New Vaccines in Developing Countries: Evidence, Practice, Policy, and Challenges

Global Vaccines 202X: Access, Equity, EthicsPhiladelphia, USA

2 May 2011

Jon Kim Andrus, MDDeputy Director

Number of childhood vaccines routinelyused industrialized countries and in

Latin America and the Caribbean, 1975-2010

5

7

9

11

13

15

17

19

1975 1980 1985 1990 1991-1995

1996-2000

2001-2005

2006-2010

Industrialized countries

Latin America and the Caribbean

Current GAPHPVVaricelaHepatitis AMeningococcal

Seasonal flu - 2006Rotavirus - 2006Pneumococcal- 2006

Measles, DPTPoliomyelitis, BCG

Haemophilus Influenzae b

RubellaMumps

Hepatitis B**

Accelerating PolicyAccelerating Policy

PrioritiesHPV vaccine and cervical cancer

PrioritiesHPV vaccine and cervical cancer

Source: IARC 2004 estimates

0

20

40

60

80

100

120

0-14 15-44 45-54 55-64 65+

AGE GROUP [years]

AG

E SP

ECIF

IC M

OR

TALI

TY R

ATE

S

N. America

Cen. America

Caribbean

So. America

Cervical Cancer Disease

Burden • Taking advantage of new technologies while enhancing approaches to screening to reduce mortality of this disease of poverty

• Reducing the developing country uptake time lag >2 decades

• Taking advantage of new technologies while enhancing approaches to screening to reduce mortality of this disease of poverty

• Reducing the developing country uptake time lag >2 decades

77,000 new cases per year

33,000 deaths per year

77,000 new cases per year

33,000 deaths per year

Urged Member States to:

Expand legal and fiscal space and identify new revenue sources to sustainably finance the introduction of new vaccines against rotavirus, pneumococcus, influenza, and human papillomavirus;

Support the mortality reduction targets, consistent with GIVS and the MDGs, for HPV, RV, influenza, and pneumo associated disease;

Utilize the PAHO Revolving Fund for Vaccine procurement to purchase new and underutilized vaccines

47th Directing Council, September 2006

ProVac Policy Framework

Technical criteriaProgrammatic criteria

Financial criteria

www. paho.org/immunization

Andrus et al. Public Health Reports 2007;122(6):811-19

Tools for Economic Analysis

CostsHealth Gains

Vaccine Intro

Costs Tool

Burden of Disease

Tools

Economic Analysis

Cost Effectiveness

Studies Rotavirus

Cost Effectiveness

StudiesPneumococcus

Cost Effectiveness

StudiesHPV

Cost Effectiveness

StudiesInfluenza

Number of Countries with Seasonal Influenza

Vaccination Programs in the Americas, 1975-2008

0

5

10

15

20

25

30

35

40

45

Nu

mb

er o

f co

un

trie

s

1975 1980 1985 1990 1995 2000 2005 2007 2008 2009

42 Countries

Accelerating DeploymentAccelerating Deployment

Pro-Vac Workshop, September 2006

Congenital Rubella SyndromeCongenital Rubella Syndrome

Strategies

Strategies always rely on:

• Immunizing susceptible population

• Conducting effective surveillance

• Sustaining the gains

*Vaccination of men and women

Vaccination of women only

82

98 98 99 99 97 99 99 98 99 969999

0

20

40

60

80

100

CAR COR HON ELS PAR COL NIC BOL PER DOR ARG* CHI BRA

Source: Country reportsAndrus JK, et al. Vaccine 2008

Co

vera

ge

(%

)Rubella Vaccination Coverage in Selected

Countries of the Americas,1997-2006

Rubella elimination and primary health care

PAHO. Changing lives: The EHDI experience in Costa Rica. EPI Newsletter August 2007;29(4):1.

Castillo-Solorzano C, Andrus JK. Rubella elimination and improving health care for women. Emerging Infectious Diseases 2004;10(11):17-21.

14

0

50,000

100,000

150,000

200,000

250,000

300,000

Nu

mb

er

Rubella

Measles

Rubella Elimination

Source: Country reports

Accelerated rubella control

Measles Elimination

Rubella and Measles Elimination,The Americas, 1980–2009

Future ChallengesFuture Challenges

Pro-Vac Workshop, September 2006

16Pan AmericanHealthOrganization

Uptake of Pentavalent Vaccine in the Americas

0

5

10

15

20

25

30

35

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

Nu

mb

er o

f C

ou

ntr

ies

$0

$1

$2

$3

$4

$5

$6

$7

$8

Pri

ce (

$)

Countries Purchasing Price per dose

4 Countries,3.9 million Doses

31 Countries,10.5 million Doses

$7.20

$3.94

Urban cluster of yellow fever Urban cluster of yellow fever cases in Paraguay, 2008cases in Paraguay, 2008

A urban cluster of A urban cluster of human YF cases, human YF cases, Asunción Metropolitan Asunción Metropolitan area*. area*.

10 deaths10 deaths

Median of age: 24 Median of age: 24 years (11-39)years (11-39)

Female: 55%Female: 55%

Infestation Index by Infestation Index by Ae. AegyptiAe. Aegypti: 23%: 23%

*Laurelty, Central Department*Laurelty, Central Department

In summary, there is no magic bullet to ensuring equitable and sustainable introduction of new vaccines into

developing countries. Ultimately, the solution requires a strategic vision

grounded in long-term goals, not short-term fixes.

Pan AmericanHealthOrganization

www. paho.org/immunization