 07 7-23 yrs + 24-40yrs

2,264,026 96.4%

Uzbekistan 12-25 Nov 07 11-29 yrs 8,143,635 99.8%

Georgia Sep-Oct 08 5-26 yrs 1,100,000

Ukraine 08 15-29 yrs 9,000,000


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Looking ahead

Where we are going
http://customersrock.files.wordpress.com/2007/04/binoculars.jpg


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Planned Measles SIAs, 2008

MeaslesMeasles - Rubella


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Figure 2: Measles Initiative Annual Donations (2001-2007) and Financial

Resource Requirements, Contributions, & Funding Gap (2008-2010)*

0

50

100

150

200

250

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

$USMillion

Donations Funds from 2007 Funds projected or pledged Funding Gap

2001-2007

Total donations: US$ 635 million

2008: Funding gap US$ 23 million



* Excluding anticipated country contributions for catch-up and follow-up SIAs for 2008-2010

Annual Donor Expenditure and FinancialResource Requirements, 20012010*

C


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Figure 3: External contributions since 2001, and Funding Gap for 2008-2010

UNICEF

Japan

UNF*ARC**

CDC

CIDAGAVI IFFIm

2008-2010 funding

gap $202 million

* includes UNF and partners: The Bill & Melinda Gates Foundation, Izumi,Vodafone, The Church of Jesus Christ of Latter-Day Saints

** includes ARC and The Church of Jesus Christ of Latter-Day Saints

Total: $973 million (excluding country contributions)

External Contributions since 2001, andFunding Gap for 2008 - 2010


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Estimated Measles Vaccines Shipped by UNICEF1999 2007 and projections - 2020

020406080

100120

140160180200220240260

1999

2001

2003

2005

2007

2009

2011

2013

2014

2016

2018

2020

Dose

sMillions

India Needs
http://www.unicef.org/infobycountry/27402_30951.html


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Summary

Most ambitious measles goal

Less than 3 years to go

The strategy works

Africa already reached 2010 goal

South East Asia accounts for 74% remaining deaths

Secure funding for 2009 and beyond
http://www.unicef.org/infobycountry/27402_30951.html


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Measles InitiativeWorking Together to Save Lives

Thank You

Melinda and Bill GatesFoundation

IFFIm

JapaneseGovernment

Vodafone

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