WHO‐EM/EPI/289/E

Strategicframework

WHO‐EM/EPI/289/E

StrategicframeworkVaccination Week

in the Eastern Mediterranean Region

©WorldHealthOrganization2009Allrightsreserved.

ThedesignationsemployedandthepresentationofthematerialinthispublicationdonotimplytheexpressionofanyopinionwhatsoeveronthepartoftheWorldHealthOrganizationconcerningthelegalstatusofanycountry,territory,cityorareaorofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundaries.Dottedlinesonmapsrepresentapproximateborderlinesforwhichtheremaynotyetbefullagreement.Thementionofspecificcompaniesorofcertainmanufacturers’productsdoesnotimplythattheyareendorsedorrecommendedbytheWorldHealthOrganizationinpreferencetoothersofasimilarnaturethatarenotmentioned.Errorsandomissionsexcepted,thenamesofproprietaryproductsaredistinguishedbyinitialcapitalletters.AllreasonableprecautionshavebeentakenbytheWorldHealthOrganizationtoverifytheinformationcontainedinthispublication.However,thepublishedmaterialisbeingdistributedwithoutwarrantyofanykind,eitherexpressedorimplied.Theresponsibilityfortheinterpretationanduseofthemateriallieswiththereader.InnoeventshalltheWorldHealthOrganizationbeliablefordamagesarisingfromitsuse.PublicationsoftheWorldHealthOrganizationcanbeobtainedfromDistributionandSales,WorldHealthOrganization,RegionalOfficefortheEasternMediterranean,POBox7608,NasrCity,Cairo11371,Egypt(tel:+20226702535,fax:+20226702492;email:PAM@emro.who.int).Requestsforpermissiontoreproduce,inpartorinwhole,ortotranslatepublicationsofWHORegionalOfficefortheEasternMediterranean–whetherforsaleorfornoncommercialdistribution–shouldbeaddressedtoWHORegionalOfficefortheEasternMediterranean,attheaboveaddress:email:GAP@emro.who.int.

DocumentWHO‐EM/EPI/289/E

Contents

Executivesummary .............................................................................................................................1

Introduction ........................................................................................................................................3

Part1Commitmenttoimmunization ..................................................................................................4

Whyisimmunizationimportant? ............................................................................................................4

Whyareadvocacy,education,andcommunicationimportantforstrengtheningimmunizationservicesandsystems? .............................................................................................................................5

Part2ImmunizationsituationintheEasternMediterraneanRegion...................................................7

Adiverseregionwithacommongoal .....................................................................................................7

ChildmortalityintheRegion ...................................................................................................................8

Polio.........................................................................................................................................................8

Part3VaccinationWeekintheEasternMediterraneanRegion .........................................................10

Buildingonexperience ..........................................................................................................................11

Nationalactivitieswithinaregionalframework....................................................................................12

Partners .................................................................................................................................................12

Timingandprocess ................................................................................................................................12

Evaluation ..............................................................................................................................................12

Rolesandresponsibilitiesofstakeholders ............................................................................................13

1

Executivesummary

Vaccinesandimmunizationhaveplayedaremarkableandimportantroleinthehealthgainsoverthelast

century.Thisyeartheworldcelebratesthe30thanniversaryoftheeradicationofsmallpox,thefirstdiseaseofhumankindtobeeradicated,throughvaccination.Poliocaseshavedropped99%since1998,

throughvaccination.Globalmeaslesdeathshavedroppedby78%between2000and2008,throughvaccination.Andthebenefitsofimmunizationareincreasinglybeingextendedtoadolescentsandadults,

providingprotectionagainstlife‐threateningdiseasessuchasinfluenza,meningitis,andcancersthatoccurinadulthood.

TheWHOEasternMediterraneanRegioninparticularhasexperiencedremarkablesuccessinreducingmorbidityandmortalityduetovaccine‐preventablediseases.Vaccinationcoveragewiththreedosesof

diphtheria–tetanus–pertussis(DTP3)hasincreasedto82%,upfrom18%in1980.Otherregionalachievementsincludereachingthe90%measlesmortalityreductiontargetthreeyearsaheadofschedule

andmaintaining20polio‐freecountries.

Despiteextraordinaryprogressinimmunizingmorechildrenoverthepastdecade,in2008,almost20%ofthechildrenborndidnotgetthecompleteroutineimmunizationsscheduledfortheirfirstyearoflife.In

otherwords,everyday,morethan7000infantsdonotcompletetheirroutineimmunizationscheduleintheregion.Moreover,maternalandneonataltetanusarestillincirculation;progressmadeinmeasles

mortalityreductionandeliminationofmeasleshastobesustained;and25%ofunder‐fivedeathsareattributedtovaccine‐preventablediseaseseachyear.Reachingthesevulnerablechildren,finishingthe

unfinishedagendaandsustainingthesuccessstoriesareessentialiftheMillenniumDevelopmentGoal4–toreduceunder‐fivemortalitybytwothirdsbetween1990and2015–aretobeequitablymet.

Recentstudieshavedemonstratedthatthestructuraldeterminantsandconditionsofdailyliferesponsible

fortheunvaccinatedchildrenareprimarilyrelatedto1)parentalattitudesandknowledge,suchasperceivedbenefitsandthreats,andgrouppressuresfororagainstvaccination;and2)family

characteristics,suchaseducationlevel,familysize,incomeandoccupation.Othercontributingfactorsincludecommunication,informationandimmunizationsystem,suchashealthworkerknowledge.

Inresponsetoboththeopportunitiesandchallenges,theWHORegionalOfficefortheEastern

Mediterranean,inpartnershipwiththeUnitedNationsChildren’sFund(UNICEF),islaunchinganewinitiative,VaccinationWeekintheEasternMediterraneanRegionRegionduringtheweekof24‐30April

2010,whichwillcoincidewiththeEuropeanImmunizationWeekandtheVaccinationWeekintheAmericas.TheVaccinationWeekwillbeanannualregion‐wideinitiativecelebratingandpromoting

immunizationthroughadvocacy,educationandcommunicationactivities.ThegoalsandobjectivesoftheinitiativeareinlinewiththosesetoutintheGlobalImmunizationVisionandStrategy(GIVS)–developed

jointlywithUNICEF―whichcallsforcountriestoimprovecommunicationanddisseminationofinformation,increasecommunitydemandforimmunizationanduseacombinationofinnovative

approachesandsolutionstoprotectallpeopleatriskagainstvaccine‐preventablediseases.

TheWHORegionalOfficewillprovidetechnicalassistancetothe20participatingcountries,representing

nearly99%ofregion’spopulation,toplanandimplementrelevanthealthpromotionactivitiesaccordingtonationalhealthgoalsandcurrentepidemiologicevidenceduring24‐30April2010.

2

Goal

• Protectingallpeopleatriskagainstvaccine‐preventablediseases.

Objectives

• Increasingstakeholderawarenessofthevalueofimmunization.

• Promotingandmaintainingimmunizationasapriorityforpolicy‐anddecision‐makers.• Advocatingforandmobilizinghumanandfinancialresources.

• Improvingaccesstoimmunizationforhigh‐riskpopulationsandhard‐to‐reachareasintheRegion.

Strategies

• Targetedadvocacy.

• Education,communicationandmediaactivities.• Expansionofimmunizationservices.

TakingintoaccounttheuniquedifferenceswithintheRegion,theVWEMinitiativeoffersajoint

frameworkallowingcountriestotailortheiractivitiestotheirnationalhealthprioritiesandchallenges.Thesynergyoftheinitiativeisstrengthenedthrough:

• Acommonstrategicframeworkandvisualidentity• Jointtrainingtoassistcoutnriesinstartingtheirplanningprocess(October2009)

• Aguidetoassistcountriesindeveloping,implementing,andevaluatingnationalactivities• Coordinatedtiming,encouragingjointplanningandactivities• SharedmonitoringandevaluationprocessesincludingsharinglessonslearnedacrosstheRegion.

Eachcountrywillallocatethenecessaryfundsaswellasdevelop,implement,andevaluateitsnational

VWEMactivities.SometechnicalsupportmaybeprovidedfromWHOthroughtheRegionalOfficeandcountryoffices.Theinvolvementofregionalandnationalimmunizationpartners,suchasUNICEF,

nongovernmentalorganizationsandcharityorganizations,cancontributetothesuccessandsustainabilityoftheinitiative.Partnersareaninvaluablesourceofknowledge,accesstovulnerablegroupsandfinancial

support.

3

Introduction

ThisdocumentprovidesregionalandnationalstakeholderswithastrategicframeworkfortheVaccination

WeekintheEasternMediterraneanRegion(VWEM).AguidehasalsobeendevelopedtoassistMemberStatesindeveloping,implementingandevaluatingnationalactivities.

TheVWEMhasbeeninitiatedbasedonencouragingexperiencesfromtheWHORegionoftheAmericasandEuropeanRegion,whichsince2002and2005,respectively,havecoordinatedregion‐widevaccinationweeks.

Theseexperiencesdemonstratethataregionalvaccinationweekinitiativeprovidesanopportunityforcountriestostrengthenimmunizationservicesandsystemsthroughadvocacy,educationand

communicationtoolsandactivities.Avaccinationweekinitiativealsoprovidesanopportunityforcountriestoshareexperiencesandlessonslearned.Poolingresourcesandcoordinatingeffortscreates

synergywhichbenefitsallstakeholdersengagedintheregion‐wideinitiative.TheVWEMwillbelaunchedduringtheweekof24‐30April2010.

Theregionalstrategicframeworkispresentedinthreeparts:

Part1 Commitmenttoimmunization

Thissectionconcernsthecommitmentsfromcountriestostrengthenimmunizationservicesandsystemsandusingadvocacy,educationandcommunication.

Part2 ImmunizationsituationintheEasternMediterraneanRegion

Thissectionconcernsvaccine‐preventablediseasesandimmunizationintheRegion.

Part3 VaccinationWeekintheEasternMediterraneanRegion(VWEM)Thissectionconcernsthestrategicgoal,objectives,rolesandresponsibilitiesandthe

structureoftheinitiative.

4

Part1Commitmenttoimmunization

Whyisimmunizationimportant?Immunizationisoneofthemostsuccessfulandeffectivehealthinterventions.Thishealthinterventionhas

reducedmorbidityandmortalityacrosstheworldinasafeandcost‐effectivemanner.Immunizationisanimportantinvestmentforallcountries.

Frominfantstoseniorcitizens,immunizationpreventsdebilitatingillness,disabilityanddeathfromvaccine‐preventablediseases.Whenvaccinesarecombinedwithotherhealthinterventionssuchas

vitaminAsupplementationtoboostchildren'simmunesystems,provisionofdewormingmedicine,growthmonitoring,anddistributionofinsecticide‐treatednetstopreventmalaria,immunizationbecomesamajorforceforchildsurvival.Immunizationisalsoakeystrategytoensureglobalhealthsecurityandto

respondtothethreatofemerginginfections,suchaspandemicinfluenza.

Goal4oftheUnitedNationsMillenniumDevelopmentGoals,towhichallcountriesaresignatories,

commitsworldleaderstoreducingchildmortality.Thetargetspecifiesreducingunder‐fivemortalitybytwothirdsbetweentheyears1990and2015,usingtheproportionofchildrenunder1yearsofage

immunizedagainstmeaslesasanindicator.

AttheSpecialSessionoftheUnitedNationsGeneralAssemblyonChildren,heldin2002,allMemberStatesadoptedresolutionA/RES/S‐27/2,Aworldfitforchildren,statingthattheywouldensurefull

immunizationofchildrenunder1yearofage,reducedeathsduetomeaslesandextendthebenefitsofnewandimprovedvaccinestochildreninallcountries.

AWorldFitforChildrenAllMemberStateswill“ensurefullimmunizationofchildrenunderoneyearofage,at90percent,coveragenationally,withatleast80percentcoverageineverydistrictorequivalentadministrativeunit;reducedeathsduetomeaslesbyhalfby2005…andextendthebenefitsofnewandimprovedvaccinesandotherpreventivehealthinterventionstochildreninallcountries”(ResolutionA/RES/S‐27/2,Aworldfitforchildren.AdoptedbyallMemberStates,atthe27thspecialsessionofthe

SpecialSessionoftheUNGeneralAssemblyonChildren)

[www.unicef.org/specialsession/docs_new/documents/A‐RES‐S27‐2E.pdf]

MillenniumDevelopmentGoal4

Goal:Reducechildmortality

Target(4.A):Reducebytwothirds,between1990and2015,theunder‐fivemortalityrate

Indicatorsinclude:Proportionofone‐year‐oldchildrenimmunizedagainstmeasles

[www.mdgmonitor.org/goal4.cfm]

5

Whyareadvocacy,education,andcommunicationimportantforstrengtheningimmunizationservicesandsystems?InresponsetotheMilleniumDevelopmentGoals,theWorldHealthOrganizationandUnitedNationsChildren’sFund(UNICEF)jointlydevelopedtheGlobalImmunizationVisionandStrategy(GIVS)2006–

2015,whichcallsforcountriestoimproveequityinimmunizationservicesbyimprovingcommunicationanddisseminationofinformation.Italsoencouragescountriestoincreasethecommunitydemandfor

immunizationandtocombinedifferentapproachesinthiseffort,withanaimtoreachmorepeople,especiallythehardtoreachgroups.

Recentstudieshavedemonstratedthatthestructuraldeterminantsandconditionsofdailyliferesponsible

fortheunvaccinatedchildrenareprimarilyrelatedto1)parentalattitudesandknowledge,suchasperceivedbenefitsandthreats,andgrouppressuresfororagainstvaccination;and2)family

characteristics,suchaseducationlevel,familysize,incomeandoccupation.Othercontributingfactorsincludecommunication,informationandimmunizationsystem,suchashealthworkerknowledge.

Increasingawarenessandknowledgecanchangetheattitudesandpracticesofstakeholdersinimmunization,resultinginincreasedimmunizationcoverage.Lackofinformationandunderstandingof

theimportanceofimmunization,aswellasmyths,misunderstandingsandmisconceptions,areoftenbarrierstoutilizingimmunizationservices,resultinginlowcoverageandcomplianceorhighdrop‐out

rates.

Advocacy,educationandcommunicationcanhelpimmunizationsystemsbecomefullyeffectivesincekeystakeholderscanbecomewell‐informedandknowledgeable,anddeveloppositiveattitudestowards

immunization.

GlobalImmunizationVisionandStrategy(GIVS)

Goalsby2010• Increasecoverage.Countrieswillreachatleast90%nationalvaccinationcoverageandatleast80%

vaccinationcoverageineverydistrictorequivalentadministrativeunit.• Reducemeaslesmortality.Globally,mortalityduetomeasleswillhavebeenreducedby90%

comparedtothe2000level.Relevantstrategies• Useacombinationofapproachestoreacheverybodytargetedforimmunization(Strategy1)• Increasecommunitydemandforimmunization(Strategy2)• Improvecommunicationanddisseminationofinformation(Strategy22)

[www.who.int/immunization/givs/en/index.html]

6

Case:SuccessininvolvingpoliovictimsinthefightagainstpolioExperienceshowsthatproperattentiontopoliovaccinerefusalscanovercomemanybarriers,hesitation,doubtsandrumours.InSomalia,thestrategyhasbeeninnovative:poliovictimsplayedanimportantroleinincreasingcoverageintheirowncommunities.Oncerefusalswereidentified,poliovictimsvisitedthehouseholdtodiscuss,answerquestions,addresssuspicionsandconvinceparents–andadministermOPViftheinterventionwassuccessful.Thepoliovictimsweretrainedtomasteralltopicsinordertohandledifferentsortsofrefusals.

Thepersuasionmadebypoliovictims–andperhapsmoreimportantlytheirphysicaldisabilityduetopolio–weresuccessfulinfightingresistanceandrejectionofvaccinationintheircommunities.

Asaresultofthecampaign,therefusalconversionratewasashighas78%.

Case:KAPstudyinSudanAknowledge,attitudesandpractices(KAP)studyofSudanesecommunitiestowardstuberculosisshowedthatalmosteveryonehadheardoftuberculosis–themajorityofthemfromradioandtelevision.

However,morethan15%didnotknowthattuberculosiswasaninfectiousdisease.Also,almostonethirdofthepopulationwasunawareofthepropertimeforvaccinationwithBCG.

Almost40%considereditshamefultohavetuberculosis,and13%thoughtitbesttohideitifsomeonehadtuberculosis.

Themainreasonsfornotunderstandinginformationaboutthediseasewerevagueinformation,difficultlanguageandincompleteinformation.

TheKAP‐relatedinformationhasbeencrucialintheplanningofBCGvaccinationandothertuberculosiscontrolactivities.

(Sudan,FederalMinistryofHealth,2007)

7

Part2ImmunizationsituationintheEasternMediterraneanRegion

AdiverseregionwithacommongoalTheWHOEasternMediterraneanRegioncomprises22countries,includinghigh‐,middle‐andlow‐incomecountries,andcoversavastareawhichrangesfromPakistantotheeastandMoroccointhewest.More

than535millionpeopleliveinthisRegionwhereprofounddifferencesexistinwealth,security,healthandotherconditions.Anyregionalinitiativeshouldtakeintoconsiderationthediversitybetweenandwithin

countries,aswellastheuniquechallengesfacingtheRegion.Thesechallengesincludethefollowing.

Demandandutilization:Somecountriesensurehighaccesstoimmunizationservices;however,therearestillsomepopulationgroupswhodonotutilizetheservicesforreasonsrelatedtoknowledge,attitudesor

practices.Someparentsorcaretakerslackinformationandunderstandingoftheimportanceofimmunization.Mythsandmisunderstandingsmayalsoresultinanegativeviewtowardsimmunization.

Qualityofservicedelivery:Theperformanceofvaccinationteamsandtheserviceprovidedmaycreateadistrustfulatmospherewherepeopledonotfeelsafe,preventingpeoplefrombeingvaccinatedorhaving

theirchildrenvaccinated.

Safetyandsecurity:Inanumberofcountrieswithwartornandunstableenvironments,accessto

immunizationservices,oroutreachtohighriskpopulationsorhard‐to‐reachareasisseriouslyhampered.

Managerialandtechnicalcapacities:Theimmunizationprogrammestructureinseveralcountriesand

pre‐serviceandin‐servicetrainingfortheirhealthcarepersonnelarenotalwaysadequatetomeetoranticipatetherapidchangesandinnovationinimmunization.

8

Vaccine‐preventablediseasesandimmunizationintheRegion

TheWHOEasternMediterraneanRegionhasexperiencedremarkablesuccessinreducingmorbidityandmortalityduetovaccine‐preventablediseases.Vaccinationcoveragewiththreedosesofdiphtheria–tetanus–pertussis(DTP3)hasincreasedto82%,upfrom18%in1980.Otherregionalachievements

includereachingthe90%measlesmortalityreductiontargetthreeyearsaheadofscheduleandmaintaining20polio‐freecountries.

Despiteextraordinaryprogressinimmunizingmorechildrenoverthepastdecade,in2008,almost20%ofthechildrenborndidnotgetthecompleteroutineimmunizationsscheduledfortheirfirstyearoflife.In

otherwords,everyday,morethan7000infantsdonotcompletetheirroutineimmunizationscheduleintheregion.Moreover,maternalandneonataltetanusarestillincirculation;progressmadeinmeasles

mortalityreductionandeliminationofmeasleshastobesustained;and25%ofunder‐fivedeathsareattributedtovaccine‐preventablediseaseseachyear.Reachingthesevulnerablechildren,finishingthe

unfinishedagendaandsustainingthesuccessstoriesareessentialiftheMillenniumDevelopmentGoal4–toreduceunder‐fivemortalitybytwothirdsbetween1990and2015–aretobeequitablymet.

ChildmortalityintheRegionAccordingtoUNICEF,childmortalityhasdecreasedbynearlytwothirdsinthepastdecadeintheMiddle

EastandNorthernAfricanRegion1.Still,some529000childrenunderfivecontinuetodieeveryyearintheRegion.Atleasthalfofthesedeathsareeasilypreventablethroughimprovednutritionand

immunization.

PolioThenumberofpoliocasesdecreasedtothelowestleveleverin2007with58cases,representinglessthan5%ofglobalcases.However,casesincreasedto106in2008.PakistanandAfghanistancontinuetobe

polioendemic.Outbreaksinre‐infectedcountries―Sudan,YemenandSomalia―during2004to2007werecontrolled.

1TheUNICEFMiddleEastandNorthAfrica(MENA)regionincludesAlgeria,Bahrain,Djibouti,Egypt,IslamicRepublicofIran,Iraq,Jordan,Kuwait,Lebanon,LibyanArabJamahiriya,Morocco,occupiedPalestinianterritory,Oman,Qatar,SaudiArabia,Sudan,SyrianArabRepublic,Tunisia,UnitedArabEmiratesandYemen

9

MeaslesTheimpactofvaccinationsonthemeaslesburdenhasprovenimmense,withcountriesdrasticallyreducingthenumberofmeaslescasesfollowingsuccessfulvaccinationcampaigns.Countrieshaveshown

strongcommitmenttoachievemeasleselimination,andestimatedmeaslesmortalitywasreducedby90%from1999to2008(seefigurebelow).Whilesomecountriesareapproachingmeasleseliminationstatus,

othersarefacingseriousdifficulties,includinglowpopulationimmunityandinadequatemeaslessurveillance.Despitehighreportedcoveragewithbothmeaslescatch‐upcampaignsandroutinemeasles

vaccination,outbreaksarestilloccurringinsomecountriesintheRegion.

WHOmeaslesmortalityandMCV1coverageestimatesintheRegion,1999–2007

0

20,000

40,000

60,000

80,000

100,000

1999

2000

2001

2002

2003

2004

2005

2006

2007Yea

r

Deaths

66

68

70

72

74

76

78

80

82

84

Percent

Measles deaths

MCV1

10

Part3VaccinationWeekintheEasternMediterraneanRegion

InresponsetoboththeopportunitiesandchallengesfacingimmunizationservicesandsystemsintheRegion,theWHORegionalOfficeforEasternMediterraneanislaunchingVaccinationWeekintheEastern

MediterraneanRegion(VWEM)asanadvocacy,educationandcommunicationinitiativetosustainandstrengthennationalimmunizationservicesandsystems.

TheinitiativetakesintoaccounttheUNGeneralAssemblySpecialSessiononChildrenresolutiontocreate

aworldfitforchildrenandtheUNMilleniumDevelopmentGoaltoreducechildmortality.ItalsorecognizesthattheWHO/UNICEFGlobalImmunizationVisionandStrategy(GIVS)callsforcountriesto

improvecommunicationanddisseminationofinformation;toincreasecommunitydemandforimmunization;andtouseacombinationofapproachestoreacheverybodytargetedforimmunization

withtheaimofincreasingvaccinationcoverageandreducingmortalityandmorbidity.

Theinitiativeisanopportunitytofosterpartnerships,raiseawareness,advocate,educate,and

communicateinordertoensurelong‐termbehaviouralchangeamongstakeholdersandkeytargetgroups.Itisacomprehensiveinitiativewhichincludesadvocacy,educationandcommunicationactivities

inadditiontorelevantacceleratedactivitiesorcampaigns.

Animportantaimistoincrease,expandandleverageadvocacy,educationandcommunicationasmeanstomaintainimmunizationonthepoliticalagendaofdecision‐makers.

Goal

• Protectingallpeopleatriskfromvaccine‐preventablediseases

Objectives

• Increasingstakeholderawarenessofthevalueofimmunization

• Promotingandmaintainingimmunizationasapriorityforpolicy‐anddecision‐

makers

• Advocatingforandmobilizinghumanandfinancialresources

• Improvingaccesstoimmunizationforhigh‐riskpopulationsandhard‐to‐reachareas

intheRegion

Strategies

• Targetedadvocacy

• Education,communicationandmediaactivities

• Expansionofimmunizationservices

11

BuildingonexperienceCurrentlyseveralcountriesintheRegionareimplementingImmunizationDaysorsimilaractivities.TheVWEMshouldbuildontheseexperiences.

TheVWEMwillalsobenefitfromtheencouragingexperiencesoftheWHORegionoftheAmericasand

EuropeanRegionwhichhavecoordinatedvaccinationweekssince2002and2005,respectively.In2007thetworegionsdecidedtoalignthetimingoftheirvaccinationweeksinAprileachyear.Thestrengthened

collaborationbetweenthetworegions,showcasedinthedevelopmentofjointpromotionalvideos,hasbeenfollowedbyacalltootherregionstojointheeffort.

Experiencesfromthetworegionsshowthataregionalvaccinationweekinitiativeprovidesaframework

forcountriestoreinforcetheirsuccessstoriesandcapitalizeonimminentopportunities.Thisframework

Examplesofvaccinationweekactivities

Nationalandlocal‐levellaunchingceremonies:Highlevelrepresentation,dignitariesorcelebritiestoattractattention–pressandmediaattention–involvementofpolicy‐anddecision‐makers,givingtheircommitmenttosupport.

Vaccination:Extendingopeninghours–outreachactivitiesinhigh‐riskcommunities/territories–mobilevaccinationteams–vaccinationinrelevantlocations(schools,communitycentres).

Masscommunication:Distributionofinformationmaterials(pamphlets,reports,books,or...babyblankets,calendars,mugs,t‐shirts,keyrings,bracelets)–billboardsorpaidadvertisements,publicserviceannouncements–radioandtelevisionspots,CDs,audiotapes,orvideospots–textmessagesonmobilephones,directmailing,newsletters–telephonehotlineorinternetchatroom‐displaysandexhibits–mediaactivities.

Socialmobilization:Awarenesseventsinhigh‐riskcommunities–publicmeetings–activitiesinschools,kindergartens,healthcentres,communitycentresandsimilar–peertopeeractivities.

Activitiesintegratedwithotherservices:Vaccinationorinformationactivitiesperformedincollaborationwithrelevantotherservices:otherhealthrelatedprogrammessuchasHIV/AIDS,familyplanning,nutrition,foodsafety,etc.–border/emigrationservices–airportservices–educationalfacilities–workplaces–participationinalreadyplannedcommunityactivities.

Training:Trainingormeetingsforhealthpersonnel–trainingforotherprofessionalsincontactwithyoungparents,e.g.schoolorkindergartenteachers–trainingformedicalstudents,nursingstudentsorothers.

Meetings/policywork:Roundtablemeetingswithnationalorsubnationalpolicy‐anddecisionmakers–developmentofstrategies,actionplans,policypapersandadvocacypapers,includingsurveysoranalysestosupportarguments.

12

alsocreatesaplatformforexchangeofexperiencesandlessonslearned,withinregionsaswellasamongregions.

Inaddition,thevaccinationweekinitiativecanfacilitatestrengthenedcooperationbetweencountriesofdifferentregions.Forexample,startingin2008aspartofitsVaccinationWeekeffort,Franceprovides

technicalandfinancialsupporttotheVaccinationWeekinFrenchGuyana.

NationalactivitieswithinaregionalframeworkTheVWEMframeworkoffersacommonvisionandgoal,whileencouragingcountriestodevelopandimplementactivitiesrelevanttotheirindividualnationalandsubnationalpriorities.Thecommonalityof

theinitiativeisstrengthenedthroughjointtiming,planningandactivities(e.g.inborderareas,mediafocusandattention)andsharingoflessonslearned.

Coordinationamongcountriesisencouraged,especiallyforcountrieswithcommonbordersorthose

facingsimilarchallenges.Countriesmayevendecidetoagreeoncommonsub‐regionalobjectives,themes,approachesoractivities.

PartnersTheGlobalImmunizationVisionandStrategy(2006‐2015)emphasizesstakeholderengagementand

synergyfromintegratinginterventions(Strategy14).Therefore,involvementofkeypartnersandfosteringstronginter‐agencycooperationareofhighimportance,especiallyinrelationtointegrationwithother

healthrelatedactivitiesandsharingofhumanandfinancialresources.

Participatingcountriesshouldestablishanationalplanningcommitteeasaforumforplanning,discussion,andresourcemobilization.MinistriesofHealthareencouragedtoworktogetherwithrelevantnational

counterparts(suchasotherministries,publicinstitutes,healthprofessionals,nongovernmentalorganizationsanddonors).

TimingandprocessThelaunchoftheVWEMisplannedfortheweekof24‐30April2010,concurrentwith‘VaccinationWeek

intheAmericas’and‘EuropeanImmunizationWeek’.

EvaluationAllcountriesareencouragedtodefineobjectivesfortheirvaccinationweekactivities.AVWEMguidehasbeendevelopedtoassistcountriesindefiningtheseobjectivesandindeveloping,implementingand

evaluatingnationalactivities.

Theinitiativewillbemonitoredandevaluatedatregionallevelinordertodocumentlessonslearntand

generatekeyevidence‐basedrecommendations.Someregionalprocessmeasuresmayinclude:• PercentageoftargetedcountriesparticipatinginVWEM.

• Percentageofimplementingcountriesmeetingtheirspecifiedobjectives.• Percentageofcountriesevaluatingtheiradvocacyandcommunicationactivities(i.e.preandpost

conductingknowledge,attitudesandpracticessurveys,focusgroups,etc).• NumberofpeoplevaccinatedduringtheVaccinationWeek.

13

RolesandresponsibilitiesofstakeholdersEachcountryisexpectedtofundaswellasdevelop,implement,andevaluateitsnationalVWEMactivities.Ifrequested,sometechnicalsupportmaybeprovidedfromWHOthroughtheRegionalOfficeandcountry

offices.

RolesandresponsibilitiesoftheRegionalOfficeandMemberStatesareoutlinedbelow.

WHORegionalOfficeforEasternMediterranean→ Raiseawareness,inspire,andensurecommitmenttoparticipatinginRegionalVaccinationWeek.

→ Liaisewithregionalpartners,includingUNICEF,PanAmericanHealthOrganization,WHORegionalOfficeforEuropeandCentersofDiseaseControlandPrevention(Atlanta).

→ Developanddistributeregionaldocuments,includingastrategicframeworkandaVWEMguidetoassistcountriesindeveloping,implementingandevaluatingnationalactivities.

→ DevelopsloganandcommonvisualidentityfortheVWEM.

→ Facilitatebriefingandorientationsessionforcountries(October2009).→ Supportcountriesinresourcemobilization.

→ ProvidetechnicalsupporttocountriesinplanningfortheVWEMinitiative.

→ ParticipateinandmonitornationalVWEMactivities.

→ Plan,coordinate,andcelebratealaunchingevent,ensuringregionallevelmediaattentionandinvolvement.

→ Performresearch,analysis,datagatheringandassessments.

→ DeveloparegionalevaluationreportandrecommendationsforfutureVWEMactivities.

MemberStates→ Educate,motivateandadvocateforinitiatingVaccinationWeekintheirnationalsetting.

→ Plan,fundanddevelopnationalVWEMactivities.

→ SetupnationalVWEMPlanningCommittees.

→ Mobilizeresourcesandcollaboratewithlocalpartnersandmedia.

→ ImplementandevaluatenationalVWEMactivities.

TheVWEMGuideproposesanddescribes10stepstoassistcountriesindeveloping,implementingandevaluatingnationalactivities.